title: Molecular epidemiology of Cryptosporidium in HIV/AIDS patients in Malaysia.
abstract: Cryptosporidiosis is a particular concern in immunocompromised individuals where symptoms may be severe. The aim of this study was to examine the epidemiological and molecular characteristics of Cryptosporidium infections in HIV/AIDS patients in Malaysia in order to identify risk factors and facilitate control measures. A modified Ziehl-Neelsen acid fast staining method was used to test for the presence of Cryptosporidium oocysts in the stools of 346 HIV/AIDS patients in Malaysia. Standard coproscopical methods were used to identify infections with other protozoan or helminths parasites. To identify the species of Cryptosporidium, DNA was extracted and nested-PCR was used to amplify a portion of the SSU rRNA gene. A total of 43 (12.4%) HIV-infected patients were found to be infected with Cryptosporidium spp. Of the 43 Cryptosporidium-positive HIV patients, 10 (23.3%) also harboured other protozoa, and 15 (34.9%) had both protozoa and helminths. The highest rates of cryptosporidiosis were found in adult males of Malay background, intravenous drug users, and those with low CD4 T cell counts (i.e., < 200 cells/mm3). Most were asymptomatic and had concurrent opportunistic infections mainly with Mycobacterium tuberculosis. DNA sequence analysis of 32 Cryptosporidium isolates identified C. parvum (84.3%), C. hominis (6.3%), C. meleagridis (6.3%), and C. felis (3.1%). The results of the present study revealed a high prevalence of Cryptosporidium infection in hospitalized HIV/AIDS patients. The results also confirmed the potential significance of zoonotic transmission of C. parvum in HIV infected patients, as it was the predominant species found in this study. However, these patients were found to be susceptible to a wide range of Cryptosporidium species. Epidemiological and molecular characterization of Cryptosporidium isolates provides clinicians and researchers with further information regarding the origin of the infection, and may enhance treatment and control strategies.
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
authors.forename: I
authors.initials: I
authors.lastname: Asma
authors.affiliation: Infectious Disease Unit, Department of Medicine, Hospital Sungai Buloh, 47000 Sungai Buloh, Selangor Darul Ehsan, Malaysia.
authors.forename: B L H
authors.initials: BL
authors.lastname: Sim
authors.affiliation: Microbiology Research Division, Bureau of Microbial Hazards, Food Directorate, Health Canada, Banting Research Centre, 251 Sir Frederick Banting Driveway, P.L.2204E, Ottawa, Ontario, K1A 0K9 Canada.
authors.forename: R D
authors.initials: RD
authors.lastname: Brent
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
authors.forename: S
authors.initials: S
authors.lastname: Johari
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
authors.forename: A L
authors.initials: AL
authors.lastname: Yvonne Lim
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003457:Cryptosporidiosis / Q000453:epidemiology* / Q000469:parasitology*; D003458:Cryptosporidium / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D016054:DNA, Protozoan / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D005243:Feces / Q000469:parasitology; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012337:RNA, Ribosomal, 18S / Q000235:genetics; D012307:Risk Factors; D017422:Sequence Analysis, DNA; D055815:Young Adult
chemical_list: D016054:DNA, Protozoan; D004275:DNA, Ribosomal; D012337:RNA, Ribosomal, 18S