Cryptosporidium meleagridis from Humans: Molecular Analysis and Description of Affected Patients

OBJECTIVES: To genetically characterize an unusual genotype of Cryptosporidium from the stools of humans with diarrhoea and to identify risk factors in the affected patients. METHODS: DNA was extracted from human faeces where Cryptosporidium oocysts were detected by light microscopy. Cryptosporidial gene fragments from six different loci were analysed by PCR alone, PCR/RFLP and by DNA sequencing. Oocysts were characterized by light and immunofluorescence microscopy and epidemiological data was collected from the affected patients. RESULTS: Analysis of the Cryptosporidium oocyst wall protein (COWP) gene amplified from > 2000 human faecal samples identified 19 patients all of which produced an unusual RFLP profile. Subsequent DNA sequence analysis of this and an additional four genetic loci (including 18S rRNA sequences) confirmed these as a homogeneous group which was genetically distinct from Cryptosporidium parvum. The isolates were identified as Cryptosporidium meleagridis since the gene sequences were identical to those from this species recovered from birds. Conventional microscopy showed oocysts indistinguishable from C. parvum and reacted strongly with two different commercially available anti-oocyst monoclonal antibodies. None of the patients showed risk factors unusual for cryptosporidiosis; however, ten of the cases occurred during the summer/autumn, six had a history of foreign travel, four were co-infected with Giardia, two were HIV positive, and six were without identifiable immunocompromising factors. CONCLUSIONS: This study further confirms that C. meleagridis, in addition to C. parvum, is involved in human disease. The study also highlights the lack of basic information on the host range of this genus of parasites, the complexity of the transmission routes involved in human cryptosporidiosis, and the value of molecular techniques in identify hitherto unrecognised differences in Cryptosporidium from human faeces.     

Identification of 5 types of Cryptosporidium parasites in children in Lima, Peru

Cryptosporidium parvum is usually considered to be the pathogen responsible for human cryptosporidiosis. We genotyped Cryptosporidium in 132 stool specimens from 80 Peruvian children, representing 85 infection episodes, using techniques that differentiate Cryptosporidium species and C. parvum genotypes. Five types of Cryptosporidium were identified: C. parvum human (67), bovine (8), and dog (2) genotypes, C. meleagridis (7), and C. felis (1). Twenty-five (29%) of the 85 infection episodes were associated with diarrhea. There was no significant difference in age, antecedent stunting, percentage with diarrhea, or duration of diarrhea for episodes with human genotype, compared with those of zoonotic Cryptosporidium. Duration of oocyst shedding was longer for human genotype than for zoonotic Cryptosporidium (mean, 13.9 days and 6.4 days, respectively; P=.004). Serum samples from 8 children with C. meleagridis, C. felis, or C. parvum dog genotype were tested for anti-human immunodeficiency virus (HIV) type 1 antibodies; all were found to be negative. Contrary to common belief, novel Cryptosporidium species and C. parvum genotypes can infect HIV-negative children.     

The use of a nested PCR-RFLP technique, based on the parasite's 18S ribosomal RNA, to characterise Cryptosporidium isolates from HIV/AIDS patients

Since there have been few studies on human cryptosporidiosis in Iran, attempts were made to identify Cryptosporidium isolates from HIV-positive Iranians, to genotype level. A nested PCR (based on a fragment of the parasite's 18S ribosomal-RNA gene) was first used to see if faecal samples from 35 HIV-positive patients (of whom 17 had apparently been found smear-positive for Cryptosporidium oocysts) contained Cryptosporidium. Twenty-one of the samples (including all 17 of those that appeared smear-positive) were found PCR-positive. Each of these 21 samples was then investigated further, by RFLP analysis in which the amplicons from the secondary PCR were digested with VspI. Curiously, although HIV-infected individuals are known to be susceptible to infection with a wide range of Cryptosporidium genotypes, all the Iranian subjects of the present study were found to be infected with C. hominis (71%) or C. parvum (29%).     

