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Original Article

Detection of Cryptosporidium spp. in Diarrheic Immunocompetent Patients in Beni-Suef, Egypt: Insight into Epidemiology and Diagnosis

Samah S. Abdel Gawad1, Mousa A. M. Ismail2, Naglaa F. A. Imam2, Ahmed H. A. Eassa2,*, Enas Yahia abu-Sarea1
The Korean Journal of Parasitology 2018;56(2):113-119.
Published online: April 30, 2018

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*Corresponding author (ahmegy@hotmail.com)
• Received: October 6, 2017   • Revised: April 17, 2018   • Accepted: April 17, 2018

Copyright © 2018 by The Korean Society for Parasitology and Tropical Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Detection of Cryptosporidium spp. in Diarrheic Immunocompetent Patients in Beni-Suef, Egypt: Insight into Epidemiology and Diagnosis
Korean J Parasitol. 2018;56(2):113-119.   Published online April 30, 2018
DOI: https://doi.org/10.3347/kjp.2018.56.2.113
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Detection of Cryptosporidium spp. in Diarrheic Immunocompetent Patients in Beni-Suef, Egypt: Insight into Epidemiology and Diagnosis
Korean J Parasitol. 2018;56(2):113-119.   Published online April 30, 2018
DOI: https://doi.org/10.3347/kjp.2018.56.2.113
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Detection of Cryptosporidium spp. in Diarrheic Immunocompetent Patients in Beni-Suef, Egypt: Insight into Epidemiology and Diagnosis
Image Image Image Image
Fig. 1 Graphic representation of age distribution of study population.
Fig. 2 Agarose gel electrophoresis and nPCR results.
Fig. 3 Cryptosporidium oocysts (MZN stain ×1,000).
Fig. 4 ROC analysis of sensitivity and specificity of ELISA and microscopy with MZN stain.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Detection of Cryptosporidium spp. in Diarrheic Immunocompetent Patients in Beni-Suef, Egypt: Insight into Epidemiology and Diagnosis

Descriptive statistics of patients’ demographics and history data

Variable No. (%)
Gender Male 120 (60.0)
Female 80 (40.0)
Residence Urban 81 (40.5)
Rural 119 (59.5)
Animals at home Yes 145 (72.5)
No 55 (27.5)
Source of water Tap water 172 (86.0)
Filtered 28 (14.0)
Clinical manifestations Abdominal pain 130 (65.0)
Abdominal pain and vomiting 32 (16.0)
Abdominal pain and flatulence 10 (5.0)
Vomiting and fever 16 (8.0)
Flatulence 1 (0.5)
Abdominal pain, flatulence and fever 1 (0.5)
Abdominal pain and tenesmus 10 (5.0)

Cryptosporidium positive samples by PCR, ELISA, and microscopy using MZN stain

Test used Status No. (%)
PCR Positive 42 (21.0)
Negative 158 (79.0)
ELISA Positive 25 (12.5)
Negative 175 (87.5)
Microscopy using MZN Positive 19 (9.5)
Negative 181 (90.5)

Comparison between PCR, ELISA, and microscopy results using MZN stain

Tests used PCR P-value Cohen’s Kappa value Sensitivity (%) Specificity (%) PPV (%) NPV (%)
Negative no. (%) Positive no. (%)
ELISA Negative 157 (89.7) 18 (10.3) <0.0001a 0.664 57.1 99.4 96.0 89.7
Positive 1 (4.0) 24 (96.0)
Microscopy (MZN) Negative 158 (87.3) 23 (12.7) <0.0001b 0.566 45.2 100.0 100.0 87.3
Positive 0 (0.0) 19 (100)

aP-value calculated using chi-square test.

bP-value calculated using Fischer’s exact test.

Patient positivity by age groups vs PCR, ELISA, and microscopy using MZN stain

Stratified age groups (year) ELISA positive no. (%) PCR positive no. (%) Microscopic examination positive no. (%) MZN stain positive no. (%)
1–10 1 (9.1) 1 (9.1) 2 (18.2) 0 (0.0)
11–20 3 (11.1) 6 (22.2) 8 (29.6) 3 (11.1)
21–30 5 (12.2) 6 (14.6) 9 (22.0) 2 (4.9)
31–40 7 (19.4) 14 (38.9) 11 (30.6) 9 (25.0)
41–50 2 (5.7) 4 (11.4) 11 (31.4) 1 (2.9)
51–60 6 (20.7) 8 (27.6) 7 (24.1) 3 (10.3)
>60 1 (4.8) 3 (14.3) 6 (28.6) 1 (4.8)
Total 25 (12.5) 42 (21.0) 54 (27.0) 19 (9.5)
P-value 0.38a 0.05b 0.9b 0.03a

aP-value calculated using likelihood ratio.

bP-value calculated using chi square test.

Association between patients’ data and positivity by PCR results

No. positive (%) No. negative (%) P-value
Gender Male 93 (77.5) 27 (22.5) 0.6a
Female 65 (81.3) 15 (18.8)
Residence Urban 63 (77.8) 18 (22.2) 0.7a
Rural 95 (79.8) 24 (20.2)
Source of water Tap water 133 (77.3) 39 (22.7) 0.1a
Filtered water 25 (89.3) 3 (10.7)
Animals at home Yes 43 (78.2) 12 (21.8) 0.86a
No 115 (79.3) 30 (20.7)
Associated symptoms Abdominal pain and vomiting 25 (78.1) 7 (21.9) 0.81b
Abdominal pain 107 (82.3) 23 (17.7)
Flatulence 1 (100.0) 0 (0.0)
Vomiting and fever 14 (87.5) 2 (12.5)
Abdominal pain and flatulence 5 (50.0) 5 (50.0)
Abdominal pain, vomiting and fever 0 (0.0) 1 (100.0)
Abdominal pain and tenesmus 6 (60.0) 4 (40.0)

aP-value calculated using chi-square test.

bP-value calculated using likelihood ratio.

Other parasites detected in stool samples by direct microscopy (n=200)

Parasite No. positive (%)
Giardia lamblia 28 (14.0)
Entamoeba histolytica 12 (6.0)
Entamoeba coli 7 (3.5)
Capillaria philippinensis 5 (2.5)
Hymenolepis nana 2 (1.0)
Blastocystis hominis 1 (0.05)
Table 1 Descriptive statistics of patients’ demographics and history data
Table 2 Cryptosporidium positive samples by PCR, ELISA, and microscopy using MZN stain
Table 3 Comparison between PCR, ELISA, and microscopy results using MZN stain

P-value calculated using chi-square test.

P-value calculated using Fischer’s exact test.

Table 4 Patient positivity by age groups vs PCR, ELISA, and microscopy using MZN stain

P-value calculated using likelihood ratio.

P-value calculated using chi square test.

Table 5 Association between patients’ data and positivity by PCR results

P-value calculated using chi-square test.

P-value calculated using likelihood ratio.

Table 6 Other parasites detected in stool samples by direct microscopy (n=200)

Table 1

Table 2

Table 3

Table 4

Table 5

Table 6

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