CRIPTOSPORIDIOSE HUMANA: PANORAMA DA OCORRÊNCIA E DOS FATORES DE RISCO EVIDENCIADOS EM UMA REVISÃO INTEGRATIVA
Resumo
Uma revisão integrativa foi conduzida para determinar a prevalência global e os potenciais fatores de risco para criptosporidiose humana em vários países. Artigos científicos foram identificados por meio de busca sistemática nas bases de dados Science Direct, Scopus, Web of Science, Pubmed e Google Scholar. Os seguintes descritores foram usados: “outbreak” AND (Cryptosporidium OR cryptosporidiosis) AND “human”. Os principais fatores de risco foram consumo e contato com água contaminada, consumo de alimento contaminado e contato com animais. As espécies predominantes em humanos foram C. hominis e C. parvum e a microscopia e a técnica PCR foram os métodos de diagnóstico mais usados em amostras de fezes. Nas análises de amostras de água, as técnicas imunofluorescência e separação eletromagnética foram usadas. Concluiu-se que no período entre 2010 e 2025, o Cryptosporidium spp. causou vários casos de diarreia em indivíduos que vivem em países desenvolvidos e os principais fatores de risco foram o consumo de água ou alimento contaminados, natação em águas recreativas contaminadas e o contato com animais de fazenda.
Biografia do Autor
Médica Veterinária e Mestra em Zootecnia pela Universidade Federal de Viçosa. Doutora em Zootecnia pela Universidade Estadual Paulista Júlio de Mesquita Filho. Professora Titular da Faculdade de Medicina Veterinária na Universidade de Rio Verde . Em 2023 graduou-se em Farmácia pela Unibrás/Rio Verde.
Graduada em Medicina Veterinária pela Universidade de Rio Verde, GO. Mestra pelo Programa de Pós-graduação em Ciência Animal da Universidade Federal de Goiás, GO. Médica Veterinária autônoma.
Graduado em Zootecnia pela Universidade de Rio Verde. Doutor em Ciência Animal pela UFG - Universidade Federal de Goiás. Atualmente trabalha no setor financeiro da Universidade de Rio Verde.
Graduando em Medicina pela Universidade de Rio Verde (UniRV), Membro das Ligas de Cirurgia Geral do Hospital Santa Terezinha e presidente da Liga de Farmacologia Médica (LAFAMED) da faculdade de medicina da UniRV. Aluno do programa de iniciação científica voluntária (PIBIC) no ciclo 2025-2026 com pesquisas na área do câncer de pulmão e imunoterapia.
Graduanda em Medicina Veterinária pela Universidade de Rio Verde (UniRV) e bolsista de PIBIC com o projeto de pesquisa sobre interações medicamentosas em cães e gatos.
Graduanda em Medicina Veterinária pela Universidade de Rio Verde – UniRV.
Referências
1. Bonsere WCP, Mioranza SL, Fariña LO, Santos KC, Ayala TS. Surtos de criptosporidiose pelo mundo: uma revisão sistemática. Rev Bras Meio Ambiente. 2020;8(2):62-73.
2. Ryan U, Fayer R, Xiao L. Cryptosporidium species in humans and animals: current understanding and research needs. Parasitology. 2014;141(13):1667-1685.
3. Efstratiou A, Ongert J, Karanis P. Evolution of monitoring for Giardia and Cryptosporidium in water. Water Res. 2017;123:96-112.
4. Del Coco VF, Córdoba MA, Basualdo JA. Criptosporidiosis: una zoonosis emergente. Rev Argent Microbiol. 2009;41(3):185-196.
5. Shirley DAT, Moonah SN, Kotloff K. Burden of disease from cryptosporidiosis. Curr Opin Infect Dis. 2012;25(5):555-563.
6. Sevá AP, Funada MR, Souza SO, Nava A, Richtzenhain LJ, Soares RM. Occurrence and molecular characterization of Cryptosporidium spp. isolated from domestic animals in a rural area surrounding Atlantic dry forest fragments in Teodoro Sampaio municipality, State of São Paulo, Brazil. Rev Bras Parasitol Vet. 2010;19(4):249-253.
7. Vanathy K, Parija SC, Mandal J, Hamide A, Krishnamurthy S. Cryptosporidiosis: a mini review. Trop Parasitol. 2017;7(2):72-80.
