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EndNote
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Risk Factors for Cryptosporidiosis Among Children in a Semi Urban Slum in Southern India: A Nested Case-Control Study
Rajiv Sarkar
Rajiv Sarkar
Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India; Community Health Department, Christian Medical College, Vellore, India; Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Deepthi Kattula
Deepthi Kattula
Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India; Community Health Department, Christian Medical College, Vellore, India; Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Mark R. Francis
Mark R. Francis
Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India; Community Health Department, Christian Medical College, Vellore, India; Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Sitara S. R. Ajjampur
Sitara S. R. Ajjampur
Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India; Community Health Department, Christian Medical College, Vellore, India; Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Ashok D. Prabakaran
Ashok D. Prabakaran
Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India; Community Health Department, Christian Medical College, Vellore, India; Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Nithya Jayavelu
Nithya Jayavelu
Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India; Community Health Department, Christian Medical College, Vellore, India; Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Jayaprakash Muliyil
Jayaprakash Muliyil
Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India; Community Health Department, Christian Medical College, Vellore, India; Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Vinohar Balraj
Vinohar Balraj
Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India; Community Health Department, Christian Medical College, Vellore, India; Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Elena N. Naumova
Elena N. Naumova
Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India; Community Health Department, Christian Medical College, Vellore, India; Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Honorine D. Ward
Honorine D. Ward
Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India; Community Health Department, Christian Medical College, Vellore, India; Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Gagandeep Kang
Gagandeep Kang
Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India; Community Health Department, Christian Medical College, Vellore, India; Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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The risk factors for acquisition of cryptosporidial infection in resource-poor settings are poorly understood. A nested case-control study was conducted to assess factors associated with childhood cryptosporidiosis (detected by stool polymerase chain reaction) in an endemic, Indian slum community using data from two community-based studies with 580 children followed prospectively until their second birthday. Factors were assessed for overall cryptosporidiosis (N = 406), and for multiple (N = 208), asymptomatic (N = 243), and symptomatic (N = 163) infections, respectively. Presence of older siblings (odds ratio [OR] = 1.88, P = 0.002) and stunting at 6 months of age (OR = 1.74, P = 0.019) were important risk factors for childhood cryptosporidiosis. Always boiling drinking water before consumption, the use of a toilet by all members of the family, and maternal age ≥ 23 years were protective. These results provide insights into acquisition of childhood cryptosporidiosis in settings with poor environmental sanitation, contaminated public water supply systems, and close human–animal contact. Disease control strategies will require a multifaceted approach.
Author Notes
Financial support: This work was supported by National Institute of Allergy and Infectious Diseases (grant Nos. R01 A1075452 to G.K. and R01 A1072222 to H.W.). R.S. and D.K. were supported by a Fogarty International Center training grant (grant No. D43 TW007392 to G.K.).
Authors' addresses: Rajiv Sarkar, Deepthi Kattula, Mark R. Francis, Sitara S. R. Ajjampur, Ashok D. Prabakaran, Nithya Jayavelu, and Gagandeep Kang, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India, E-mails: rsarkar@cmcvellore.ac.in, deepthikattula@cmcvellore.ac.in, elysium28@gmail.com, sitararao@cmcvellore.ac.in, ashokdani@gmail.com, nithya_jey@yahoo.co.in, and gkang@cmcvellore.ac.in. Jayaprakash Muliyil and Vinohar Balraj, Community Health Department, Christian Medical College, Vellore, India, E-mails: jpmuliyil@gmail.com and vinoharbalraj@gmail.com. Elena N. Naumova, Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, E-mail: elena.naumova@tufts.edu. Honorine D. Ward, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, E-mail: hward@tuftsmedicalcenter.org.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Fayer R, Morgan U, Upton SJ, 2000. Epidemiology of Cryptosporidium: transmission, detection and identification. Int J Parasitol 30: 1305–1322.
-
2.
