Longitudinal study of Cryptosporidium infection in children in northeastern Brazil

A prospective, 4-year cohort study of children born in an urban slum in nor theastern Brazil was undertaken to elucidate the epidemiology of Cryptospor idium infection in an endemic setting, describe factors associated with Cry ptosporidium-associated persistent diarrhea, and clarify the importance of copathogens in symptomatic cryptosporidiosis, A total of 1476 episodes of d iarrhea, accounting for 7581 days of illness (5.25 episodes/child-year), we re recorded: of these, 102 episodes (6.9%) were persistent. Cryptosporidium oocysts were identified in 7.4% of all stools, and they were found more fr equently in children with persistent diarrhea (16.5%) than in those with ac ute (8.4%) or no (4.0%) diarrhea (P < .001). Low-birth-weight children and those living in densely crowded subdivisions were at greater risk for sympt omatic infection. Disease course was highly variable and was not associated with the presence of copathogens, Recurrent Cryptosporidium infection and relapsing diarrhea associated with it were moderately common. In light of t hese data, the applicability of the current World Health Organization diarr heal definitions to Cryptosporidium-associated diarrheal episodes may need to be reconsidered.