Transmission dynamics of Cryptosporidium infection in a natural population of non-human primates at Polonnaruwa, Sri Lanka

Infections from Cryptosporidium parvum are of interest not only to public health, but also to wildlife conservation, particularly when humans and livestock encroach on nature and thereby increase the risk of cross-species transmissions. To clarify this risk, we used polymerase chain reaction to examine the hypervariable region of the C. parvum 18S rRNA gene in feces from three monkey species. Samples were isolated from regions where disease transmission between monkeys, livestock, and humans was likely (soiled habitat) or unlikely (clean habitat). Monkey individuals, their social groups, and different species shared multiple genotypes/isolates of C. parvum. Ecological and molecular analyses suggested that Cryptosporidium infection among Toque macaques in soiled habitats was mainly the bovine genotype C. parvum. Monkeys inhabiting clean habitat, particularly gray and purple-faced langurs, lacked Cryptosporidium species/types associated with bovines. Livestock apparently was a main source of infection for wild primates.     

规模化引种场进口奶牛隐孢子虫种类、基因亚型鉴定及其生物安全评价

目的为了解进口奶牛寄生的隐孢子虫对引种场污染情况及是否影响隐孢子虫种类和基因型在当地的分布。方法采用PCR方法检测河南省某规模化引种场奶牛隐孢子虫感染情况。结果基于18S rRNA基因位点进行PCR检测,奶牛隐孢子虫总感染率为17.8%(90/507),鉴定出4种隐孢子虫,分别为微小隐孢子虫、牛隐孢子虫、芮氏隐孢子虫和安氏隐孢子虫,隐孢子虫感染率随牛年龄增长而呈递减趋势,差异有统计学意义(P<0.01)。断奶前犊牛以微小隐孢子虫为优势感染种,断奶前犊牛腹泻与微小隐孢子虫感染呈正相关性,差异有统计学意义(P<0.01)。基于gp60基因位点,43份微小隐孢子虫阳性样品成功扩增出35份,序列分析显示35个微小隐孢子虫均为人兽共患基因亚型IIdA19G1, 而奶牛引种地(澳大利亚)的牛源微小隐孢子虫均为IIa亚型家族存在显著不同。结论证实微小隐孢子虫为犊牛腹泻病原之一,IId亚型为中国独特分布的微小隐孢子虫亚型,其基因亚型存在地理隔离遗传特征,引种青年牛和成年牛不影响当地重要人兽共患虫种微小隐孢子虫基因亚型分布,从这个角度考虑不具有生物安全重要性。     

Zoonotic species of Cryptosporidium are as prevalent as the anthroponotic in HIV-infected patients in Thailand

The epidemiology of chronic diarrhoea in adults with late-stage HIV infection was investigated in a prospective study in Bangkok, Thailand. During this investigation, 34 Cryptosporidium isolates were obtained from the faeces of 36 patients, with mean CD4(+) counts of only 14 x 10(6) CD4(+) cells/litre (range = 2 x 10(6) - 53 x 10(6)/litre), who had symptomatic cryptosporidiosis. Genotyping of these isolates, by RFLP analysis and DNA sequencing of the hypervariable region of the 18S rRNA gene, indicated that only 17 (50%) were of the C. parvum human genotype. The rest were of C. meleagridis (seven), the C. parvum 'bovine' genotype (five), C. felis (three) and C. canis (two). Extensive genotypic heterogeneity was observed among the C. parvum isolates, and two other isolates, one of C. meleagridis and the other of C. felis, produced atypical restriction patterns and were only identified by sequencing. This appears to represent the first report of C. canis and the 'bovine' genotype of C. parvum in HIV-infected Thai patients.     

