人体隐孢子虫病流行病学调查

在江苏省城乡7个居民点进行人体感染隐孢子虫情况的调查,各点均查见隐孢子虫感染者,人群隐孢子虫感染率为0.7％-3.8％,平均为 1.6％(97/6 221);其中儿童的为 1.8％(89/5 089),成人的为0.7％(8/1 132)。在门诊病人中隐孢子虫检出率为3.3％(39/1 172),其中儿童的为 3.6％(38/1 056),成人的为0.9％(1/116),病例来自徐州市及毗邻的江苏、安徽两省的8县。136 例隐孢子虫感染者中,婴幼儿为 65.4％(89/136),是本病的多发人群组。腹泻为本病的主要临床表现,本组有 69.1％(94/136)出现腹泻,呈水样便或粘液稀便。本文对患儿隐孢子虫感染与免疫,本病的流行因素进行了初步探讨。     

对隐孢子虫引起腹泻的儿童进行免疫和营养状况的评估

隐孢子虫是一种微小的肠道寄生球虫,分布于全世界,感染率为0.6％—12.9％,过去曾报道许多免疫缺陷者和艾滋病病人患隐孢子虫性腹泻,但近年来发现,它不仅寄生于免疫缺陷的人群,而且在一些发展中国家,也可引起免疫功能正常儿童的腹泻,其重要性仅次于病毒。本文研究目的旨在检查急性腹泻(AD)或慢性腹泻(CD)儿童的隐孢子虫感染情况,并观察正常儿童(无免疫缺损表现)患隐孢子虫性腹泻,是否具有局部免疫缺损(SIgA减少)和营养不良状况。     

隐孢子虫病病原分类及虫种

1976年 Nime及 Meisel等[1 ,2 ] 首先报告人的隐孢子虫病。此后证实隐孢子虫可致急性肠道感染 ,临床特征是腹泻。免疫正常人群感染呈自限性 ,免疫缺损者特别易感 ,可引起严重的慢性腹泻 ,并可发生胃肠道外感染甚至可导致死亡。目前已经证明 ,隐孢子虫病是一人畜共患疾病 ,分布广泛 ,世界上已有六大州 74个国家 ,至少 30 0个地区发现隐孢子虫病流行。在发达国家和不发达国家的腹泻患者中 ,隐孢子虫感染率分别为 0 .6 %～2 0 %与 4 .0 %～ 2 0 % [3] ,是致儿童和免疫缺陷病人腹泻的重要的病原。估计全世界每年约有 5 0 0 0万 5岁以下儿童感染…     

安徽省学生隐孢子虫感染特征的研究

目的调查安徽省学生隐孢子虫感染情况、流行特点及主要临床表现,为在学生中防治隐孢子虫病的感染提供依据. 方法采集安徽省各地市不同教育层次学生粪便标本共4 048份,采用金胺-酚染色法和改良抗酸染色法检查隐孢子虫卵囊. 结果隐孢子虫感染率为1.33%(54/4048).幼儿、小学生、中学生和大学生隐孢子虫的感染率分别为3.15%(28/889)、0.82%(9/1098)、0.82%(9/1092)和0.83%(8/969),幼儿与其他学生相比均有显著性差异 (P<0.01).男生与女生隐孢子虫的感染率分别为1.49%(28/1880)和1.20%(26/2168),差异无显著性(P>0.05).城、乡学生隐孢子虫检出率分别为0.75%(13/1740)和1.78%(41/2308),差异有显著性(P<0.01).隐孢子虫感染以亚临床感染为主,主要临床表现为间断性轻度腹痛、轻度腹泻、稀便. 结论安徽省学生隐孢子虫感染以幼儿多见,农村较城市多见;隐孢子虫病缺乏特异的临床表现,亚临床感染是其主要表现形式,易误诊和漏诊.     

