title: Respiratory cryptosporidiosis in HIV-seronegative children in Uganda: potential for respiratory transmission.
abstract: BACKGROUND
  Respiratory cryptosporidiosis is recognized as a late-stage complication in persons with human immunodeficiency virus (HIV) infection and AIDS. However, respiratory signs and symptoms are common in otherwise healthy children with intestinal cryptosporidiosis, which suggests that respiratory infection may occur in immunocompetent hosts.
  
  
  METHODS
  We recruited children 9-36 months of age who presented with diarrhea to Mulago Hospital in Kampala, Uganda, from November 2007 through January 2009. Children with stool samples positive or negative for Cryptosporidium species were selected for further evaluation, including sputum induction in those with cough or unexplained respiratory signs and collection of saliva and blood specimens. Sputum samples were subjected to comprehensive bacteriologic testing, and both sputum and saliva specimens were tested for Cryptosporidium species by nested polymerase chain reaction.
  
  
  RESULTS
  Of 926 fecal samples screened, 116 (12.5%) were positive for Cryptosporidium. Seventeen (35.4%) of 48 sputum samples tested from children with positive stool samples were positive for Cryptosporidium. Sixteen (94.1%) of the 17 children with confirmed respiratory cryptosporidiosis were HIV seronegative, and 10 (58.8%) of 17 children were not malnourished. None of the 12 sputum specimens from children with negative stool samples tested positive for Cryptosporidium (P = .013, compared with children who tested positive for Cryptosporidium in the stool). Parasite DNA was detected in only 2 (1.9%) of 103 saliva samples (P < .001, compared with sputum samples).
  
  
  CONCLUSIONS
  Respiratory cryptosporidiosis was documented in one-third of HIV-seronegative children who were tested. These novel findings suggest the potential for respiratory transmission of cryptosporidiosis. Trial registration. ClinicalTrials.gov identifier: NCT00507871.
authors.affiliation: Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA.
authors.forename: Siobhan M
authors.initials: SM
authors.lastname: Mor
authors.forename: James K
authors.initials: JK
authors.lastname: Tumwine
authors.forename: Grace
authors.initials: G
authors.lastname: Ndeezi
authors.forename: Maheswari G
authors.initials: MG
authors.lastname: Srinivasan
authors.forename: Deogratias H
authors.initials: DH
authors.lastname: Kaddu-Mulindwa
authors.forename: Saul
authors.initials: S
authors.lastname: Tzipori
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Griffiths
mesh_terms: D000818:Animals; D002675:Child, Preschool; D003457:Cryptosporidiosis / Q000150:complications* / Q000469:parasitology*; D003458:Cryptosporidium / Q000302:isolation & purification*; D003967:Diarrhea / Q000150:complications / Q000469:parasitology; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000469:parasitology*; D012463:Saliva / Q000469:parasitology; D013183:Sputum / Q000469:parasitology; D014454:Uganda / Q000453:epidemiology