Molecular analysis of Cryptosporidium species isolated from HIV-infected patients in Thailand

Cryptosporidium isolates from diarrhoeal stools of human immunodeficiency virus (HIV)-infected patients in Thailand were genetically analysed by sequencing the variable region in the 18S rRNA gene. Twenty-nine isolates from four children and 25 adults attending King Chulalongkorn Memorial Hospital in Bangkok during 1996 and 2000 were analysed. All patients suffered from chronic watery diarrhoea and had low CD4+ lymphocytes (mean +/- SD=105.5 +/- 133.2 cells/microl). Four Cryptosporidium species were identified, i.e. C. parvum (genotype 1), C. meleagridis, C. muris and C. felis occurring in 24, 3, 1 and 1 isolates, respectively. Oocysts of C. muris were significantly larger than oocysts of other species; C. felis was the smallest in these populations (P < 0.01). Sequences of the ITS1, 5.8S rRNA and ITS2 regions of C. muris and C. meleagridis identified in this study displayed unique sequences from those of other known species. Based on a limited number of isolates analysed, only C. meleagridis and C. muris were found in HIV-infected children, whereas the genotype 1 of C. parvum predominated in HIV-infected adults.     

Genotypic identification of Cryptosporidium spp. isolated from HIV-infected patients and immunocompetent children of São Paulo, Brazil

Cryptosporidium isolates identified in fourteen stool samples, collected from five HIV-infected patients and nine immunocompetent children, living in the State of S?o Paulo, Brazil, were submitted to a molecular analysis using a nested PCR followed of restriction fragment length polymorphism (RFLP), for genetic characterization. The analysis was based on digestion with RsaI restriction enzyme of a DNA fragment amplified from the Cryptosporidium oocyst wall protein (COWP) gene. Based on this analysis, four samples were identified as Cryptosporidium parvum, eight as Cryptosporidium hominis and two presented a profile that corresponded to Cryptosporidium meleagridis when compared to the standards used in the analysis. The use of molecular methods can be helpful to identify source of infections and risk factors related to Cryptosporidium infection in our communities.     

Human cryptosporidiosis and Cryptosporidium spp. in Haiti

Contamination by water-born infectious diseases is closely linked to urban slums conditions such as overcrowding and high level of faecal pollution by animal and human excreta. In this environment, cryptosporidiosis is a major cause of acute diarrhoea in children and chronic persistent diarrhoea in AIDS patients, resulting in increased morbidity and mortality in both populations. The aims of this study conducted in Port-au-Prince, Haiti were to: (i) determine the frequency of Cryptosporidium infection in two populations of patients with diarrhoea, children and AIDS patients, and the existence of Cryptosporidium carriage in healthy adults living in close contact with them; (ii) identify by molecular genotyping the Cryptosporidium species involved; and (iii) evaluate the viability of Cryptosporidium oocysts isolated from human stools. From January 2000 to January 2001, 158 of 1529 diarrhoea stool samples collected from 93 patients with diarrhoea, 57 adults followed at Centres GHESKIO and 36 children admitted at the University Hospital in Port-au-Prince contained Cryptosporidium oocysts (10.3%). The majority of adult patients (98%) were HIV-infected whereas the majority of children (81%) tested negative for HIV. Cryptosporidium was documented in only 1/102 healthy persons living in contact with Cryptosporidium infected patients and infection was with the same genotype as that of the contact patient. Among the 69 Cryptosporidium isolates studied for genotyping, three species were identified: C. hominis (59%), C. parvum (38%) and C. felis (3%). The two C. felis cases are the first reported from AIDS patients in the Caribbean. Most of the children regardless of their HIV status were infected with C. hominis (72%), whereas AIDS patients were more likely to be infected by either human or animal genotypes. These data confirm that immunocompromised individuals are susceptible to a wide range of Cryptosporidium spp. Viability of Cryptosporidium oocysts were determined in an experimental mouse model for 17/18 specimen studied including in 12/13 C. hominis, 4/4 C. parvum and 1/1 C. felis. Infectivity in newborn mice was found to be dose-dependent and more effective with C. parvum than the other two genotypes. Cryptosporidiosis remains a frequent hazard for both AIDS patients and young children in Haiti because of poor hygiene, particularly contaminated water and overcrowded conditions associated with urban slums.     