重庆市渝东片区人群隐孢子虫病流行病学调查

目的探讨重庆市渝东片区人群隐孢子虫病感染现状,为防治隐孢子虫病流行提供依据。方法 2011年对渝东片区采集的人粪便标本用改良抗酸染色法检查隐孢子虫卵。结果共采集1 238份标本,隐孢子虫卵检出率为3.39%;其中,屠宰场从业人员(16人)感染率为6.25%,医院就诊患者(1 062人)感染率为3.48%,散居人群(160人)感染率为2.50%。男性673例,隐孢子虫检出率3.42%,女性565例,检出率3.36%,男女性别差异无统计学意义(χ2=0.00,P>0.05);儿童388例,检出率4.12%,成人850例,检出率3.06%,儿童与成人差异无统计学意义(χ2=0.00,P>0.05)。结论重庆市渝东片区人群隐孢子虫感染率较高,且无性别及年龄差异。     

四川省奶牛犊牛隐孢子虫流行情况及其分子特性分析

目的了解四川部分地区断奶前奶牛犊隐孢子虫感染情况及其分子特征。方法 2016年6月至2017年3月在四川省10个地区的11个奶牛场(规模化养殖7个,散养4个)采集1月龄内断奶前牛犊的新鲜粪样。采用改良饱和蔗糖溶液漂浮法处理粪样,提取粪样DNA,巢式PCR扩增隐孢子虫小亚基核糖体核苷酸(SSU r RNA)基因,以扩增阳性数计算隐孢子虫感染率,分析不同养殖模式感染率差异。感染率间的比较采用卡方检验。SSU r RNA基因测序后提交GenBank中进行BLAST比对,鉴定扩增序列所属的虫种,采用MEGA 7邻接法构建基于SSU r RNA基因的系统发育树。对SSU r RNA序列比对确定为微小隐孢子虫的样品,扩增相对分子质量(Mr)为60 000的糖蛋白基因(gp60),鉴定基因亚型。结果共调查牛犊278头,采集粪样278份。SSU r RNA基因检测隐孢子虫阳性40份,总感染率为14.4%。11个养殖场中10个存在隐孢子虫感染,其中感染率最高为绵阳1场,为35.7%(10/28),其次为阿坝(35%, 7/20)和资阳(30.8%, 8/26),最低为眉山(0)。10个检测阳性的养殖场牛犊的感染率差异有统计学意义(P 0.05)。规模化和散养养殖场的牛犊感染率分别为17.4%(34/195)和7.2%(6/83)(P 0.05)。隐孢子虫感染阳性的共40头牛犊中,感染牛隐孢子虫、微小隐孢子虫、瑞氏隐孢子虫分别为28、 7、5头。40条隐孢子虫序列剔除相同的序列后共获得10条序列(ABC881、 AYC6953、 AYC6969、 CDC16111、CDC16117、 DYC014、 MYC116、 MYC117、 MYC126、 ZYC6874, GenBank登录号:MF671870至MF671879)。序列比对结果显示,AYC6953、 AYC6969、 CDC16117、 ZYC6874序列与牛隐孢子虫(JX515546)一致性均为99%; DYC014序列与瑞氏隐孢子虫(HQ179574)一致性为99%; MYC126与牛隐孢子虫(JX416366)一致性为99%; ABC881与微小隐孢子虫(AH006572), CDC16111与瑞氏隐孢子虫(HQ179574), MYC116与牛隐孢子虫(HQ179573), MYC117与牛隐孢子虫(MH166335)的一致性均为100%,在系统进化树上显示为同一分支。7份鉴定为微小隐孢子虫样品的gp60基因亚型分析结果均为ⅡdA15G1,与已报道的宁夏分离株(KM067092)一致性为100%结论四川省部分地区断奶前牛犊存在隐孢子虫感染,感染虫种为牛隐孢子虫、微小隐孢子虫、瑞氏隐孢子虫。     

隐孢子虫检测方法的研究进展

隐孢子虫(Cryptosporidium)是一种可引起人兽共患病的病原体,是导致人类和幼畜严重腹泻的重要致病原.隐孢子虫在自然环境中以卵囊的形式存在,主要通过污染的水(90%)和食物进行传播,在发达国家和发展中国家的腹泻病人中隐孢子虫感染率分别为0.6%～20%和4%～20%[1],我国腹泻病人的隐孢子虫感染率为0.32%～15.22%[2,3].免疫功能正常的人感染隐孢子虫,主要表现为无症状感染或自限性腹泻.婴幼儿、先天性或获得性免疫缺陷者感染隐孢子虫可引起严重的霍乱样水泻,导致脱水、营养不良,甚至危及生命.此外,在艾滋病患者中隐孢子虫感染率高达48%左右,长期的严重腹泻是艾滋病病人的重要致死因素之一.     

