Prevalence and identification of cryptosporidium species in post-renal transplant patients in Sri Lanka

Abstract

Cryptosporidiosis, caused by Cryptosporidium spp., is one of the major causes of diarrhoeal disease worldwide. It causes self-limiting disease in immunocompetent patients and life-threatening disease in the majority of immunosuppressed patients. However, there is limited data available regarding cryptosporidiosis, specifically in post-renal transplant patients (PRT) in Sri Lanka. Hence, this study aimed to determine the prevalence of Cryptosporidium species and identify associated risk factors in this patient population. The study was carried out on PRT patients attending nephrology clinics at teaching hospitals Kandy and Peradeniya between January 2020 and December 2022. An information sheet was used to collect demographic and risk factors. Faecal samples w ere collected and transported to the laboratory. Samples were concentrated using modified formalin ethyl acetate and stained with the Modified Ziehl-Neelsen (MZN) stain. All the Cryptosporidium oocyst-positive samples were subjected to PCR using Cryptosporidium genus specific primers. A chi-square comparison test was utilized to assess correlation. Of 430 consented patients, 209 faecal samples were collected. Among them, the majority were males (163, 52.6%) and aged between 1 and 70 years (mean age 42). Of the 209 stool samples tested, 11 (5.3%) were positive for Cryptosporidium oocysts on MZN staining and PCR. A significantly high Cryptosporidium positivity was in patients aged 36–50 years (P=0.02). Out of 209, 28 had diarrhoea and all the Cryptosporidium positives had diarrhoea. Cryptosporidium infections were significantly associated with occasionally drinking boiled water (P=0.001) and washing hands after going to toilets (P=0.05). Sources of drinking water, animal contact, and washing hands before meals were not significantly associated with Cryptosporidium infection. In conclusion, present study identified Cryptosporidium as one of the etiological agents causing diarrhoea. It is important to practice good personal hygiene and consume boiled water to prevent transmission. Furthermore, this study recommends routine screening for Cryptosporidium oocysts in all PRT patients.