Prevalence and Genotyping of Cryptosporidium parvum in Gastrointestinal Cancer Patients

Gastrointestinal cancers are the most commonly occurring malignancies which contributing to over 1/5 of cancer incidences worldwide. Increasing evidences have shown that Cryptosporidium spp., an apicomplexan protozoan, is highly associated with gastrointestinal cancers. However, the prevalence of Cryptosporidium spp. infections among gastrointestinal cancer patients in China has not been estimated yet. We here performed a case-control study to evaluate the occurrences of Cryptosporidium spp. in patients with digestive malignancies before chemotherapy and in control population. Nested PCR amplifying 18S rRNA gene was used to detect the presence of Cryptosporidium spp. in each fecal sample. The results herein confirmed the correlation of Cryptosporidium spp. infection with colorectal and liver cancers, while first identified the high frequencies of Cryptosporidium spp. in esophageal cancer and small intestine cancer. The infection rates of Cryptosporidium spp. in colorectal, esophageal, liver and small intestine cancers were 17.24% (20/116, P<0.001), 6.25% (1/16, P=0.029), 14.29% (1/7, P<0.001) and 40% (2/5, P<0.001), respectively. In addition, molecular characterization indicated that all the Cryptosporidium spp. obtained were Cryptosporidium parvum (C. parvum), and the 18S rRNA sequences were identical to the reference sequences isolated from cattle, suggesting potential zoonotic transmission. Furthermore, subtyping analyses revealed that IIaA15G2R1 and IIaA15G2R2 were the predominant subtypes in colorectal cancer, while IIaA13G2R2 subtype was first named and identified in colorectal and liver cancers. Taken together, for the first time, the prevalence of Cryptosporidium spp. infections in digestive cancer patients has been estimated among Chinese. Our results indicated that C. parvum were highly associated with gastrointestinal cancers, supporting that cryptosporidiosis could be a potential risk factor for these diseases.