CRYPTOSPORIDIUM SPP. IN ROMANIA

Cryptosporidium was first discovered in the stomach glands of a mouse in 1907 by Tyzzer and was given the name Cryptosporidium muris in 1910. Tyzzer later identified another species, Cryptosporidium parvum, which varies from the first in that it infects the small intestine rather than the stomach and has smaller oocysts. Since then, approximately 20 species have been identified, with C. hominis and C. parvum appearing most commonly. In our country, the first incidence was discovered by Dan et al. in calves and Olteanu (1983) in humans, cattle, goats, sheep, pigs, deer, rabbits, mice, and rats. Darabus et al. reported the prevalence in several species of animals, genotypes, and subtypes.

The review aimed to sort the epidemiological data about Cryptosporidium spp. Studies were carried out in Romania with an emphasis on epidemiology, genetic diversity, and distribution. There is limited information about the prevalence of Cryptosporidium in Romania in the international literature because many of these studies are published in national journals. In our country, Cryptosporidium is not regularly examined in clinical laboratories. Most cases were identified through microscopic examination and/or modified Ziehl-Neelsen staining; alternative approaches included enzyme-linked immunosorbent tests, qualitative immunochromatography, and immunofluorescence assays.

The first case of Cryptosporidium was first diagnosed in 1983, which showed a prevalence of 9.1% in healthy children and 12.3% in children with diarrhea. Children hospitalized at the Dystrophic Center and Colentina Hospital in Bucharest had a Cryptosporidium IgA or IgG rate of 72-73%. Still, no cases of infection were found in patients hospitalized at the Emergency Clinical County Hospital in Cluj-Napoca. Hospitalized patients from Timiş and Arad counties had the highest occurrence rate, approximately 16.66%. IgA antibodies against Cryptosporidium were associated with HIV seropositivity and the degree of malnutrition, but IgG antibodies were solely associated with severe malnutrition, according to Brannan et al. (1996). Darabus et al. reviewed various research conducted on children with immunodeficiency, including those afflicted by HIV, and concluded that there is an increased variability of infection rates.

Various experiments were conducted on animals (cattle, buffalo, sheep, goats, pigs, dogs, cats, birds), employing Henriksen-modified ZiehlNeelsen staining procedures, Giemsa, toluidine blue stains, HEA, PAS, direct microscopy, PGR, electron microscopy and the enzyme-linked immunosorbent test. A study on 100 calves found a prevalence of 63% Cryptosporidium single infection or associated with other enteropathogens. In the case of sheep, out of 383 examined, they found a 63.7% positive rate.

There are more than 120 genotypes and 44 species of Cryptosporidium in the world, most identified by molecular studies. Eight species (Cryptosporidium parvum, C. andersoni, C. bovis, C. ryanae, C. felis, C. hominis, C. meleagridis, and C. suis) and three genotypes (Cryptosporidium deer-like genotype, C. suis-like genotype, and Cryptosporidium pig genotype) have been found in Europe in 2011. In Romania, the species identified from calves (in a 2007 study) were C. parvum and C. andersoni.

Overall, Darabus et al. reveal that cryptosporidiosis is a significant public health issue in our country. However, acute infection and longterm consequences remain unknown at this time. The evaluation recommends tighter monitoring systems and increased medical personnel education to improve early detection and source identification, particularly among vulnerable groups.

References

* Gheorghe D, Maria Alina L, Narcisa M, Rodica GD, Kalman I, Ovidiu M, et al. Epidemiology of Cryptosporidium Infection in Romania: A Review. Microorganisms 2023,11(7):1793.