Tzipori S, Ward H, 2002. Cryptosporidiosis: biology, pathogenesis and disease. Microbes Infect 4: 1047–1058.
-
3.
Dillingham RA, Lima AA, Guerrant RL, 2002. Cryptosporidiosis: epidemiology and impact. Microbes Infect 4: 1059–1066.
-
4.
Kosek M, Alcantara C, Lima AA, Guerrant RL, 2001. Cryptosporidiosis: an update. Lancet Infect Dis 1: 262–269.
-
5.
Desai NT, Sarkar R, Kang G, 2012. Cryptosporidiosis: an under-recognized public health problem. Trop Parasitol 2: 91–98.
-
6.
Leav BA, Mackay M, Ward HD, 2003. Cryptosporidium species: new insights and old challenges. Clin Infect Dis 36: 903–908.
-
7.
Shirley DA, Moonah SN, Kotloff KL, 2012. Burden of disease from cryptosporidiosis. Curr Opin Infect Dis 25: 555–563.
-
8.
Snelling WJ, Xiao L, Ortega-Pierres G, Lowery CJ, Moore JE, Rao JR, Smyth S, Millar BC, Rooney PJ, Matsuda M, Kenny F, Xu J, Dooley JS, 2007. Cryptosporidiosis in developing countries. J Infect Dev Ctries 1: 242–256.
-
9.
Checkley W, Epstein LD, Gilman RH, Black RE, Cabrera L, Sterling CR, 1998. Effects of Cryptosporidium parvum infection in Peruvian children: growth faltering and subsequent catch-up growth. Am J Epidemiol 148: 497–506.
-
10.
Guerrant DI, Moore SR, Lima AA, Patrick PD, Schorling JB, Guerrant RL, 1999. Association of early childhood diarrhea and cryptosporidiosis with impaired physical fitness and cognitive function four-seven years later in a poor urban community in northeast Brazil. Am J Trop Med Hyg 61: 707–713.
-
11.
Molbak K, Hojlyng N, Gottschau A, Sa JC, Ingholt L, da Silva AP, Aaby P, 1993. Cryptosporidiosis in infancy and childhood mortality in Guinea Bissau, West Africa. BMJ 307: 417–420.
-
12.
Collinet-Adler S, Ward HD, 2010. Cryptosporidiosis: environmental, therapeutic, and preventive challenges. Eur J Clin Microbiol Infect Dis 29: 927–935.
-
13.
Cruz JR, Cano F, Caceres P, Chew F, Pareja G, 1988. Infection and diarrhea caused by Cryptosporidium sp. among Guatemalan infants. J Clin Microbiol 26: 88–91.
-
14.
Molbak K, Aaby P, Hojlyng N, da Silva AP, 1994. Risk factors for Cryptosporidium diarrhea in early childhood: a case-control study from Guinea-Bissau, West Africa. Am J Epidemiol 139: 734–740.
-
15.
Javier Enriquez F, Avila CR, Ignacio Santos J, Tanaka-Kido J, Vallejo O, Sterling CR, 1997. Cryptosporidium infections in Mexican children: clinical, nutritional, enteropathogenic, and diagnostic evaluations. Am J Trop Med Hyg 56: 254–257.
-
16.
Newman RD, Sears CL, Moore SR, Nataro JP, Wuhib T, Agnew DA, Guerrant RL, Lima AA, 1999. Longitudinal study of Cryptosporidium infection in children in northeastern Brazil. J Infect Dis 180: 167–175.
-
17.
Bhattacharya MK, Teka T, Faruque AS, Fuchs GJ, 1997. Cryptosporidium infection in children in urban Bangladesh. J Trop Pediatr 43: 282–286.
-
18.
Katsumata T, Hosea D, Wasito EB, Kohno S, Hara K, Soeparto P, Ranuh IG, 1998. Cryptosporidiosis in Indonesia: a hospital-based study and a community-based survey. Am J Trop Med Hyg 59: 628–632.
