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Clinical Significance of Respiratory Involvement in Cryptosporidiosis: Cross-Sectional Study of Children with Diarrhea and Respiratory Symptoms in Uganda
Siobhan M. Mor
Siobhan M. Mor
Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom;
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Grace Ndeezi
Grace Ndeezi
Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda;
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Luke R. Ascolillo
Luke R. Ascolillo
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts;
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Hannington B. Tasimwa
Hannington B. Tasimwa
Department of Microbiology, Makerere University College of Health Sciences, Kampala, Uganda;
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Charalampos Attipa
Charalampos Attipa
Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom;
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Jerlyn Sponseller
Jerlyn Sponseller
Department of Infectious Disease and Global Health, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts;
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David Mukunya
David Mukunya
Department of Community and Public Health, Busitema University, Busitema, Uganda;
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Ritah Nakato
Ritah Nakato
Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda;
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Lilian N. Kayondo
Lilian N. Kayondo
Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda;
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Saul Tzipori
Saul Tzipori
Department of Infectious Disease and Global Health, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts;
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James K. Tumwine
James K. Tumwine
Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda;
Department of Paediatrics and Child Health, School of Medicine, Kabale University, Kabale, Uganda;
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Department of Paediatrics and Child Health, School of Medicine, Kabale University, Kabale, Uganda;
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Jeffrey K. Griffiths
Jeffrey K. Griffiths
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts;
Department of Infectious Disease and Global Health, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts;
Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts;
Tufts University Friedman School of Nutrition Science and Policy, Boston, Massachusetts
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Department of Infectious Disease and Global Health, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts;
Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, Massachusetts;
Tufts University Friedman School of Nutrition Science and Policy, Boston, Massachusetts
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Respiratory cryptosporidiosis is considered an occasional, late-stage complication of HIV/AIDS. This study aimed to assess the clinical importance of respiratory cryptosporidiosis in children with diarrhea and respiratory symptoms at Mulago Hospital, Kampala, Uganda. Children aged 9 to 36 months presenting with diarrhea and cough or unexplained tachypnea (N = 1,918) were screened for fecal Cryptosporidium using polymerase chain reaction (PCR). Children with positive stool samples were eligible for further diagnostic tests, including sputum induction. Sputum samples were subjected to PCR for Cryptosporidium, as well as routine microbiology (culture and gram stain) and auramine stain for tuberculosis. Regression analyses were used to investigate 1) factors associated with respiratory cryptosporidiosis and 2) whether respiratory cryptosporidiosis was independently associated with hospitalization. Prevalence of enteric cryptosporidiosis was 260/1,918 (13.6%) (>80% Cryptosporidium hominis). Of the 236 children who had sputum available for analysis, 62 (26.3%) had Cryptosporidium in the sputum, only two of whom had HIV infection. Children with Cryptosporidium in the sputum were more likely to have abnormal oxygen saturation at presentation (SpO2 <96%; P = 0.053); no other differences in frequency or severity of respiratory signs were noted. No alternative bacterial cause of respiratory symptoms was identified in 37.7% of children with respiratory cryptosporidiosis, compared with 23.6% of children without (P = 0.04). Sputum-positive children had twice the odds of hospitalization compared with children without Cryptosporidium infection at this site (adjusted odds ratio = 2.08, 95% confidence interval: 1.02–4.22; P = 0.043). Respiratory tract involvement is common in children with intestinal cryptosporidiosis who are experiencing respiratory symptoms. Such children may experience some degree of respiratory compromise and may be at increased risk for hospitalization.
Author Notes
Financial support: This research was funded through a grant from the
Current contact information: Siobhan M. Mor, University of Liverpool, Neston, United Kingdom, E-mail: siobhan.mor@liverpool.ac.uk. Grace Ndeezi, Ritah Nakato, and Lilian N. Kayondo, Makerere University, Kampala, Uganda, E-mail: gndeezi@gmail.com, nakato.ritah@gmail.com, and liliankayondo@gmail.com. Luke R. Ascolillo, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, E-mail: luke.ascolillo@comcast.net. Tasimwa H.B., deceased. Charalampos Attipa, University of Edinburgh, Edinburgh, United Kingdom, E-mail: charalampos.attipa@ed.ac.uk. Jerlyn Sponseller and Saul Tzipori, Department of Infectious Disease and Global Health, Tufts University Cummings School of Veterinary Medicine, North Graton, MA, E-mails: jerlyn.sponseller@tufts.edu and saul.tzipori@tufts.edu. David Mukunya, Busitema University, Busitema, Uganda, E-mail: zebdaevid@gmail.com. James K. Tumwine, Department of Paediatrics and Child Health, School of Medicine, Kabale University, Kabale, Uganda, E-mail: kabaleimc@gmail.com. Jeffrey K. Griffiths, Tufts University, Boston, MA, E-mail: jeffrey.griffiths@tufts.edu.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 317 | 317 | 0 |
| Full Text Views | 281 | 281 | 170 |
| PDF Downloads | 127 | 127 | 56 |