2015-2016年南京市隐孢子虫抽样调查报告

目的 对南京市人群感染隐孢子虫状况进行抽样调查,为隐孢子虫病防治提供科学依据。方法 选择南京市六合、栖霞、高淳等3个区的3个村,以及南京市中大医院门诊部为抽样调查点,于2015年和2016年每年每点各收集100份左右人群粪便样品,采用金胺酚—改良抗酸染色法对粪便样本进行检测,并采用荧光定量PCR法对阳性样本再进行分子生物学检测确认。 结果 2015年和2016年在3个村抽样点共调查健康人群581人,未发现隐孢子虫感染者。在中大医院门诊部的慢性腹泻患者中采集202份粪样,检测出隐孢子虫阳性者9例,隐孢子虫感染率为4.46%;阳性者经采用荧光定量PCR法对隐孢子虫进行确认,结果有7例显示了明显的对数扩增曲线、为隐孢子虫核酸阳性,2例无明显的对数扩增曲线,隐孢子虫核酸阳性率为3.47%。结论 在南京地区抽查的健康人群中未发现隐孢子虫感染者,而在医院门诊的慢性腹泻患者中发现了隐孢子虫感染者。提示应加强对门诊慢性腹泻患者隐孢子虫的检测,为该病的诊断、治疗提供依据。     

涪陵区畜禽隐孢子虫感染现状调查

目的 了解涪陵地区畜、禽养殖场隐孢子虫感染现状,为防治隐孢子虫病对人群健康危害提供科学依据.方法 2011年对涪陵部分猪、牛、羊、鸡、鸽子等养殖场开展隐孢子虫调查.分别采集各养殖场畜、禽粪便,用改良-抗酸染色法和蔗糖漂浮法检测隐孢子虫卵.结果 调查累计抽检畜、禽粪便样822件,其中猪粪便333件,牛粪便192件,检出隐孢子虫卵分别为144件和63件,检出率分别为43.2％、32.8％;羊、鸡、鸽子粪便分别为117件、141件和39件,均未检出隐孢子虫卵.结论 涪陵地区猪、牛粪便中均检出隐孢子虫卵,且感染率较高,其他畜、禽未检出隐孢子虫卵.     

广西西南部分地区龟隐孢子虫感染情况调查与分析

目的 了解广西西南部分地区4种龟类隐孢子虫的感染情况。方法 采集4个种类总计148只龟的粪便样品，利用巢氏PCR对18S rRNA基因进行检测和分析。结果 龟隐孢子虫总感染率为23.65%(35/148),其中黄额闭壳龟感染率为35.29%(6/17),地龟感染率为29.00%(29/100),黄缘闭壳龟(0/16)和木纹龟(0/15)中未检测出隐孢子虫感染，两种龟类隐孢子虫检测结果均为阴性，感染率为0。不同龟种中，地龟感染了Cryptosporidium.ducismarci,黄额闭壳龟存在Cryptosporidium.ducismarci与Cryptosporidium.testudinis两种隐孢子虫的混合感染。结论 广西西南部分地区龟类存在两种隐孢子虫的感染，且C.testudinis隐孢子虫可能对人兽健康存在潜在风险，本研究为明确目前广西西南地区的龟隐孢子虫的流行情况提供了参考依据。     

Cryptosporidium infection in young children with diarrhea in Rawalpindi, Pakistan.

Fecal excretion of Cryptosporidium parvum oocysts was determined in 625 children less than five years old who presented at the pediatric clinic of a teaching hospital in Rawalpindi, Pakistan. Single stool specimens were collected from 475 children with acute diarrhea and from 150 children without diarrhea. The Cryptosporidium infection rate was significantly higher in children with diarrhea than in children without diarrhea (10.3% versus 3.3%). The C. parvum infection rate was highest in children 19-24 months of age (21.8%). There was no significant difference in the Cryptosporidium infection rate among male and female children of any age group studied. Sociodemographic information, drinking water supply, and contact with domestic animals had no significant role in the acquisition of C. parvum infection in our study population. The data suggest that C. parvum is relatively endemic in young children in the Rawalpindi area and that C. parvum may be an important pathogen associated with diarrhea.     

