A retrospective study of cryptosporidial diarrhea in a region with high HIV prevalence
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Published on: June 11, 2011
Etienne D Nel1, Helena Rabie, Jeremy Goodway
1Department of Pediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, 7505, South Africa. edn@sun.ac.za
Insights
Cryptosporidial diarrhea significantly impacts children under 18 in South Africa, particularly during dry months. Outcomes are worse for HIV-infected children, highlighting a critical public health concern.
Area of Science:
- Pediatric infectious diseases
- Public health epidemiology
- Immunocompromised host research
Background:
- Cryptosporidium is a significant enteric pathogen causing diarrhea in children globally.
- Understanding its epidemiology and clinical impact in specific regions is crucial for targeted interventions.
- The Western Cape, South Africa, faces a considerable burden of childhood diarrheal diseases.
Purpose of the Study:
- To describe the clinical characteristics and outcomes of cryptosporidial diarrhea in children (<18 years) at a South African referral center.
- To investigate the association between HIV infection and the severity and outcome of cryptosporidial diarrhea.
- To identify seasonal patterns in cryptosporidial diarrhea presentation.
Main Methods:
- Retrospective analysis of 63 pediatric patients diagnosed with cryptosporidial diarrhea.
- Data collected from Tygerberg Children's' Hospital, Western Cape, South Africa (June 2004 - May 2005).
- Comparison of outcomes (hospitalization duration, mortality) between HIV-infected and HIV-uninfected children.
Main Results:
- Most patients (62%) were male, with a mean age of 18.7 months.
- 13 (20.6%) patients were HIV-infected; 57% presented during hot, dry months (December-March).
- HIV-infected children had longer hospitalizations (median 18 days vs. 8.5 days) and higher mortality (30.7% vs. 15.4%, p=0.049).
Conclusions:
- Cryptosporidium is a notable cause of diarrhea in young children in the Western Cape.
- Diarrhea incidence peaks during the dry season.
- HIV-infected children experience more severe disease and poorer outcomes, underscoring the need for integrated care.
Abstract:
This retrospective study describes 63 patients <18 years of age presenting with cryptosporidial diarrhea to Tygerberg Children's' Hospital, a referral centre in the Western Cape, South Africa, from June 2004 through May 2005. Their mean age was 18.7 months (SD 17 months). Of the patients, 39 (62%) were male and 13 (20.6%) were HIV infected. Most children (57%) presented during the hot dry months of the year (December to March) and the majority (75%) of them required hospitalization. HIV-infected children were hospitalized for longer duration (median 18 days) than HIV-uninfected children (median 8.5 days). Four HIV-infected children (30.7%) died vs. four who were either HIV uninfected or of unknown status (p = 0.049). Seven of the children who died were malnourished. The CD4 count of HIV-infected children who died was 416 × 10⁹) l⁻¹ compared with 1269 × 10⁹ l⁻¹ (p = 0.1) for uninfected children. Cryptosporidium is an important cause of diarrhea among younger children in the Western Cape, which occurs more frequently during the dry months of the year and has a worse outcome in HIV-infected children.
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