Update of Human Infections Caused by Cryptosporidium spp. and Cystoisospora belli, Honduras

Background: Cryptosporidium spp., and Cystoisospora belli are two intestinal apicomplexa protozoa associated with diarrhea and malnutrition in individuals of different ages and immune competency.

Objectives: Update diagnosis of infection with either Apicomplexa species, twelve years cumulative results at the University Hospital, Honduras.

Methodology: Observational, non-interventional revision of stool examination results, in the diagnosis of intestinal apicomplexa oocysts as identified in fixed and stained smears by the modified carbolfuchsin method (MAF).

Results: Of 42,935 stool samples received during a 12 year period, 30.4% (13,041) were MAF stained and examined, of which 8,705 (20.3%) came from children 0 to 5 years old. For C. belli infections, 89 of a total of 109 (81.6%) cases were identified in patients 21 years old or older (p=0.001); 67.2% of the stools were diarrheic or liquid. In 19 individuals the excretion of C. belli oocytes persisted several months to a year despite treatment with trimetroprim sulfametoxazol. Age distribution of a total of 202 (1.5%) cryptosporidiasis cases showed two peaks: one in children 0 to 5 years old (56.4%) and the second in individuals 21 years old or older (35.1%) (p=0.001). The highest proportion of cryptosporidiasis cases was diagnosed in the age group 0 to 35 months old (91/114, 79.8%). No statistical differences were found in cryptosporidiasis and seasonality, stool consistency or sex. Strongyloides stercoralis larvae, Blastocystis spp., leukocytes and mucus were main additional findings. It appears that no other laboratory in the country diagnoses these parasite infections routinely.

Conclusion: It was evident that these apicomplexa parasites are important etiologic agents of diarrheal disease, both in children and in immunocompromised individuals. Cryptosporidiasis burden of disease was evident in children seeking hospital care. Responsible commitment to tackling interdisciplinary research in Honduras regarding these parasites in particular is required.