8. Ulloa-Stanojlovic FM, Aguiar B, Jara LM, Sato MIZ, Guerrero JA, Hachich E, et al. Occurrence of Giardia intestinalis and Cryptosporidium sp. in wastewater samples from São Paulo State, Brazil, and Lima, Peru. Environ Sci Pollut Res. 2016;23(21):22197-22205.
9. Silva DP, Scalize PS. Detection of Cryptosporidium spp. oocysts and Giardia spp. cysts in surface water destined for public supply in the state of Goiás, Brazil. Eng Sanit Ambient. 2020;25(5):777-787.
10. Brankston G, Boughen C, Ng V, Fisman DN, Sargeant JM, Greer AL. Assessing the impact of environmental exposures and Cryptosporidium infection in cattle on human incidence of cryptosporidiosis in Southwestern Ontario, Canada. PLoS One. 2018;13(4):e0196573.
11. Diptyanusa A, Sari IP. Treatment of human intestinal cryptosporidiosis: a review of published clinical trials. Int J Parasitol Drugs Drug Resist. 2021;17:128-138.
12. Kotloff KL, Nataro JP, Blackwelder WC, Nasrin D, Farag TH, Panchalingam S, et al. 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. Lancet. 2013;382(9888):209-222.
13. Khalil IA, Troeger C, Rao PC, Blacker BF, Brown A, Brewer TG, et al. Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analysis study. Lancet Glob Health. 2018;6(7):e758-e768.
14. Xiao L, Feng Y. Molecular epidemiology tools for waterborne pathogens Cryptosporidium spp. and Giardia duodenalis. Food Waterborne Parasitol. 2017;8-9:14-32.
15. Munn Z, Stern C, Aromataris E, Lockwood C, Jordan Z. What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC Med Res Methodol. 2018;18:5.
16. Mason BW, Chalmers RM, Carnicer-Pont D, Casemore DP. A Cryptosporidium hominis outbreak in North-West Wales associated with low oocyst counts in treated drinking water. J Water Health. 2010;8(2):299-310.
17. Al-Warid HS, Al-Saqur IM, Mahmood SH. Occurrence of Cryptosporidium spp. among people living in north of Baghdad. Eur J Sci Res. 2012;78(4):539-545.
18. Cantey PT, Kurian AK, Jefferson D, Moerbe MM, Marshall K, Blankenship WR, et al. Outbreak of cryptosporidiosis associated with a man-made chlorinated lake—Tarrant County, Texas, 2008. J Environ Health. 2012;75(4):14-19.
19. Kasper MR, Lescano AG, Lucas C, Gilles D, Biese BJ, Stolovitz G, et al. Diarrhea outbreak during U.S. military training in El Salvador. PLoS One. 2012;7(7):e40404.
20. Cho EJ, Yang J, Lee E, Kim S, Cha S, Kim S, et al. A waterborne outbreak and detection of Cryptosporidium oocysts in drinking water of an older high-rise apartment complex in Seoul. Korean J Parasitol. 2013;51(4):461-466.
21. Moon S, Kwak W, Lee S, Kim W, Oh J, Youn S. Epidemiological characteristics of the first water-borne outbreak of cryptosporidiosis in Seoul, Korea. J Korean Med Sci. 2013;28(7):983-989.
22. Fuentes I, Martín C, Beristain X, Mazón A, Saugar JM, Blanco A, et al. Cryptosporidium hominis genotypes involved in increased incidence and clusters of cases, Navarra, Spain, 2012. Epidemiol Infect. 2012;140(5):1033-1036.
23. Hasajová A, Valenčáková A, Malčeková B, Danišová O, Halán O, Godová M, et al. Significantly higher occurrence of Cryptosporidium infection in Roma children compared with non-Roma children in Slovakia. Eur J Clin Microbiol Infect Dis. 2014;33(8):1401-1406.
24. Lange H, Johansen OH, Vold L, Robertson LJ, Anthonisen IL, Nygård K. Second outbreak of infection with a rare Cryptosporidium parvum genotype in schoolchildren associated with contact with lambs/goat kids at a holiday farm in Norway. Epidemiol Infect. 2014;142(10):2105-2113.
