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Abstract

Background: Cryptosporidiosis is recognized worldwide as a significant cause of diarrheal diseases in both adults and children especially in children less than 2 years of age. There has been an increase in the incidence of cryptosporidiosis especially in the tropical and sub-tropical countries. Importance: Kuwait is home to more than 2 million migrant worker, the majority of which comes from the countries where Cryptosporidium infection is endemic. Furthermore, due to relative increased transmissibility of this infection it is important to determine the incidence of this infection in Kuwait especially in the children, the major high risk age-group. Thus the Cryptosporidium species were isolated from young children in Kuwait positive for Cryptosporidiosis and were further characterized at the molecular level to understand the transmission of infection. Detailed socio-demographic data of all included in the study were collected to determine the risk factors for the transmission. The study was approved by the Ethical Committee of Faculty of Medicine, Kuwait. Over a period of 2 years, fecal specimens from 200 Kuwaiti children with persistent diarrhea found to be positive for Cryptosporidium species. By microscopy they were genotyped and sub-typed with a small subunit rRNA-based PCR-restriction fragment length polymorphism analysis. An approved detailed socio-demographic data was obtained from all included in the study. Informed consent was taken from all individuals included in the study. The median age of infected children was 4.9 years and the majority of the infections (>70%) occurred during the cooler months January to April, indicating a marked seasonal variation. More than 85% of the children with cryptosporidiosis had only Cryptosporidium infection. Socio-demographic information did not reveal any particular mode of transmission of infection. Genotyping of the organisms isolated showed that ninety-two (95%) of the children had C. parvum, 4 (4%) had C. hominis, and 1 (1%) had both C. parvum and C. hominis. Altogether, 9 subtypes of C. parvum and C. hominis were observed. The analysis of the socio-demographic data revealed a close association of C. parvum 2a subtype, that showed increased symptoms, with decreased nutritional status (p<0.03), consumption of stored water rather than piped-water supply (p<0.05) and presence of an infected case in the family (p<0.05). Conclusion: Our study revealed a very different distribution of Cryptosporidium genotypes in Kuwaiti children as compared to other tropical countries. The study also showed a close association with the use of stored water and decreased nutritional status thus, highlighting the importance of testing the water supply. The genotypes and subtypes isolated are discussed with relation to the seasonality and possible mode of transmission of this infection in Kuwait.

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