-
19.
Bern C, Ortega Y, Checkley W, Roberts JM, Lescano AG, Cabrera L, Verastegui M, Black RE, Sterling C, Gilman RH, 2002. Epidemiologic differences between cyclosporiasis and cryptosporidiosis in Peruvian children. Emerg Infect Dis 8: 581–585.
-
20.
Nchito M, Kelly P, Sianongo S, Luo NP, Feldman R, Farthing M, Baboo KS, 1998. Cryptosporidiosis in urban Zambian children: an analysis of risk factors. Am J Trop Med Hyg 59: 435–437.
-
21.
Leach CT, Koo FC, Kuhls TL, Hilsenbeck SG, Jenson HB, 2000. Prevalence of Cryptosporidium parvum infection in children along the Texas-Mexico border and associated risk factors. Am J Trop Med Hyg 62: 656–661.
-
22.
Pereira MD, Atwill ER, Barbosa AP, Silva SA, Garcia-Zapata MT, 2002. Intra-familial and extra-familial risk factors associated with Cryptosporidium parvum infection among children hospitalized for diarrhea in Goiania, Goias, Brazil. Am J Trop Med Hyg 66: 787–793.
-
23.
Roy SL, DeLong SM, Stenzel SA, Shiferaw B, Roberts JM, Khalakdina A, Marcus R, Segler SD, Shah DD, Thomas S, Vugia DJ, Zansky SM, Dietz V, Beach MJ, 2004. Risk factors for sporadic cryptosporidiosis among immunocompetent persons in the United States from 1999 to 2001. J Clin Microbiol 42: 2944–2951.
-
24.
Solorzano-Santos F, Penagos-Paniagua M, Meneses-Esquivel R, Miranda-Novales MG, Leanos-Miranda B, Angulo-Gonzalez D, Fajardo-Gutierrez A, 2000. Cryptosporidium parvum infection in malnourished and non-malnourished children without diarrhea in a Mexican rural population. Rev Invest Clin 52: 625–631.
-
25.
Lake IR, Harrison FC, Chalmers RM, Bentham G, Nichols G, Hunter PR, Kovats RS, Grundy C, 2007. Case-control study of environmental and social factors influencing cryptosporidiosis. Eur J Epidemiol 22: 805–811.
-
26.
Hunter PR, Hughes S, Woodhouse S, Syed Q, Verlander NQ, Chalmers RM, Morgan K, Nichols G, Beeching N, Osborn K, 2004. Sporadic cryptosporidiosis case-control study with genotyping. Emerg Infect Dis 10: 1241–1249.
-
27.
Al-Mekhlafi HM, Mahdy MA, Azlin MY, Fatmah MS, Norhayati M, 2011. Childhood Cryptosporidium infection among aboriginal communities in Peninsular Malaysia. Ann Trop Med Parasitol 105: 135–143.
-
28.
Khalili B, Mardani M, 2009. Frequency of Cryptosporidium and risk factors related to cryptosporidiosis in under-5 year old hospitalized children due to diarrhea. Iranian Journal of Clinical Infectious Diseases 4: 151–155.
-
29.
Molloy SF, Tanner CJ, Kirwan P, Asaolu SO, Smith HV, Nichols RA, Connelly L, Holland CV, 2011. Sporadic Cryptosporidium infection in Nigerian children: risk factors with species identification. Epidemiol Infect 139: 946–954.
-
30.
Chacin-Bonilla L, Barrios F, Sanchez Y, 2008. Environmental risk factors for Cryptosporidium infection in an island from western Venezuela. Mem Inst Oswaldo Cruz 103: 45–49.
-
31.
Ajjampur SS, Gladstone BP, Selvapandian D, Muliyil JP, Ward H, Kang G, 2007. Molecular and spatial epidemiology of cryptosporidiosis in children in a semiurban community in south India. J Clin Microbiol 45: 915–920.
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