开封地区奶牛隐孢子虫种类及基因型鉴定

目的探讨开封地区奶牛隐孢子虫感染情况和种类分布。方法采用饱和蔗糖溶液漂浮法检查新鲜粪便样本的隐孢子虫卵囊,用18S rRNA基因对隐孢子虫进行PCR扩增和限制性片段长度多态性分析;基于gp60基因位点对微小隐孢子虫进行基因亚型鉴定。结果粪便样本中隐孢子虫阳性率为8.4% (52/622),不同调查点、年龄段和养殖条件下奶牛隐孢子虫感染率具有统计学意义(P<0.01)。基于18S rRNA基因位点成功扩增出50个样本,分别经Ssp I和MboII酶切进行鉴定,发现安氏隐孢子虫为优势虫种,为23份,微小隐孢子虫、牛隐孢子虫和芮氏隐孢子虫分别为5份、12份和6份,4份为牛隐孢子虫和芮氏隐孢子虫混合感染。序列分析显示5个微小隐孢子虫均为人兽共患基因亚型IIdA19G1。结论开封地区奶牛感染人兽共患微小隐孢子虫基因亚型,具有人兽共患传播的可能性。     

以18SrRNA基因为分子标记的微小隐孢子虫系统发育研究

目的以18SrRNA基因为分子标记对分离自我国人和牛，以及澳大利亚和美国不同宿主来源微小隐孢子虫的系统发育进行探讨。方法用PCR扩增我国两个虫株的18SrRNA基因片段并进行序列测定，与登录于GenBank的澳、美两国虫株的相应序列进行比对。用NJ法构建分子系统树进行系统发育分析。结果分离自我国的小牛虫株（JLC）与GenBank中3个牛源虫株（澳大利亚的C1，美国的UCP和AUCP-1）亲缘关系近，位于系统发育树的同一枝；分离自我国的人源虫株（JSH）与澳大利亚鼠源虫株（M24）同源，共同位于系统发育树的另一枝。结论本研究中微小隐孢子虫株间亲缘关系的远近似主要由宿主因素决定，而受地理位置的影响较小。     

几种新现人体隐孢子虫种和基因型流行现状

隐孢子虫是一种寄生于宿主胃肠道上皮细胞内的原虫。人感染后,免疫功能正常者,常引起自限性腹泻;但在高危人群(如儿童、老人和免疫缺陷者等)中可发生严重腹泻和肠外感染,尤其是艾滋病患者。目前,隐孢子虫的分子流行病学研究已鉴定了30个有效种和40多种基因型,其中21个隐孢子虫种和基因型在人体发现。人体隐孢子虫病多数由人隐孢子虫(C.hominis)和微小隐孢子虫(C.parvum)引起。火鸡隐孢子虫(C.meleagridis)、泛在隐孢子虫(C.ubiquitum)、猫隐孢子虫(C.felis)和犬隐孢子虫(C.canis)引起的隐孢子虫病例也逐渐增多。除此之外,随着人体隐孢子虫病分子流行病学数据的增加,在人体内鉴定到一些新的隐孢子虫和基因型。特对上述新现的人体隐孢子虫种和基因型的流行现状进行综述。     

Variability among Cryptosporidium parvum genotype 1 and 2 immunodominant surface glycoproteins

Published genomic differences between Cryptosporidium parvum genotype 1 (human-derived) and genotype 2 (animal and human-derived) isolates suggest that these may belong to two distinct species. This is of significant interest since genotype 1 isolates are associated with sporadic cases of human cryptosporidiosis in 30-40 % of cases in contrast to 60-70 % of cases caused by genotype 2. The lower genetic sequence similarity between genotype 1 and 2 surface glycoproteins (gp40/15) suggests that antigenic differences should also occur, a feature that was investigated in this study. Using immune and convalescent serum samples from gnotobiotic piglets previously inoculated with genotype 1 and 2 isolates, we demonstrated that C. parvum gp15 was immunodominant for both genotype 1 and 2 isolates. Lower genetic sequence similarity between genotype 1 and 2 Cpgp40/15 did correspond to gp15 protein differences as detected by Western blot. Moreover, we confirmed that gp15 contains epitopes that are also immunodominant. Deglycosylation of C. parvum proteins resulted in decreased ability of gp15, gp23 and gp900 to react with homologous polyclonal antibodies, suggesting that these proteins also express carbohydrate epitopes. Taken together, our data suggest that there is a high phenotypic variability between C. parvum genotype 1 and 2 isolates at the level of gp15. We contemplate that gp15 surface glycoprotein plays an important role in the biology of C. parvum as a potent inducer of immune response and a possible virulence factor.     

