Abstract:
Background: Cryptosporidium species infections cause severe diarrhea especially in children
and immuno-compromised people worldwide. However, laboratory detection and identification
of the Oocyst stage of these parasites seems overlooked with the routine saline wet mount stool
examination.
Objective: The objective of this study was to compare Modified Zeihl-Neelson (MZN), Auramine
Phenol (AP) and Immunofluorescent Antibody test (IFAT) for the detection of Cryptosporidium
species infections in under five years old children with diarrhea at Jimma University Medical
Center (JUMC).
Method: A cross-sectional study design was conducted from January 01, 2019 to March 30,
2019 enrolling a total of 221 children. Stool specimen was collected and examined by the direct
saline wet mount, formol-ether oocyst concentration, MZN, AP and IFAT staining with a smear
made both from direct and concentrated sediment. Comparison of diagnostic performances was
evaluated in calculating for sensitivity, specificity, NPV and PPV, agreement compared with
kappa values and level of significance at p-value of < 0.05 with the 95% confidence interval.
Result: The overall prevalence of intestinal parasites was 91(41.2%). Intestinal coccidian
parasites detected by MZN after formol-ether concentration was 34 (15.84%), of which
Cryptosporidium spp. accounts for 23 (10.4%), C. cayatenensis 8 (3.6%), and C. belli 3 (1.4%).
Whereas, 47(21.26%) was detected in AP staining after formal-ether Oocyst concentration
technique. Of this, Cryptosporidium spp. accounts 39 (17.64%), C. cayatenensis 6 (2.7%), & C.
belli 2 (0.9%). Cryptosporidium species detected by IFAT was 54 (24.4%). Generally, the
sensitivity of MZN & AP against the Gold standard test was (42.6%) & (72.2%), respectively so
that AP revealed a better NPV (92.0%) as compared to the MZN (84.34%).
Conclusion and recommendation: the prevalence of Cryptosporidium species are still
underestimated due to the low sensitivity of diagnostic methods used. Therefore, it is preferable
to use the accessible, rapid, sensitive and specific method. According to findings in here, it is
recommended to use Auramine phenol staining technique for the detection of intestinal
Cryptosporidiosis in routine diagnostic in health facilities.