25. Ng-Hublin JSY, Hargrave D, Combs B, Ryan U. Investigation of a swimming pool-associated cryptosporidiosis outbreak in the Kimberley region of Western Australia. Epidemiol Infect. 2015;143(5):1037-1040.
26. Puleston RL, Mallaghan CM, Modha DE, Hunter PR, Nguyen-Van-Tam JS, Regan CM, et al. The first recorded outbreak of cryptosporidiosis due to Cryptosporidium cuniculus (formerly rabbit genotype), following a water quality incident. J Water Health. 2014;12(1):41-50.
27. Widerström M, Schönning C, Lilja M, Lebbad M, Ljung T, Allestam G, et al. Large outbreak of Cryptosporidium hominis infection transmitted through the public water supply, Sweden. Emerg Infect Dis. 2014;20(4):581-589.
28. Åberg R, Sjöman M, Hemminki K, Pirnes A, Räsänen S, Kalanti A, et al. Cryptosporidium parvum caused a large outbreak linked to frisée salad in Finland, 2012. Zoonoses Public Health. 2015;62(8):618-624.
29. Cope JR, Prosser A, Nowicki S, Roberts MW, Scheer D, Anderson C, et al. Preventing community-wide transmission of Cryptosporidium: a proactive public health response to a swimming pool-associated outbreak—Auglaize County, Ohio, USA. Epidemiol Infect. 2015;143(16):3459-3467.
30. Gertler M, Dürr M, Renner P, Poppert S, Askar M, Breidenbach J, et al. Outbreak of cryptosporidiosis following river flooding in the city of Halle (Saale), Germany, August 2013. BMC Infect Dis. 2015;15:88.
31. Johansen H, Hanevik K, Thrana F, Carlson A, Hagen TS, Skaare D, et al. Symptomatic and asymptomatic secondary transmission of Cryptosporidium parvum following two related outbreaks in schoolchildren. Epidemiol Infect. 2015;143(8):1702-1709.
32. Kinross P, Beser J, Troell K, Silverlås C, Björkman C, Lebbad M, et al. Cryptosporidium parvum infections in a cohort of veterinary students in Sweden. Epidemiol Infect. 2018;143(13):2748-2756.
33. McKerr C, Adak GK, Nichols G, Gorton R, Chalmers RM, Kafatos G, et al. An outbreak of Cryptosporidium parvum across England and Scotland associated with consumption of fresh pre-cut salad leaves, May 2012. PLoS One. 2015;10(5):e0125955.
34. Thivierge K, Iqbal A, Dixon B, Dion R, Lévesque B, Cantin P, et al. Cryptosporidium hominis is a newly recognized pathogen in the Arctic region of Nunavik, Canada: molecular characterization of an outbreak. PLoS Negl Trop Dis. 2016;10(4):e0004534.
35. Bjelkmar P, Hansen A, Schönning C, Bergström J, Löfdahl M, Lebbad M, et al. Early outbreak detection by linking health advice line calls to water distribution areas retrospectively demonstrated in a large waterborne outbreak of cryptosporidiosis in Sweden. BMC Public Health. 2017;17(1):328.
36. Hall V, Taye A, Walsh B, Maguire H, Dave J, Wright A, et al. A large outbreak of gastrointestinal illness at an open-water swimming event in the River Thames, London. Epidemiol Infect. 2007;145(6):1246-1255.
37. Hijjawi N, Zahedi A, Kazaleh M, Ryan U. Prevalence of Cryptosporidium species and subtypes in paediatric oncology and non-oncology patients with diarrhoea in Jordan. Infect Genet Evol. 2017;55:127-130.
38. Mahon M, Doyle S. Waterborne outbreak of cryptosporidiosis in the South East of Ireland: weighing up the evidence. Ir J Med Sci. 2017;186(4):989-994.
39. Mosnier E, Martin N, Razakandrainibe R, Dalle F, Roux G, Buteux A, et al. Cryptosporidiosis outbreak in immunocompetent children from a remote area of French Guiana. Am J Trop Med Hyg. 2018;98(6):1727-1732.
40. Osman M, Benamrouz S, Guyot K, El Safadi D, Mallat H, Dabboussi F, et al. Molecular epidemiology of Cryptosporidium spp. in north Lebanon. J Infect Dev Ctries. 2018;12(2.1):34S.
