Abstract
Cryptosporidium spp. and Cyclospora cayetanensis have emerged as important causes of epidemic and endemic diarrhea in immunocompetent and immunocompromised hosts. The exact modes of transmission in certain rural areas are still unclear. Reports of water-borne and food-borne outbreaks suggest that fecally contaminated water or food acts as a vehicle of transmission. Two hundred stool samples of patients with gastroenteritis from four health centers in a rural area of Jordan were examined using formalin-ethyl acetate concentration, wet preparation, and modified acid-fast staining methods. Oocysts of C. cayetanensis and Cryptosporidium spp. were found in 6% and 8% of the samples respectively, mainly those of children. Parasites such as Entamoeba histolytica, Giardia lamblia, and other enteropathogens were also observed. The results reflect the seasonality of natural cyclosporiasis and cryptosporidiosis, being higher in the spring. The risk factors that were found by the Fisher test to be significant and might be associated with illness are the source of drinking water, contact with animals, and eating unwashed vegetables (p<0.028, p<0.0005, p<0.00005 respectively).
Similar content being viewed by others
References
Ashford RW (1979) Occurrence of an undescribed coccidian in man in Papua New Guinea. Ann Trop Med Parasit 73:497–500
Centers for Disease Control and Prevention (1991) Outbreaks of diarrheal illness associated with cyanobacteria (blue-green algae)-like bodies in Chicago and Nepal, 1989 and 1990. Morb Mortal Wkly Rep 40:325–327
Centers for Disease Control and Prevention (1998) Outbreak of cyclosporiasis in Ontario, Canada, May 1998. Morb Mortal Wkly Rep 47:806–809
Clark DP (1999) New insights into human cryptosporidiosis. Clin Microbiol Rev 12:554–563
Eberhard ML, Nace EK, Freeman AR (1999) Survey for Cyclospora cayetanensis in domestic animals in an endemic area in Haiti. J Parasitol 85:562–563
Ebrahimzadeh A, Rogers L (1995) Diarrhea caused by a cyanobacterium-like organism. Eur J Epidemiol 11:661–664
Fayer R, Morgan U, Upton SJ (2000) Epidemiology of Cryptosporidium: transmission, detection, and identification. Int J Parasitol 30:1305–1322
Garcia-Lopez HL, Rodriguez-Tovar LE, Medina-De la Garza CE (1996) Identification of Cyclospora in poultry. Emerg Infect Dis 2:356–357
Herwaldt BL, Ackers ML, The Cyclospora Working Group (1997) An outbreak in 1996 of cyclosporiasis associated with imported raspberries. New Engl J Med 336:1548–1556
Herwaldt BL (2000) Cyclospora cayetanensis: A review, focusing on the outbreaks of cyclosporiasis in the 1990s. Clin Infect Dis 31:1040–1057
Hoge CW, Shlim DR, Rajah R, et al. (1993) Epidemiology of diarrhoeal illness associated with coccidian-like organism among travellers and foreign residents in Nepal. Lancet 341:1175–1179
Hoge CW, Shlim DR, Ghimire M, Rabold JG, Pandey P, Walch A, Rajah R, Gaudio P, Echeverria P (1995) Placebo-controlled trial of co-trimoxazole for Cyclospora infections among travelers and foreign residents in Nepal. Lancet 345:691–693
Koumans EH, Katz D, Malecki J, Wahlquist S, Kumar S, Hightower A, et al. (1996) Novel parasite and mode of transmission: Cyclospora infection—Florida. Annual Epidemic Intelligence Service Conference 45:60
Lima AA (2001) Tropical diarrhoea: new developments in traveler's diarrhoea. Curr Opin Infect Dis 14:547–552
Long EG, Ebrahimzadeh A, White EH, Swisher B, Callaway CS (1990) Alga associated with diarrhea in patients with acquired immunodeficiency syndrome and in travelers. J Clin Microbiol 28:1101–1104
Lopez FA, Manglicmot J, Schmidt TM, Yeh C, Smith HV, Relman DA (1999) Molecular characterization of Cyclospora-like organisms from baboons. J Infect Dis 179:670–676
MacKenzie WR, Schell WL, Blair KA, Addiss DG, Peterson DE, Hoxie NJ, Kazmierczak JJ, Davis JP (1995) Massive outbreak of waterborne Cryptosporidium infection in Milwaukee, Wisconsin: recurrence of illness and risk of secondary transmission. Clin Infect Dis 21:57–62
Madico G, McDonald J, Gilman RH, Cabrera L, Sterling CR (1997) Epidemiology and treatment of Cyclospora cayetanensis infection in Peruvian children. Clin Infect Dis 24:977–981
Neill MA, Rice SK, Ahmad NV, Flanigan TP (1996) Cryptosporidiosis an unrecognized cause of diarrhea in elderly hospitalized patients. Clin Infect Dis 22:168–170
Nimri LF (1993) Evidence of an epidemic of Blastocystis hominis infections in preschool children in northern Jordan. J Clin Microbiol 31:2706–2708
Nimri LF (1994) Prevalence of giardiasis among primary school children. Child Care Health Dev 20:231–237
Nimri LF, Hijazi S (1994) Cryptosporodium: A cause of gastroenteritis in preschool children in Jordan. J Clin Gastroenterol 19:288–291
Okhuysen PC, Chappell CL (2002) Cryptosporidium virulence determinants – are we there yet? Int J Parasitol 32:517–525
Orlandi PA, Lampel KA (2000) Extraction-free, filter-based template preparation for rapid and sensitive PCR detection of pathogenic parasitic protozoa. J Clin Microbiol 38:2271–2277
Ortega YR, Sterling CR, Gilman RH, Cama VA, Diaz F (1993) Cyclospora species – a new protozoan pathogen of humans. New Eng J Med 328:1308–1312
Ortega YR, Gilman RH, Sterling CR (1994) A new coccidian parasite (Apicomplexa: Eimeriidae) from humans. J Parasitol 80:625–629
Ortega YR, Roxas CR, Gilman RH, et al. (1997) Isolation of Cryptosporidium parvum and Cyclospora cayetanensis from vegetables collected in markets of an endemic region in Peru. Am J Trop Med Hyg 57:683–686
Rabold JG, Hoge CW, Shlim DR, Kefford C, Rajah R, Echeverria P (1994) Cyclospora outbreak associated with chlorinated drinking water [letter]. Lancet 344:1360–1361
Soave R (1996) Cyclospora: an overview. Clin Infect Dis 23:429–437
Walker-Smith JA ( 2001) Post-infective diarrhoea. Curr Opin Infect Dis 14:567–571
Acknowledgements
The author is grateful to the staff of the Safawi Center, and the physicians and staff in the Badia health centers for their cooperation during the study. This study was financially supported by the Jordan Badia Research and Development Program, The Higher Council of Science and Technology, grant # 129/99.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nimri, L.F. Cyclospora cayetanensis and other intestinal parasites associated with diarrhea in a rural area of Jordan. Int Microbiol 6, 131–135 (2003). https://doi.org/10.1007/s10123-003-0121-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10123-003-0121-4