Cryptosporidiosis: an update in molecular epidemiology

PURPOSE OF REVIEW: Molecular tools have been developed to detect and differentiate Cryptosporidium at the species/genotype and subtype levels. These tools have been increasingly used in the characterization of the transmission of Cryptosporidium spp. This review addresses the most recent developments in molecular epidemiology of cryptosporidiosis. RECENT FINDINGS: The recent development of subtyping tools has led to better understanding of the population genetics and transmission of Cryptosporidium in humans. The population structure of C. parvum and C. hominis is apparently more complicated than previously suggested, with the likely existence of both clonal and panmictic populations. Thus, the transmission of C. parvum (genotype II) in humans is shown to be different in different areas, with zoonotic transmission important in certain places and anthroponotic transmission in others. The use of molecular tools has also led to the identification of geographic and temporal differences in the transmission of C. parvum and C. hominis, and better appreciation of the public health importance of other Cryptosporidium species/genotypes and the frequency of infections with mixed genotypes or subtypes. SUMMARY: Factors involved in the transmission of human cryptosporidiosis are difficult to examine using conventional methods. The use of molecular tools has been helpful in the assessment of the zoonotic potential of various Cryptosporidium spp. and sources of human infections, and has started to play a significant role in the characterization of transmission dynamic in endemic and epidemic areas.     

Comparative study of the antigenic composition of oocyst isolates of Cryptosporidium parvum from different hosts

An investigation was made of the antigenic composition of oocyst isolates of Cryptosporidium parvum by immunoblotting using rabbit polyclonal or murine monoclonal antibodies (MoAbs) developed against this parasite. Using the polyclonal antibodies in blots, a common antigenic profile was obtained from a number of human oocyst isolates from AIDS patients and immunocompetent children in the UK and Portugal. Antigenic differences were observed, however, between a human isolate from Turkey and these other human isolates. The antigenic profiles of oocyst isolates from deer and cattle were similar, but the profiles of the animal and human isolates differed to some extent. Two MoAbs which, in immunofluorescence microscopy, reacted with the surface of the C. parvum sporozoite were also used in blots. A major antigen(s) from 9 of 11 human oocyst isolates recognized by these MoAbs had a molecular weight of 47 kD, but the sizes of the corresponding antigens of the remaining 2 human isolates, one from Turkey (same as above) and one from the UK, were 45.5 and 51 kD, respectively. The equivalent antigen(s) from 4 bovine and 4 ovine isolates was 48 kD. One of the MoAbs failed to react in blots with 2 of the isolates, 1 human and 1 bovine.     

牛隐孢子虫多重PCR方法的建立及应用

摘要：目的 为寻求一种牛源隐孢子虫的快速检测手段。方法 根据牛隐孢子虫COWP基因和ITS-1基因,设计合成两对特异性引物,用以特异性扩增牛微小隐孢子虫和安氏隐孢子虫,扩增长度分别为1033bp和263bp。通过反应条件的优化,特异性试验及扩增片段的序列测定的验证,建立多重PCR方法。结果 应用该方法对采集自广西不同地区的1613份牛粪样进行牛隐孢子虫检测,安氏隐孢子虫阳性粪样为189份,微小隐孢子虫阳性粪样1份,与常规隐孢子虫分离鉴定结果一致。结论 表明该方法可用于隐孢子虫的流行病学调查及临床诊断。     

