Burden of intestinal parasites in a cohort of diarrheic Egyptian children: Predominance of Cryptosporidium using nested PCR

Background: Diarrheic children are more vulnerable to a variety of pathogens including gastrointestinal parasites. Cryptosporidiosis is a major etiology of chronic diarrhea in Egyptian children; it has both short and long-term consequences for their growth and development. Objective: The purpose of this study was to determine in a cohort of children with diarrhea the prevalence of Cryptosporidium spp., molecularly; and other intestinal parasites, coproscopically, and to assess the association between Cryptosporidium and patient characteristics. As well as to evaluate the usefulness of molecular assay in detection of cryptosporidiosis in diarrheic children. Subjects and Methods: Fecal specimens were collected from 102 diarrheic Egyptian children, aged 12 years and under. All fecal specimens were examined coproscopically by wet mount prior to and after concentration, as well as permanent staining with modified acid-fast (MAF) for detection of intestinal parasites. Molecular assay using nested PCR (nPCR) was performed for detection of Cryptosporidium oocyst wall protein (cowp) gene. The association of patient demographics and clinical data with detection of Cryptosporidium spp. was determined. Results: Cryptosporidium copro-DNA was detected in 12 (11.8%) cases, for 5 (4.9%) of which oocysts were detected by MAF coproscopy; 9 cases of E. histolytica complex and 7 cases of G. intestinalis were detected by coproscopy. Other than the measure of head circumference, none of the patient characteristics had a significant association (P=0.027) with the detection of Cryptosporidium. Conclusion: There is a clear predominance of intestinal protozoa in diarrheic children, and Cryptosporidium spp. was the major enteric pathogen. Molecular assay should be included for the routine laboratory diagnosis of cryptosporidiosis.