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Cryptosporidium is an important protozoan parasite and due to its resistance to chlorine is a major cause of swimming pool-associated gastroenteritis outbreaks. The present study combined contact tracing and molecular techniques to analyse cryptosporidiosis cases and outbreaks in Western Australia in 2019 and 2020. In the 2019 outbreak, subtyping at the 60 kDa glycoprotein (gp60) gene identified 89.0% (16/18) of samples were caused by the C. hominis IdA15G1 subtype. Amplicon next generation sequencing (NGS) at the gp60 locus identified five C. hominis IdA15G1 subtype samples that also had C. hominis IdA14 subtype DNA, while multi locus sequence typing (MLST) analysis on a subset (n = 14) of C. hominis samples identified three IdA15G1 samples with a 6 bp insertion at the end of the trinucleotide repeat region of the cp47 gene. In 2020, 88.0% (73/83) of samples typed were caused by the relatively rare C. hominis subtype IbA12G3. Four mixed infections were observed by NGS with three IdA15G1/ IdA14 mixtures and one C. parvum IIaA18G3R1 sample mixed with IIaA16G3R1. No genetic diversity using MLST was detected. Epidemiological and molecular data indicates that the outbreaks in 2019 and 2020 were each potentially from swimming pool point sources and a new C. hominis subtype IbA12G3 is emerging in Australia. The findings of the present study are important for understanding the introduction and transmission of rare Cryptosporidium subtypes to vulnerable populations.

In the present study, a 37‐year‐old immunosuppressed female in Western Australia (WA) was identified as positive for Cryptosporidium by microscopy and treated with nitazoxanide. Molecular analyses at the 18S ribosomal RNA (18S) and 60 kDa glycoprotein (gp60) loci identified C. fayeri subtype IVgA10G1T1R1, which had previously been identified in western grey kangaroos (Macropus fuliginosus) in WA. Next generation sequencing (NGS) of the gp60 locus confirmed the absence of mixed infections with other Cryptosporidium species. This is only the second report of C. fayeri in a human host highlighting the zoonotic potential of this wildlife‐associated species. Routine diagnosis using molecular methods in laboratories is required to better understand the diversity and epidemiology of Cryptosporidium parasite.

Purpose There is a dearth of research conducted on the Knowledge, Attitude and Practices (KAP) of swimming pool patrons and staff to determine their understanding of the importance of Cryptosporidium and its transmission in swimming pools. Methods We conducted a KAP survey of public swimming pool patrons (n = 380) and staff (n = 40) attending five public swimming pools in Western Australia (WA). Results Knowledge, attitudes and practices (KAP) of Cryptosporidium varied between patrons and staff but were generally limited. Only 26.1% and 25.0% of patrons and staff had heard of Cryptosporidium, while 17.4% and 10.0% knew that it causes diarrhoea, respectively. Thirty-one percent of patrons were aware of their pool policy concerning gastroenteritis and Cryptosporidium, compared to 62.5% of staff. Less than 50% of patrons demonstrated awareness of how features within the pool environment were relevant to the control of Cryptosporidium. Only about a third of patrons (35%) and staff (37.5%) were aware that showering before swimming reduced the risk of gastroenteritis. Conclusion Raising awareness about hygiene-related practices through the delivery of targeted health education messages to the general public is essential to reduce the burden of Cryptosporidium infections in aquatic environments.

The present study was performed to investigate the role of IGF‐1 in agedependent bone loss in postmenopausal Sudanese women. 121 Sudanese women aged 45–80 y (mean age, 59.3) were enrolled in the cross‐sectional study. BMD was measured at the lumbar spine and total hip by DXA, classified into three groups, osteoporotic, Tscore (≥ -2.5), osteopenia, T-score (-1 to -2.5) and normal, T-score (≤ -1) as the control group. Serum levels of IGF‐1 was measured by ADVIA (Siemens Healthcare Diagnostics Inc. Deerfield, IL USA). In our study, BMD at two sites as well as serum levels of IGF‐1 declined with age. According to our results Serum IGF-1 values can be used as predictor marker for determine early decreased BMD and a predictive factor for determining the risk of osteoporosis. Further study with large sample size is needed to confirm the results of our study.

Objective: BMD is the hallmark of OP and exhibits high heritability; efforts to understand OP genetic determinants have therefore been increased. In this study a polymorphism of IGF-I gene was examined in Sudanese postmenopausal women to analyse the genetic background for osteoporosis. Method: A cross-sectional study conducted during the periodof 2014-2015. We studied 836 women refereed to our hospital. Based on the DXA results and inclusion criteria 121 postmeno-pause women (45-80 years old) were selected. Classified intothree groups, osteoporotic, T-score (≥-2.5), osteopenia, T-score(-1 to -2.5) and normal, T-score (≤-1) as the control group. A most common single nucleotide polymorphisms (SNP) in (IGF-1) gene (rs35767) were measured using RT-PCR TaqMan. Serum concentration of IGF-1 was measured by ADVIA(Siemens Healthcare Diagnostics Inc., Deerfield, IL, USA). Results: The IGF-I SNP (rs11568820) CC genotype was found to be associated with osteoporosis and BMD at the total hip (not lumbar spine (L1–L4) under recessive and additive genetic model (AOR (95%CI)=2.0(1.0-8); p=0.0) and (OR(95%CI)=1.5 (0.1-7); p=0.02) respectively. Serum level of IGF-I was strongly associated with decreased BMD with level significantly decreasing (P<0.01). Conclusions: We found significant associations between CC genotype of IGF-1 rs35767, BMD and osteoporosis risk, suggesting that IGF-1 rs35767 can be used as a predictive factor for determining the risk of osteoporosis. Serum IGF-1 can be used as predictor marker for determine early decreased BMD. Further study with large sample size are needed to confirm the results of our study.

Cryptosporidium species are a major cause of diarrhoea worldwide. In the present study, a retrospective analysis of 109 microscopically Cryptosporidium-positive faecal specimens from Western Australian patients, collected between 2015 and 2018 was conducted. Sequence analysis of the 18S rRNA and the 60 kDa glycoprotein (gp60) gene loci identified four Cryptosporidium species: C. hominis (86.2%, 94/109), C. parvum (11.0%, 12/109), C. meleagridis (1.8%, 2/109) and C. viatorum (0.9%, 1/109). Subtyping at the gp60 locus identified a total of 11 subtypes including the emergence of the previously rare C. hominis IfA12G1R5 subtype in 2017 as the dominant subtype (46.7%, 21/45). This subtype has also recently emerged as the dominant subtype in the United States but the reasons for its emergence are unknown. This is also the first report of C. viatorum in humans in Australia and a novel subtype (XVaA3g) was identified in the one positive patient.

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