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Asymptomatic carriage of intestinal Cryptosporidium in immunocompetent and immunodeficient children: a prospective
M Pettoello-Mantovani1, L Di Martino, G Dettori
1Department of Pediatrics, Albert Einstein College of Medicine, New York, NY 10461, USA.
Insights
Asymptomatic cryptosporidiosis is common in immunocompromised children. Early treatment with spiramycin reduced oocyst shedding and prevented gastrointestinal symptoms in children carrying Cryptosporidium.
Area of Science:
- Pediatric Infectious Diseases
- Parasitology
- Public Health
Background:
- Limited data exists on asymptomatic Cryptosporidium carriage in children.
- Cryptosporidiosis can affect both immunocompetent and immunodeficient pediatric populations.
Purpose of the Study:
- To determine the incidence of asymptomatic Cryptosporidium carriage in children.
- To evaluate the impact of spiramycin treatment on oocyst shedding and symptom development.
- To investigate co-infections with other enteric pathogens like Giardia lamblia.
Main Methods:
- Prospective study of 78 immunocompetent and 50 immunodeficient asymptomatic children.
- Stool sample analysis for Cryptosporidium and Giardia lamblia detection.
- Intervention group received spiramycin treatment (100 mg/kg/day for 14 days).
Main Results:
- Asymptomatic Cryptosporidium carriage was found in 6.4% of immunocompetent and 22% of immunodeficient children.
- Spiramycin treatment significantly reduced the duration of infectious oocyst shedding.
- Treated children did not develop gastrointestinal symptoms, unlike untreated controls.
Conclusions:
- Asymptomatic cryptosporidiosis is prevalent in children, particularly those who are immunodeficient.
- Spiramycin treatment is effective in reducing oocyst shedding and preventing clinical symptoms.
- Further research is needed on the long-term implications of asymptomatic carriage.
Abstract:
Little information is available on asymptomatic carriage of Cryptosporidium in immunocompetent and immunodeficient children. We prospectively studied a group of asymptomatic children, 78 immunocompetent and 50 immunodeficient, to document the incidence of asymptomatic carriage of cryptosporidiosis in such a population. We also investigated whether the treatment of children who carried asymptomatic cryptosporidiosis could help in reducing their risk of gastrointestinal symptoms as well as the shedding of infectious oocysts. The occurrence of multiple infections with common intestinal pathogens including Giardia lamblia was also investigated. Asymptomatic cryptosporidiosis was documented in 6.4% of immunocompetent and 22% of immunodeficient children. In a control symptomatic population Cryptosporidium was found in 4.4% of immunocompetent and 4.8% of immunodeficient children. Asymptomatic carriage of Cryptosporidium was documented in 2 human immunodeficiency virus-infected children, one of whom also carried Giardia asymptomatically. Treatment with spiramycin (100 mg/kg daily for 14 days) reduced significantly the duration of the shedding of potentially infectious oocysts. Finally no gastrointestinal symptoms developed in children treated for asymptomatic infection with Cryptosporidium, whereas children who were not treated developed gastrointestinal symptoms.