title: Identification of opportunistic enteric parasites among immunocompetent patients with diarrhoea from Northern India and genetic characterisation of Cryptosporidium and Microsporidia.
abstract: OBJECTIVE
  Enteric parasitic infestation is a major public health problem in developing countries. Parasites such as Cryptosporidium spp., Cyclospora spp., Cystoisospora spp. and Microsporidia may cause severe diarrhoea among immunocompromised patients. There is scanty data on their frequency among immunocompetent patients. Accordingly, we studied the frequency of enteric opportunistic parasites among immunocompetent patients with diarrhoea from northern India; we also performed genetic characterisation of Cryptosporidia and Microsporidia among them.
  
  
  METHODS
  Stool samples from 80 immunocompetent patients with diarrhoea, and 110 healthy controls were examined. Parasites were detected by direct microscopy, modified acid-fast (Kinyoun's) and modified trichrome stain. Polymerase chain reaction--restriction fragment length polymorphism was used for genetic characterisation of selected species such as Cryptosporidia and Microsporidia.
  
  
  RESULTS
  Enteric parasites were detected in 16/80 (20%) patients (mean age 28.8±20 years, 45, 56% males) and in 2/110 (1.8%) healthy controls (P=0.00007). Parasites detected were Cryptosporidium spp. (8/16, 50.0%), Cystoisospora spp. (4/16, 25%), Microsporidia (1/16, 6.25%), Cyclospora spp. (1/16, 6.25%) and Giardia spp. (1/16, 6.25%). One patient had mixed infection with Cystoisospora spp. and Giardia spp. The species of Cryptosporidia and Microsporidia detected were Cryptosporidium hominis and Enterocytozoon bieneusi, respectively. Parasites were more often detected in younger patients (≤20 years of age) than in older. Most of the parasite infected patients presented with chronic diarrhoea.
  
  
  CONCLUSIONS
  Opportunistic enteric parasitic infestation was more common among immunocompetent patients with diarrhoea than healthy subjects. Special staining as well as molecular methods are essential for appropriate diagnosis of these parasites.
authors.affiliation: Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: U
authors.initials: U
authors.lastname: Ghoshal
authors.forename: A
authors.initials: A
authors.lastname: Dey
authors.forename: P
authors.initials: P
authors.lastname: Ranjan
authors.forename: S
authors.initials: S
authors.lastname: Khanduja
authors.forename: V
authors.initials: V
authors.lastname: Agarwal
authors.forename: U C
authors.initials: UC
authors.lastname: Ghoshal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003458:Cryptosporidium / Q000145:classification / Q000235:genetics*; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology; D005243:Feces / Q000382:microbiology / Q000469:parasitology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D008828:Microbiological Techniques; D016814:Microsporidia / Q000145:classification / Q000235:genetics*; D008875:Middle Aged; D058889:Molecular Typing; D009894:Opportunistic Infections / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology; D010271:Parasites / Q000145:classification* / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D015995:Prevalence; D055815:Young Adult