Toriro, Romeo, Pallett, Scott, Woolley, Stephen 
ORCID: 0000-0002-9385-8975, Bennett, Charlie, Hale, Isra, Heylings, Jennifer, Wilkins, Daniel, Connelly, Thomas, Muia, Kennedy, Avery, Patrick et al (show 12 more authors)
(2024)
Outbreak of Diarrhea Caused by a Novel <i>Cryptosporidium hominis</i> Subtype During British Military Training in Kenya.
Open forum infectious diseases, 11 (1).
ofae001-ofae001.
Abstract
<h4>Background</h4>We report clinical, epidemiological, and laboratory features of a large diarrhea outbreak caused by a novel <i>Cryptosporidium hominis</i> subtype during British military training in Kenya between February and April 2022.<h4>Methods</h4>Data were collated from diarrhea cases, and fecal samples were analyzed on site using the multiplex polymerase chain reaction (PCR) BioFire FilmArray. Water was tested using Colilert kits (IDEXX, UK). DNA was extracted from feces for molecular characterization of <i>Cryptosporidium A135</i>, <i>Lib13</i>, <i>ssu rRNA</i>, and <i>gp60</i> genes.<h4>Results</h4>One hundred seventy-two of 1200 (14.3%) personnel at risk developed diarrhea over 69 days. One hundred six primary fecal samples were tested, and 63/106 (59.4%; 95% CI, 0.49%-0.69%) were positive for <i>Cryptosporidium</i> spp. Thirty-eight had <i>Cryptosporidium</i> spp. alone, and 25 had <i>Cryptosporidium</i> spp. with ≥1 other pathogen. A further 27/106 (25.5%; 95% CI, 0.18%-0.35%) had non-<i>Cryptosporidium</i> pathogens only, and 16/106 (15.1%; 95% CI, 0.09%-0.23%) were negative. <i>C. hominis</i> was detected in 58/63 (92.1%) <i>Cryptosporidium</i> spp.-positive primary samples, but the others were not genotypable. Twenty-seven <i>C. hominis</i> specimens were subtypable; 1 was <i>gp60</i> subtype IeA11G3T3, and 26 were an unusual subtype, ImA13G1 (GenBank accession OP699729), supporting epidemiological evidence suggesting a point source outbreak from contaminated swimming water. Diarrhea persisted for a mean (SD) of 7.6 (4.6) days in <i>Cryptosporidium</i> spp. cases compared with 2.3 (0.9) days in non-<i>Cryptosporidium</i> cases (<i>P</i> = .001).<h4>Conclusions</h4>Real-time multiplex PCR fecal testing was vital in managing this large cryptosporidiosis outbreak. The etiology of a rare <i>C. hominis gp60</i> subtype emphasizes the need for more genotypic surveillance to identify widening host and geographic ranges of novel <i>C. hominis</i> subtypes.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Cryptosporidium, DNA extraction and speciation, diarrhea, military population, outbreak |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 06 Feb 2024 09:39 |
| Last Modified: | 06 Feb 2024 09:39 |
| DOI: | 10.1093/ofid/ofae001 |
| Open Access URL: | https://doi.org/10.1093/ofid/ofae001 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3178426 |
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