Epidemiological survey of cryptosporidiosis in Anhui Province China

AIM: To provide scientific evidence for prevention and controlling of cryptosporidiosis, the infection of Cryptosporidium parvum and its epidemiological characteristics were studied in some areas of Anhui Province.METHODS: The oocyst of Cryptosporidium parvum in 5421fresh stool samples from eleven areas of Anhui Provincewas tested by auramine-phenol stain and improved anti-acidstain respectively. The specific antibody of IgG, IgM and Tsubsets of 41 patients with positive Cryptosporidium parvumin stools were detected by ELISA and biotin-streptavidin(BSA) respectively.RESULTS: The total infective rate of Cryptosporidiumparvum was 1.33 % (74/5421). Among them, the positiverates of oocyst in the areas of Huaibei (1. 82 % ) and Fuyang( 1. 80 % ) were higher. The positive rates of oocyst in stoolsof infants, pupils, middle school students, collegestudents, adults, patients with diarrhea, and those withimmunodeficiency were 3.15 % (28/889), 0.82 % (9/1098), 0.82 %(9/1092), 0.83 %(8/969), 0.85 % (9/1095), 2.88 %(8/27g) and 8.33 %(3/36) % respectively. The positive rates ofoocyst in infants and the patients with diarrhea andimmunodeficiency were significantly higher than those incontrols ( P ＜ 0.01 ). The positive rate of oocyst in maleswas similar to that in females ( P＞ 0.05). The positive rateof oocyst in urban areas ( 1. 13 %) was significantly lowerthan those in rural areas ( 1. 72 %, P ＜ 0.01 ). The positiverates of specific IgG, IgM and IgG + IgM in sera of thepatients with positive oocyst in stool were 63.4 % ( 26/41 ),17.1% (7/41), 19.5 % (8/41) respectively. The numberfractions of T subsets of CD3 + , CD4 + , CD8 + and CD4 +/CD8 + of the patients were 0.66 ± 0.07, 0.44 ± 0.06, 0.28 ± 0.04 and 1. 58 ± 0.32 respectively. The difference between thepatients and the controls was significant ( P ＜ 0. 05). Themain manifestations of the patients were subclinicalinfection, in forms of slight abdominal pain, mild diarrhea,and loose stool.CONCLUSION: There are two infection peaks in infection ofCryptosporidium parvum and its infection can he foundmore often in infants, patients with diarrhea orimmunodeficiency, and in rural areas. Subclinical infectionis the main manifestation and might he easily misdiagnosed.When the therapeutic effectiveness is low for diarrhea, theinfection of Cryptosporidium parvum should he considered,conceming their age and immune function.     

Identification of 5 types of Cryptosporidium parasites in children in Lima, Peru

Cryptosporidium parvum is usually considered to be the pathogen responsible for human cryptosporidiosis. We genotyped Cryptosporidium in 132 stool specimens from 80 Peruvian children, representing 85 infection episodes, using techniques that differentiate Cryptosporidium species and C. parvum genotypes. Five types of Cryptosporidium were identified: C. parvum human (67), bovine (8), and dog (2) genotypes, C. meleagridis (7), and C. felis (1). Twenty-five (29%) of the 85 infection episodes were associated with diarrhea. There was no significant difference in age, antecedent stunting, percentage with diarrhea, or duration of diarrhea for episodes with human genotype, compared with those of zoonotic Cryptosporidium. Duration of oocyst shedding was longer for human genotype than for zoonotic Cryptosporidium (mean, 13.9 days and 6.4 days, respectively; P=.004). Serum samples from 8 children with C. meleagridis, C. felis, or C. parvum dog genotype were tested for anti-human immunodeficiency virus (HIV) type 1 antibodies; all were found to be negative. Contrary to common belief, novel Cryptosporidium species and C. parvum genotypes can infect HIV-negative children.     

Substance P expression correlates with severity of diarrhea in cryptosporidiosis

Cryptosporidiosis, caused by Cryptosporidium parvum, is self-limited in immunocompetent hosts but may cause chronic diarrhea in patients with acquired immunodeficiency syndrome (AIDS). Substance P (SP), a neuropeptide belonging to the tachykinin family, is expressed in gastrointestinal tract and can cause electrogenic chloride anion secretion. Therefore, we studied SP mRNA and protein expression in jejunal tissue samples of patients with AIDS with naturally occurring chronic cryptosporidiosis and healthy volunteers with mild cryptosporidiosis or asymptomatic infection after experimental C. parvum challenge. SP mRNA was associated with symptoms in cryptosporidiosis. SP protein levels were greater in symptomatic than asymptomatic volunteers. Similarly, greater expression of SP mRNA and protein were noted in patients with AIDS with chronic cryptosporidiosis versus immunocompetent volunteers with self-limited infection. This study demonstrates a direct correlation between SP levels and disease severity and may imply that SP plays a role in diarrhea mediation.     

