{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T15:03:32Z","timestamp":1788102212948,"version":"build-2803163510"},"reference-count":24,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,4,4]]},"abstract":"<jats:p>Respiratory cryptosporidiosis is thought to be a rare, end-stage complication of HIV. Few studies have systematically examined the frequency of such infection in adults. Sputum specimens submitted for tuberculosis (TB) testing at Mulago Hospital, Uganda, were anonymously retested for <jats:italic>Cryptosporidium<\/jats:italic> using real-time polymerase chain reaction (PCR). Visual confirmation using immunofluorescence confocal microscopy was performed for a subset of PCR-positive samples. Of 824 sputum samples tested, 24 (2.9%) were <jats:italic>Cryptosporidium<\/jats:italic> positive. Prevalence in sputum ranged between 0% and 10% in each month of the study and exceeded TB prevalence in some months. In this referral population, respiratory <jats:italic>Cryptosporidium<\/jats:italic> prevalence was lower in people with HIV (1.3% versus 4.4% without HIV, <jats:italic>P<\/jats:italic> = 0.028) and higher in those with TB (6.8% versus 2.6% without TB, <jats:italic>P<\/jats:italic> = 0.086). The weak association between respiratory <jats:italic>Cryptosporidium<\/jats:italic> infection and TB persisted after controlling for HIV (odds ratio = 3.2, 95% confidence interval: 0.9, 11.8; <jats:italic>P<\/jats:italic> = 0.080). This is the first study to document adult respiratory tract cryptosporidiosis in a referral population with presumed TB. These findings 1) confirm that <jats:italic>Cryptosporidium<\/jats:italic> respiratory infection occurs in HIV-negative and -positive adults; 2) suggest there is potential for <jats:italic>Cryptosporidium<\/jats:italic> to be disseminated or transmitted by coughing or expectoration; and 3) identify possible synergy between <jats:italic>Cryptosporidium<\/jats:italic> and TB in the respiratory tract.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0741","type":"journal-article","created":{"date-parts":[[2018,2,6]],"date-time":"2018-02-06T07:00:37Z","timestamp":1517900437000},"page":"1086-1090","source":"Crossref","is-referenced-by-count":19,"title":["Expectoration of Cryptosporidium Parasites in Sputum of Human Immunodeficiency Virus\u2013Positive and \u2013Negative Adults"],"prefix":"10.4269","volume":"98","author":[{"given":"Siobhan M.","family":"Mor","sequence":"first","affiliation":[{"name":"University of Sydney School of Veterinary Science, Sydney, Australia;"},{"name":"Tufts University School of Medicine, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke R.","family":"Ascolillo","sequence":"additional","affiliation":[{"name":"Tufts University School of Medicine, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritah","family":"Nakato","sequence":"additional","affiliation":[{"name":"Makerere University College of Health Sciences, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Ndeezi","sequence":"additional","affiliation":[{"name":"Makerere University College of Health Sciences, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K.","family":"Tumwine","sequence":"additional","affiliation":[{"name":"Makerere University College of Health Sciences, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alphonse","family":"Okwera","sequence":"additional","affiliation":[{"name":"Makerere University College of Health Sciences, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerlyn K.","family":"Sponseller","sequence":"additional","affiliation":[{"name":"Tufts University Cummings School of Veterinary Medicine, Grafton, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saul","family":"Tzipori","sequence":"additional","affiliation":[{"name":"Tufts University Cummings School of Veterinary Medicine, Grafton, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey K.","family":"Griffiths","sequence":"additional","affiliation":[{"name":"Tufts University School of Medicine, Boston, Massachusetts;"},{"name":"Tufts University Cummings School of Veterinary Medicine, Grafton, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet","first-page":"209","article-title":"Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study","volume":"382","author":"Kotloff","year":"2013"},{"key":"b2","series-title":"PLoS Negl Trop Dis","first-page":"e0004729","article-title":"The burden of Cryptosporidium diarrheal disease among children < 24 months of age in moderate\/high mortality regions of sub-Saharan Africa and south Asia, utilizing data from the Global Enteric Multicenter Study (GEMS)","volume":"10","author":"Sow","year":"2016"},{"key":"b3","series-title":"Am J Trop Med Hyg","first-page":"710","article-title":"Cryptosporidium parvum in children with diarrhea in Mulago Hospital, Kampala, Uganda","volume":"68","author":"Tumwine","year":"2003"},{"key":"b4","series-title":"Am J Clin Nutr","first-page":"149","article-title":"Cryptosporidium infection in infancy as a cause of malnutrition: a community study from Guinea-Bissau, West