Cryptosporidium felis and C. meleagridis in Persons with HIV, Portugal

Cryptosporidium felis and C. meleagridis in Persons with HIV, Portugal To the Editor: Cryptosporidium, a pathogenic protozoan parasite with a worldwide distribution, causes diar-rheal illness in humans and animals. The parasite can be transmitted from human to human through fecal-oral contact (household contact and noso-comial transmission), sexual contact, ingestion of contaminated food or water, and contact with infected animals. Molecular diagnostic methods indicate that Cryptosporidium parvum and C. hominis are the major causes of cryptosporidiosis in humans, and other Cryptosporidium species can be associated with human infection (1–5). In Portugal, patients with AIDS have an 8% prevalence rate of cryp-tosporidiosis (6) with C. parvum and C. hominis as the etiologic agents, even though other Cryptosporidium species were found in these patients (3,7,8). This study characterizes clinical manifestations of infections with unusual two different Cryptosporidium species isolated from seven patients and demonstrates that these species can cause life-threatening disease. Cryptosporidiosis was diagnosed in 40 patients from 1994 through 2002. All patients were serologically positive for HIV-1 and had diarrhea (at least two loose stools per day) when diagnosed with cryptosporidio-sis. Demographic, clinical, and immunologic data were obtained from each patient's records. Crypto-sporidium oocysts were identified by light microscopy after concentration from fecal material by a modified water-ether sedimentation method followed by the modified Ziehl-Neelsen staining (7). The intensity of infection was quantified before molecular analysis by scoring the number of oocysts counted per microscopic field (under a 20x objective) of 50-µL volume of concentrated stool sample as + (1–5 oocysts), ++ (6–10 oocysts), +++ (11–15 oocysts), or ++++ (>15 oocysts). Genetic characterization of the isolates was based on polymerase chain reaction–restriction fragment length polymorphism analysis of the small subunit rRNA gene (2,3). The molecular analysis showed that 22 patients (55%) were infected with C. parvum, 11 (27.5%) were infected with C. hominis, 4 (10%) were infected with C. felis, and 3 (7.5%) were infected with C. melea-gridis. Of the four patients infected with C. felis, three (75%) showed low (+) and one (25%) showed moderate (++) oocyst loads. All three (100%) patients infected with C. meleagridis showed low oocyst loads (+). In contrast , of the 22 patients infected with C. parvum, 9 (41%) showed low oocyst loads (+), 3 (14%) showed moderate oocyst loads (++), 3 (14%) showed high oocyst loads (+++), and 7 (32%) showed very high (++++) oocyst loads. Similarly, of the 11 patients infected with C. hominis, …