41. Plutzer J, Kelen K, Varga E, Kucsera I, Reusz G, Szabó AJ, et al. First Cryptosporidium outbreak in Hungary, linked to a treated recreational water venue in 2015. Epidemiol Infect. 2019;147:e56.
42. Costa D, Razakandrainibe R, Sautour M, Valot S, Basmaciyan L, Gargala G, et al. Human cryptosporidiosis in immunodeficient patients in France (2015-2017). Exp Parasitol. 2018;192:108-112.
43. Wang Y, Li N, Guo Y, Wang L, Wang R, Feng Y, et al. Persistent occurrence of Cryptosporidium hominis and Giardia duodenalis subtypes in a welfare institute. Front Microbiol. 2018;9:2830.
44. Grossman T, Ken-Dror S, Pavlotzky E, Vainer J, Glazer Y, Sagi O, et al. Molecular typing of Cryptosporidium in Israel. PLoS One. 2019;14(9):e0219977.
45. Khan A, Shams S, Khan S, Khan MI, Khan S, Ali A. Evaluation of prevalence and risk factors associated with Cryptosporidium infection in rural population of district Buner, Pakistan. PLoS One. 2019;14(1):e0209188.
46. Ma DW, Lee MR, Hong SH, Cho SH, Lee SE. Molecular prevalence and genotypes of Cryptosporidium parvum and Giardia duodenalis in patients with acute diarrhea in Korea, 2013-2016. Korean J Parasitol. 2019;57(5):531-536.
47. Galván-Díaz AL, Bedoya-Urrego K, Medina-Lozano A, Urán-Velásquez J, Alzate JF, García-Montoya G. Common occurrence of Cryptosporidium hominis in children attending day-care centers in Medellín, Colombia. Parasitol Res. 2020;119(9):2935-2942.
48. Thomas-López D, Müller L, Vestergaard LS, Christoffersen M, Andersen AM, Jokelainen P, et al. Veterinary students have a higher risk of contracting cryptosporidiosis when calves with high fecal Cryptosporidium loads are used for fetotomy exercises. Appl Environ Microbiol. 2020;86(19):e01250-20.
49. Naughton P, Kelly D, Geagan-Murray S, Middleton S, Cosgrove C, Petty-Saphon NA. A foodborne outbreak of cryptosporidiosis likely linked to salad leaves. Ir Med J. 2021;114(6):381.
50. Franceschelli A, Bonadonna L, Cacciò SM, Sannella AR, Cintori C, Gargiulo R, et al. An outbreak of cryptosporidiosis associated with drinking water in north-eastern Italy, August 2019: microbiological and environmental investigations. Eurosurveillance. 2022;27(35):2200038.
51. Kifleyohannes T, Nødtvedt A, Debenham JJ, Tysnes KR, Terefe G, Robertson LJ. Cryptosporidium and Giardia infections in humans in Tigray, Northern Ethiopia: an unexpectedly low occurrence of anthropozoonotic transmission. Acta Trop. 2022;231:106450.
52. McKerr C, Chalmers RM, Elwin K, Ayres H, Vivancos R, O’Brien SJ, et al. Cross-sectional household transmission study of Cryptosporidium shows that C. hominis infections are a key risk factor for spread. BMC Infect Dis. 2022;22(1):114.
53. Adler S, Widerström M, Lindh J, Lilja M. Symptoms and risk factors of Cryptosporidium hominis infection in children: data from a large waterborne outbreak in Sweden. Parasitol Res. 2017;116(10):2613-2618.
54. Aguayo AA, Millet JP, Álvarez-Bruned L, Palma D, Gómez A, Gallés P, et al. Clostridium and Cryptosporidium outbreak linked to a splash pad. BMC Public Health. 2024;24(1):1578.
55. Bujila I, Ohlson A, Hansen A, Agudelo L, Kuhlmann-Berenzon S, Galanis I, et al. Outbreak of the novel Cryptosporidium parvum IIγA11 linked to salad bars in Sweden, December 2023. Epidemiol Infect. 2024;152:e140.
56. Chalmers RM. Cryptosporidium. In: Batt CA, Tortorello ML, editors. Encyclopedia of food microbiology. 2nd ed. Amsterdam: Elsevier; 2014. p. 533-545.