Pathogenesis of human and bovine Cryptosporidium parvum in gnotobiotic pigs

To compare the pathogenesis of human genotype 1 (HuG1) and bovine genotype 2 (BoG2) Cryptosporidium parvum, neonatal gnotobiotic pigs were given 1-10 HuG1 or BoG2 oocysts. The prepatent and patent periods were significantly longer for HuG1 than for BoG2 C. parvum (prepatent, 8.6 vs. 5.6 days; patent, 16.6 vs. 10.3 days). BoG2-infected pigs developed significantly more severe disease than did HuG1-infected pigs. BoG2 parasites were seen microscopically throughout the intestines during the prepatent and patent periods. HuG1 parasites were only detected during the patent period in the ileum and colon but colonized the mucosal surface in significantly larger numbers than did BoG2. Moderate-to-severe villus/mucosal attenuation with lymphoid hyperplasia was seen throughout the intestines of BoG2-infected pigs, whereas lesions in HuG1-infected pigs were mild to moderate and restricted to the ileum and colon. These findings provide additional support for the hypothesis that human and bovine C. parvum genotypes may be separate species.     

Molecular epidemiology of cryptosporidiosis outbreaks and transmission in British Columbia, Canada.

Isolates from 25 (13 sporadic and 12 outbreak) cryptosporidiosis cases, 24 of which were from British Columbia, Canada, were characterized using nested polymerase chain reaction amplification of the polymorphic internal transcribed spacer 1 locus. Two predominant Cryptosporidium parvum genotypes were found. Twelve (8 sporadic and 4 outbreak) isolates amplified with the cry7/cry21 primer pair and 12 (5 sporadic and 7 outbreak) isolates amplified with the cry7/cryITS1 primer pair. Multi-locus gene analysis using sequence polymorphisms on 3 other loci, i.e., the thrombospondin-related adhesion protein gene, the dihydrofolate reductase gene, and the 18S rRNA gene on 8 (4 outbreak and 4 sporadic) isolates showed non-random association among the human and animal alleles of the 4 different C. parvum gene loci. Associations between these 2 parasite genotypes and different routes of cryptosporidiosis transmission such as zoonotic, anthroponotic, and waterborne transmission were studied using municipal population and agricultural information, as well as detection of C. parvum oocysts in municipal drinking water specimens of the residential communities of sporadic and outbreak cases.     

人源隐孢子虫分离株种类鉴定与种系发育关系分析

目的确定郑州某医院分离到1株隐孢子虫(PRHN)所属种/基因型。方法用PCR对该分离株18S rRNA、HSP70、Cpn60和AOX进行PCR扩增,并对扩增产物进行测序,扩增序列经用DNAstar和ClustalX与GenBank参考序列比对,用PAUP4.0构建种系发育进化树,以确定该分离株与其他隐孢子虫虫种之间的亲缘关系。结果通过18S rRNA、HSP70基因分析该分离株与Cryptosporidium parvum(C.parvum)鼠基因型同源性最高,分别为99.9%和99.2%,在种系发育树上,PRHN均与C.parvum鼠基因型亲缘关系最近;对Chaperponin 60(Cpn60)和Alternative oxidase(AOX)进行序列分析时,该分离株与本实验室分离到的猪隐孢子虫(C.suis)亲缘关系最近。结论该分离株为C.parvum鼠基因型。     

基于凝集素基因对部分隐孢子虫种类的分子鉴定

目的 为了解隐孢子虫凝集素基因在不同分离株的序列差异及其遗传进化关系,以SSU rRNA基因作参照,评价Lectin基因位点作为隐孢子虫基因分型和进化关系分析的可行性。方法 采用巢式PCR,分别在Lectin和SSU rRNA位点处对本实验室分离保存的多个隐孢子虫分离株进行PCR的扩增。用Clustalx对扩增序列与参考序列进行比对,用MEGA5中的邻近法(Neighbor joining method NJ),进行进化树的构建。结果 基于Lectin基因位点,在C. parvum、C. hominis、C. cuniculus及其在SSU rRNA 处与人源C. hominis极为相近的horse genotype、驴源C. hominis均成功扩增出了大小在450 bp左右的目的 条带,并进行了进化树的分析,不同种类和同种不同动物来源的隐孢子虫分布在不同的分支上。结论 Lectin基因位点可很好的区分SSU rRNA序列极为相似的几种隐孢子虫,有望为人兽共患隐孢子虫分类和遗传研究提供新的基因靶标。