Intestinal cryptosporidiosis as an initial manifestation in a previously healthy Japanese patient with AIDS

Background: Cryptosporidium parvum infection has been recognized as one of the pathogens causing severe and persistent diarrhea in immunodeficient patients, such as those with AIDS, worldwide. However, in Japan, the frequency of this infection has been rare, except for environmental contamination through the water supply. In this communication, we describe a Japanese patient with AIDS presenting with intestinal Cryptosporidiosis as an initial manifestation. Methods: The oocysts of Cryptosporidium parvum in his stool were detected by the Ziehl-Neelsen method and electron microscopy. The antigen-specificity was proved by immunostaining, using a fluorescein isothiocyanate (FITC)-labeled monoclonal antibody and enzyme-linked immunosorbent assay (ELISA), using Cryptosporidium-specific antibody. Results: A 28-year-old Japanese homosexual man was admitted to our hospital because of severe watery diarrhea of 1-week duration. Numerous oocysts of Cryptosporidium parvum were observed in his stool. Cryptosporidium parvum antigen was detected in stool samples. Serological examinations revealed that anti-HIV-1 antibody was positive, and HIV RNA was positive at a high level. He was diagnosed as having AIDS associated with intestinal Cryptosporidiosis. The circulating CD4+ T-cell count was 152/μl. His diarrhea was not alleviated by administration of loperamide and an ordinary antibiotic agent, but ultimately resolved by the administration of the macrolide antibiotic agent, clarithromycin. Conclusions: We emphasize that the presence of Cryptosporidium parvum infection should be kept in mind in searching for pathogens causative of severe diarrhea in AIDS patients. Received: January 31, 2002 / Accepted: May 17, 2002 Reprint requests to: H. Miyakawa Acknowledgments. The authors sincerely appreciate Kengo Morimoto, Ph.D. (Section of Electron Microscopy, Teikyo University Mizonokuchi Hospital) for technical assistance with electron microscopy.     

Human cryptosporidiosis and Cryptosporidium spp. in Haiti

Contamination by water-born infectious diseases is closely linked to urban slums conditions such as overcrowding and high level of faecal pollution by animal and human excreta. In this environment, cryptosporidiosis is a major cause of acute diarrhoea in children and chronic persistent diarrhoea in AIDS patients, resulting in increased morbidity and mortality in both populations. The aims of this study conducted in Port-au-Prince, Haiti were to: (i) determine the frequency of Cryptosporidium infection in two populations of patients with diarrhoea, children and AIDS patients, and the existence of Cryptosporidium carriage in healthy adults living in close contact with them; (ii) identify by molecular genotyping the Cryptosporidium species involved; and (iii) evaluate the viability of Cryptosporidium oocysts isolated from human stools. From January 2000 to January 2001, 158 of 1529 diarrhoea stool samples collected from 93 patients with diarrhoea, 57 adults followed at Centres GHESKIO and 36 children admitted at the University Hospital in Port-au-Prince contained Cryptosporidium oocysts (10.3%). The majority of adult patients (98%) were HIV-infected whereas the majority of children (81%) tested negative for HIV. Cryptosporidium was documented in only 1/102 healthy persons living in contact with Cryptosporidium infected patients and infection was with the same genotype as that of the contact patient. Among the 69 Cryptosporidium isolates studied for genotyping, three species were identified: C. hominis (59%), C. parvum (38%) and C. felis (3%). The two C. felis cases are the first reported from AIDS patients in the Caribbean. Most of the children regardless of their HIV status were infected with C. hominis (72%), whereas AIDS patients were more likely to be infected by either human or animal genotypes. These data confirm that immunocompromised individuals are susceptible to a wide range of Cryptosporidium spp. Viability of Cryptosporidium oocysts were determined in an experimental mouse model for 17/18 specimen studied including in 12/13 C. hominis, 4/4 C. parvum and 1/1 C. felis. Infectivity in newborn mice was found to be dose-dependent and more effective with C. parvum than the other two genotypes. Cryptosporidiosis remains a frequent hazard for both AIDS patients and young children in Haiti because of poor hygiene, particularly contaminated water and overcrowded conditions associated with urban slums.     