57. Chiumento G, Osinski A, DeVoe K, Houghton A, Joshi A, Ivanof C, et al. Outbreak of cryptosporidiosis among collegiate swimmers and evidence of secondary transmission—Massachusetts and Rhode Island, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(26):734-735.
58. Duhaim GLMC, Minnaar A, Buys EM. Effect of chlorine, blanching, freezing, and microwave heating on Cryptosporidium parvum viability inoculated on green peppers. J Food Prot. 2012;75(5):936-941.
59. Jones G, Matizanadzo J, Nelson A, Chalmers RM, Thomas DR, Williams S, et al. A large Cryptosporidium parvum outbreak associated with a lamb-feeding event at a commercial farm in South Wales, March–April 2024: a retrospective cohort study. Epidemiol Infect. 2025;153:e82.
60. Khalil IA, Troeger C, Rao PC, Blacker BF, Brown A, Brewer TG, et al. Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analysis study. Lancet Glob Health. 2018;6(7):e758-e768.
61. Marie C, Petri WA Jr. Criptosporidiose. In: MSD Manual Profissional. 2024 [cited 2025 Sep 5]. Available from: https://www.msdmanuals.com/pt/profissional/doen%C3%A7as-infecciosas/protozo%C3%A1rios-e-microspor%C3%ADdios-intestinais/criptosporidiose
62. Meinhardt PL, Casemore DP, Miller KB. Epidemiologic aspects of human cryptosporidiosis and the role of waterborne transmission. Epidemiol Rev. 1996;18(2):118-136.
63. Menu E, Mosnier E, Cotrel A, Favennec L, Razakandrainibe R, Valot S, et al. Cryptosporidiosis outbreak in Amazonia, French Guiana, 2018. PLoS Negl Trop Dis. 2022;16(1):e0010068.
64. Messias IMO, Oliveira JHV, Silva SFF, Messias JB, Ferreira AG, Marques DAV, et al. Relação de chuvas e casos de criptosporidiose nas mesorregiões de Pernambuco, Brasil. Res Soc Dev. 2021;10(12):e571101220459.
65. Toriro R, Pallett S, Woolley S, Bennett C, Hale I, Heylings J, et al. Outbreak of diarrhea caused by a novel Cryptosporidium hominis subtype during British military training in Kenya. Open Forum Infect Dis. 2024;11(1):ofae001.
66. Yang X, Guo Y, Xiao L, Feng Y. Molecular epidemiology of human cryptosporidiosis in low and middle-income countries. Clin Microbiol Rev. 2021;34(2):e00087-19.
67. Shaposhnik EG, Abozaid S, Grossman T, Marva E, On A, Azrad M, et al. The prevalence of Cryptosporidium among children hospitalized because of gastrointestinal symptoms and the efficiency of diagnostic methods for Cryptosporidium. Am J Trop Med Hyg. 2019;101(1):160-163.
68. Jeffs E, Williman J, Martin N, Brunton C, Walls T. The epidemiology of non-viral gastroenteritis in New Zealand children from 1997 to 2015: an observational study. BMC Public Health. 2019;19(1):18.
69. Tomomh AG, Agena AM, Elamin E, Suliman MA, Elmadani M, Omara AB, et al. Prevalence of cryptosporidiosis among children with diarrhoea under five years admitted to Kosti Teaching Hospital, Kosti City, Sudan. BMC Infect Dis. 2021;21(1):349.
70. Casburn-Jones AC, Farthing MJG. Management of infectious diarrhea. Gut. 2004;53(2):296-305.
71. Cacciò SM, Chalmers RM. Human cryptosporidiosis in Europe. Clin Microbiol Infect. 2016;22(6):471-480.
72. Chen XM, Keithly JS, Paya CV, LaRusso NF. Cryptosporidiosis. N Engl J Med. 2002;346(22):1723-1731.
73. Chauret CP, Radziminski CZ, Lepuil M, Creason R, Andrews RC. Chlorine dioxide inactivation of Cryptosporidium parvum oocysts and bacterial spore indicators. Appl Environ Microbiol. 2001;67(7):2993-3001.
