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    Cryptosporidium infection in rural Gambian children: Epidemiology and risk factors

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    Author
    Nasrin, D.
    Kotloff, K.L.
    Levine, M.M.
    Date
    2019
    Journal
    PLoS neglected tropical diseases
    Publisher
    NLM (Medline)
    Type
    Article
    
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    See at
    https://doi.org/10.1371/journal.pntd.0007607
    Abstract
    BACKGROUND: Cryptosporidium is a major pathogen associated with diarrheal disease in young children. We studied Cryptosporidium diarrhea in children enrolled in the Global Enteric Multicenter Study (GEMS) in rural Gambia. METHODS: We recruited children <5 years of age with moderate-to-severe diarrhea (MSD) for 3 years (2008-2010), and children with either MSD or less severe diarrhea (LSD) for one year (November 2011-November 2012) at sentinel health centers. One or more randomly selected controls were matched to each case. Stool samples were tested to identify Cryptosporidium by immunoassay. A subset of randomly selected case-controls pairs were tested for Cryptosporidium species. We investigated the epidemiology of, and evaluated possible risk factors for, Cryptosporidium-positive diarrhea. RESULTS: We enrolled 1938 cases (1381 MSD, 557 LSD) and 2969 matched controls 231/1929 (12.0%) of diarrhea cases and 141/2962 (4.8%) of controls were positive for Cryptosporidium. Most Cryptosporidium diarrhea cases (85.7%, 198/231) were aged 6-23 months, and most (81.4%, 188/231) occurred during the rainy season. Cryptosporidium hominis (C. hominis) was the predominant (82.6%) species. We found associations between increased risk of Cryptosporidium-positive MSD or LSD, or both, with consumption of stored drinking water and certain animals living in the compound-cow, cat (MSD only) and rodents (LSD only). Larger households, fowl living in the compound, and the presence of Giardia infection were associated with decreased risk of Cryptosporidium MSD and LSD. CONCLUSION: Cryptosporidium-positive diarrhea is prevalent in this setting, especially at 6-23 months of age. The preponderance of Cryptosporidium infection in the rainy season and increased risk of Cryptosporidium-positive diarrhea with consumption of stored drinking water suggest water-borne transmission. Further investigation is needed to clarify the role of animals and contamination of stored drinking water in Cryptosporidium transmission.
    Keyword
    Cryptosporidiosis--etiology
    Risk Factors
    Gambia
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85071349198&doi=10.1371%2fjournal.pntd.0007607&partnerID=40&md5=242ae79edd460ba3c82d35313316eb4d; http://hdl.handle.net/10713/10499
    ae974a485f413a2113503eed53cd6c53
    10.1371/journal.pntd.0007607
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