Cryptosporidiosis in Haitian children

We used a modified acid-fast stain to detect Cryptosporidium oocysts in unconcentrated stools from 824 Haitian children less than 2 years of age with acute diarrhea. Oocysts were identified in stools from 17.5% of 291 children seen at a rural dispensary and in 16.3% of stools from 533 children in an urban hospital. Children with cryptosporidiosis were identified throughout a 22-month period from October 1982 to July 1984, without seasonal predilection. Cryptosporidiosis was twice as common in infants greater than 6 months of age than in younger infants. Cryptosporidium oocysts were rarely found in stools of infants receiving only breast milk. The clinical presentation of children with cryptosporidiosis was similar to other patients with diarrhea who did not have cryptosporidiosis. No asymptomatic Cryptosporidium infections were detected among 71 family members of 31 children with cryptosporidiosis. Three of the 71 family members less than 3 years of age were found to have diarrhea and Cryptosporidium oocysts. In follow-up studies of 31 patients, oocysts persisted in stools for a mean of 14 days (range 5-31 days). Duration of oocyst excretion was directly correlated with duration of diarrhea. These findings suggest that Cryptosporidium is an important cause of acute self-limited diarrheal illness to Haitian children.     

规模化引种场进口奶牛隐孢子虫种类、基因亚型鉴定及其生物安全评价

目的为了解进口奶牛寄生的隐孢子虫对引种场污染情况及是否影响隐孢子虫种类和基因型在当地的分布。方法采用PCR方法检测河南省某规模化引种场奶牛隐孢子虫感染情况。结果基于18S rRNA基因位点进行PCR检测,奶牛隐孢子虫总感染率为17.8%(90/507),鉴定出4种隐孢子虫,分别为微小隐孢子虫、牛隐孢子虫、芮氏隐孢子虫和安氏隐孢子虫,隐孢子虫感染率随牛年龄增长而呈递减趋势,差异有统计学意义(P<0.01)。断奶前犊牛以微小隐孢子虫为优势感染种,断奶前犊牛腹泻与微小隐孢子虫感染呈正相关性,差异有统计学意义(P<0.01)。基于gp60基因位点,43份微小隐孢子虫阳性样品成功扩增出35份,序列分析显示35个微小隐孢子虫均为人兽共患基因亚型IIdA19G1, 而奶牛引种地(澳大利亚)的牛源微小隐孢子虫均为IIa亚型家族存在显著不同。结论证实微小隐孢子虫为犊牛腹泻病原之一,IId亚型为中国独特分布的微小隐孢子虫亚型,其基因亚型存在地理隔离遗传特征,引种青年牛和成年牛不影响当地重要人兽共患虫种微小隐孢子虫基因亚型分布,从这个角度考虑不具有生物安全重要性。     

Cryptosporidium, enterocytozoon, and cyclospora infections in pediatric and adult patients with diarrhea in Tanzania.

Cryptosporidiosis, microsporidiosis, and cyclosporiasis were studied in four groups of Tanzanian inpatients: adults with AIDS-associated diarrhea, children with chronic diarrhea (of whom 23 of 59 were positive [+] for human immunodeficiency virus [HIV]), children with acute diarrhea (of whom 15 of 55 were HIV+), and HIV control children without diarrhea. Cryptosporidium was identified in specimens from 6/86 adults, 5/59 children with chronic diarrhea (3/5, HIV+), 7/55 children with acute diarrhea (0/7, HIV+), and 0/20 control children. Among children with acute diarrhea, 7/7 with cryptosporidiosis were malnourished, compared with 10/48 without cryptosporidiosis (P < .01). Enterocytozoon was identified in specimens from 3/86 adults, 2/59 children with chronic diarrhea (1 HIV+), 0/55 children with acute diarrhea, and 4/20 control children. All four controls were underweight (P < .01). Cyclospora was identified in specimens from one adult and one child with acute diarrhea (HIV-). Thus, Cryptosporidium was the most frequent and Cyclospora the least frequent pathogen identified. Cryptosporidium and Enterocytozoon were associated with malnutrition. Asymptomatic fecal shedding of Enterocytozoon in otherwise healthy, HIV children has not been described previously.