74. Adeyemo FE, Singh G, Reddy P, Bux F, Stenström TA. Efficiency of chlorine and UV in the inactivation of Cryptosporidium and Giardia in wastewater. PLoS One. 2019;14(5):e021604.
75. Gait R, Soutar RH, Hanson M, Fraser C, Chalmers R. Outbreak of cryptosporidiosis among veterinary students. Vet Rec. 2008;162(26):843-845.
76. Galuppi R, Piva S, Castagnetti C, Sarli G, Iacono E, Fioravanti ML, et al. Cryptosporidium parvum: from foal to veterinary students. Vet Parasitol. 2016;219:53-56.
77. Ryan U, Zahedi A, Feng Y, Xiao L. An update on zoonotic Cryptosporidium species and genotypes in humans. Animals. 2021;11(11):3307.
78. Bujila I, Troell K, Fischerström K, Nordahl M, Killander G, Hansen A, et al. Cryptosporidium chipmunk genotype I—an emerging cause of human cryptosporidiosis in Sweden. Infect Genet Evol. 2021;92:104895.
79. Zhang Z, Hu S, Zhao W, Guo Y, Li N, Zheng Z, et al. Population structure and geographical segregation of Cryptosporidium parvum IId subtypes in cattle in China. Parasit Vectors. 2020;13(1):425.
80. Chalmers RM, Smith R, Elwin K, Clifton-Hadley FA, Giles M. Epidemiology of anthroponotic and zoonotic human cryptosporidiosis in England and Wales, 2004-2006. Epidemiol Infect. 2011;139(5):700-712.
81. Chalmers RM, Robinson G, Elwin K, Elson R. Analysis of the Cryptosporidium spp. and gp60 subtypes linked to human outbreaks of cryptosporidiosis in England and Wales, 2009 to 2017. Parasit Vectors. 2019;12:95.
82. Cann KF, Thomas DR, Salmon RL, Wyn-Jones AP, Kay D. Extreme water-related weather events and waterborne disease. Epidemiol Infect. 2012;141(4):671-686.
83. Levy K, Woster AP, Goldstein RS, Carlton EJ. Untangling the impacts of climate change on waterborne diseases: a systematic review of relationships between diarrheal diseases and temperature, rainfall, flooding, and drought. Environ Sci Technol. 2016;50(10):4905-4922.
84. Keller RP, Santos R, Covre MA, Coelho ERC. Occurrence of Cryptosporidium oocysts and Giardia cysts in public water supplies in Vitória, ES, Brazil. Eng Sanit Ambient. 2024;29:e20230065.
85. Al-Abri M, Al-Ghafri B, Bora T, Dobretsov S, Dutta J, Castelletto S, et al. Chlorination disadvantages and alternative routes for biofouling control in reverse osmosis desalination. npj Clean Water. 2019;2:2.
86. Koul B, Yadav D, Singh S, Kumar M, Song M. Insights into the domestic wastewater treatment (DWWT) regimes: a review. Water. 2022;14(21):3542.
87. Esch KJ, Petersen CA. Transmission and epidemiology of zoonotic protozoal diseases of companion animals. Clin Microbiol Rev. 2013;26(1):58-85.
88. Cunha FS, Peralta JM, Peralta RHS. New insights into the detection and molecular characterization of Cryptosporidium with emphasis in Brazilian studies: a review. Rev Inst Med Trop São Paulo. 2019;61:e28.
89. Costa D, Soulieux L, Razakandrainibe R, Basmaciyan L, Gargala G, Valot S, et al. Comparative performance of eight PCR methods to detect Cryptosporidium species. Pathogens. 2021;10(6):647.
90. Fernandes ABB, Souza VAF, Baldisseri Junior FA, Toledo RF, Guelli CA, Menão MC, et al. Water security and detection of Cryptosporidium spp. in samples from the Guarapiranga Reservoir, São Paulo. Rev Cereus. 2020;12(2):40-53.
91. Osaki SC, Soccol VT, Costa AO, Oliveira-Silva MB, Pereira JT, Procópio AE. Polymerase chain reaction and nested-PCR approaches for detecting Cryptosporidium in water catchments of water treatment plants in Curitiba, State of Paraná, Brazil. Rev Soc Bras Med Trop. 2013;46(3):270-276.