Africa","volume":"65","author":"Molbak","year":"1997"},{"key":"b5","series-title":"BMJ","first-page":"417","article-title":"Cryptosporidiosis in infancy and childhood mortality in Guinea Bissau, West Africa","volume":"307","author":"Molbak","year":"1993"},{"key":"b6","series-title":"BMC Infect Dis","first-page":"195","article-title":"High dose prolonged treatment with nitazoxanide is not effective for cryptosporidiosis in HIV positive Zambian children: a randomised controlled trial","volume":"9","author":"Amadi","year":"2009"},{"key":"b7","series-title":"Lancet","first-page":"1375","article-title":"Effect of nitazoxanide on morbidity and mortality in Zambian children with cryptosporidiosis: a randomised controlled trial","volume":"360","author":"Amadi","year":"2002"},{"key":"b8","series-title":"Br J Clin Pharmacol","first-page":"387","article-title":"Treatment of cryptosporidiosis in immunocompromised individuals: systematic review and meta-analysis","volume":"63","author":"Abubakar","year":"2007"},{"key":"b9","series-title":"J Infect Dis","first-page":"103","article-title":"Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of Nitazoxanide","volume":"184","author":"Rossignol","year":"2001"},{"key":"b10","series-title":"Clin Microbiol Rev","first-page":"575","article-title":"The evolution of respiratory cryptosporidiosis: evidence for transmission by inhalation","volume":"27","author":"Sponseller","year":"2014"},{"key":"b11","series-title":"JAMA","first-page":"89","article-title":"Pulmonary cryptosporidiosis in acquired immune deficiency syndrome","volume":"252","author":"Brady","year":"1984"},{"key":"b12","series-title":"J Clin Microbiol","first-page":"227","article-title":"Microbiological findings about pulmonary cryptosporidiosis in two AIDS patients","volume":"34","author":"Dupont","year":"1996"},{"key":"b13","series-title":"Lancet","first-page":"590","article-title":"Respiratory cryptosporidiosis in HIV-positive patients","volume":"1","author":"Hojlyng","year":"1988"},{"key":"b14","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"677","article-title":"Intestinal and extraintestinal cryptosporidiosis in AIDS patients","volume":"14","author":"Lopez-Velez","year":"1995"},{"key":"b15","series-title":"JAMA","first-page":"1298","article-title":"Respiratory cryptosporidiosis in the acquired immune deficiency syndrome. Use of modified cold Kinyoun and Hemacolor stains for rapid diagnoses","volume":"252","author":"Ma","year":"1984"},{"key":"b16","series-title":"Am J Med Sci","first-page":"60","article-title":"Case report: inhalation therapy of paromomycin is effective for respiratory infection and hypoxia by Cryptosporidium with AIDS","volume":"309","author":"Mohri","year":"1995"},{"key":"b17","series-title":"Ann Intern Med","first-page":"793","article-title":"Intestinal and bronchial cryptosporidiosis in an immunodeficient homosexual man","volume":"99","author":"Forgacs","year":"1983"},{"key":"b18","series-title":"J Am Osteopath Assoc","first-page":"195","article-title":"Bronchial and gastrointestinal cryptosporidiosis in AIDS","volume":"89","author":"Goodstein","year":"1989"},{"key":"b19","series-title":"Clin Infect Dis","first-page":"1366","article-title":"Respiratory cryptosporidiosis in HIV-seronegative children in Uganda: potential for respiratory transmission","volume":"50","author":"Mor","year":"2010"},{"key":"b20","series-title":"Int J Mol Cell Med","first-page":"153","article-title":"Molecular analysis of 18S rRNA gene of Cryptosporidium parasites from patients living in Iran, Malawi, Nigeria and Vietnam","volume":"1","author":"Ghaffari","year":"2012"},{"key":"b21","series-title":"J Clin Microbiol","first-page":"918","article-title":"Detection and differentiation of Cryptosporidium spp. in human clinical samples by use of real-time PCR","volume":"49","author":"Hadfield","year":"2011"},{"key":"b22","series-title":"Am J Trop Med Hyg","first-page":"851","article-title":"Cryptosporidium hominis: experimental challenge of healthy adults","volume":"75","author":"Chappell","year":"2006"},{"key":"b23","series-title":"Am J Trop Med Hyg","first-page":"921","article-title":"Cryptosporidiosis and microsporidiosis in Ugandan children with persistent diarrhea with and without concurrent infection with the human immunodeficiency virus","volume":"73","author":"Tumwine","year":"2005"},{"key":"b24","series-title":"Clin Infect Dis","first-page":"915","article-title":"Cryptosporidiosis in children in sub-Saharan Africa: a lingering challenge","volume":"47","author":"Mor","year":"2008"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/98\/4\/article-p1086.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/98\/4\/article-p1086.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/98\/4\/article-p1086.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T15:19:22Z","timestamp":1722439162000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/98\/4\/article-p1086.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,4]]},"references-count":24,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.17-0741","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4,4]]}}}