Advancing Cryptosporidium Diagnostics from Bench to Bedside

Investigating the infection dynamics and molecular detection of Cryptosporidium in Buffaloes in Sylhet, Bangladesh

Cryptosporidiosis, a zoonotic infection impacting both livestock and humans, is inadequately understood in terms of its prevalence and transmission dynamics involving buffaloes in Bangladesh. This research, conducted in the Sylhet division, aimed to explore the prevalence and potential risk factors influencing Cryptosporidium spp. in the faecal samples of 392 buffaloes. Detection of the parasite utilized modified Ziehl-Neelsen staining, with molecular identification achieved through nested PCR (nPCR). The comprehensive analysis revealed 9.18% (36/392) prevalence at the individual animal level and 40.48% (17/42) at the herd level. Age-based analysis revealed fluctuating infection rates of Cryptosporidium spp. in buffaloes across distinct age brackets, with rates of 22.61% in those aged 0-6 months, 5.00% in those aged 6-12 months, and 1.03% in those aged 12-18 months. Diarrheic buffaloes showed a significantly (p < 0.001) higher infection rate (26.67%; 28/105) compared to non-diarrheic buffaloes (2.79%; 8/287). In risk factor analysis, binary logistic regression revealed that buffaloes aged 0-6 months were experiencing a likelihood that is 14.84 times higher to be affected by Cryptosporidium in contrast to their older counterparts (OR = 14.85; p = 0.02). Additionally, diarrhoeic buffaloes were found to be more susceptible to Cryptosporidium compared to healthy buffaloes (OR = 17.50; p < 0.001). A higher stocking density was associated with an increased likelihood of infection in buffaloes (OR = 11.20; p = 0.01). The results of this study emphasize the necessity for targeted interventions, considering factors like diarrheic condition and stocking density, to effectively manage and control cryptosporidiosis in Bangladesh.

Development and diagnostic evaluation of indirect enzyme linked immunosorbent assay for Epidermophyton floccosum infection in humans

BACKGROUND

Epidermophyton floccosum is an anthrophophilic dermatophyte widely distributed in the tropics and subtropics. It can invade keratinized tissues of humans and cause superficial mycoses called dermatophytosis (ringworm).

OBJECTIVE

The main objective of this study was to develop an in-house indirect enzyme-linked immunosorbent assay (ELISA) and to evaluate its performance for the immunological diagnosis of E. floccosum infection in humans.

METHODS

An in-house indirect ELISA was developed using partially purified E. floccosum antigens, pre immunized rabbit serum as negative control, immunized rabbit polyclonal antibodies as positive control, enzyme labeled goat anti rabbit antibodies and goat anti human antibodies. A total of 50 serum samples from E. floccosum infected patients as confirmed by direct microscopy and culture and 30 samples from humans without history of dermatophyte infection that served as controls were used to evaluate the performance of an in-house indirect ELISA developed in this study. Analytical and diagnostic performance characteristics were determined to evaluate its diagnostic value.

RESULTS

The diagnostic sensitivity, specificity, positive and negative predictive values of E. floccosum indirect ELISA were 90.00 %, 83.33 %, 90.83 %, 83.83 % respectively. The performance of indirect ELISA assay was compared with gold standard diagnostic tests such as KOH hydrolysis test and fungal culture. The correlation coefficients of E. floccosum indirect ELISA with KOH hydrolysis and fungal culture method were 0.612** and 0.826** (P < 0.01) respectively indicating significant correlation between these tests.

CONCLUSION

This revealed the great potentiality of E. floccosum indirect ELISA in early, specific and precise detection of E. floccosum infection in humans.

Aptamer-Based Electrochemical Microfluidic Biosensor for the Detection of Cryptosporidium parvum

Cryptosporidium parvum is a high-risk and opportunistic waterborne parasitic pathogen with highly infectious oocysts that can survive harsh environmental conditions for long periods. Current state-of-the-art methods are limited to lengthy imaging and antibody-based detection techniques that are slow, labor-intensive, and demand trained personnel. Therefore, the development of new sensing platforms for rapid and accurate identification at the point-of-care (POC) is essential to improve public health. Herein, we propose a novel electrochemical microfluidic aptasensor based on hierarchical 3D gold nano-/microislands (NMIs), functionalized with aptamers specific to C. parvum. We used aptamers as robust synthetic biorecognition elements with a remarkable ability to bind and discriminate among molecules to develop a highly selective biosensor. Also, the 3D gold NMIs feature a large active surface area that provides high sensitivity and a low limit of detection (LOD), especially when they are combined with aptamers,. The performance of the NMI aptasensor was assessed by testing the biosensor's ability to detect different concentrations of C. parvum oocysts spiked in different sample matrices, i.e., buffer, tap water, and stool, within 40 min detection time. The electrochemical measurements showed an acceptable LOD of 5 oocysts mL-1 in buffer medium, as well as 10 oocysts mL-1 in stool and tap water media, over a wide linear range of 10-100,000 oocysts mL-1. Moreover, the NMI aptasensor recognized C. parvum oocysts with high selectivity while exhibiting no significant cross-reactivity to other related coccidian parasites. The specific feasibility of the aptasensor was further demonstrated by the detection of the target C. parvum in patient stool samples. Our assay showed coherent results with microscopy and real-time quantitative polymerase chain reaction, achieving high sensitivity and specificity with a significant signal difference (p < 0.001). Therefore, the proposed microfluidic electrochemical biosensor platform could be a stepping stone for the development of rapid and accurate detection of parasites at the POC.

Toward waterborne protozoa detection using sensing technologies

Drought and limited sufficient water resources will be the main challenges for humankind during the coming years. The lack of water resources for washing, bathing, and drinking increases the use of contaminated water and the risk of waterborne diseases. A considerable number of waterborne outbreaks are due to protozoan parasites that may remain active/alive in harsh environmental conditions. Therefore, a regular monitoring program of water resources using sensitive techniques is needed to decrease the risk of waterborne outbreaks. Wellorganized point-of-care (POC) systems with enough sensitivity and specificity is the holy grail of research for monitoring platforms. In this review, we comprehensively gathered and discussed rapid, selective, and easy-to-use biosensor and nanobiosensor technologies, developed for the early detection of common waterborne protozoa.

Diagnosis and control of cryptosporidiosis in farm animals

Cryptosporidium is a pathogenic protozoan parasite infecting the gastrointestinal epithelium of human and animal hosts. In farm animals, cryptosporidiosis causes significant economic losses including deaths in newborn animals, retarded growth, increased labor involved and high cost of drugs. The detection of Cryptosporidium oocysts in fecal samples is traditionally dependent on examination of stained slides by light microscope or by advanced microscopical tools such as: electron microscopy and phase contrast microscopy. Immunological diagnosis using either antibody or antigen detection could offer high sensitivity and specificity. Examples for these tests are Enzyme Linked Immunosorbent Assay (ELISA), Immunochromatographic tests, Immunochromatographic lateral flow (ICLF), Immunofluorescence assays (IFA) and Flow cytometry coupled with cell sorting. Molecular methods could differentiate species and genotypes of Cryptosporidium and help in studying the epidemiological features of this parasite with rapid, simple and sensitive procedures. Nanotechnology-based platforms could improve the sensitivity and specificity of other detection methods like: ELISA, ICLF, IFA and polymerase chain reaction. As the available prophylactic and therapeutic drugs or natural products treatments are insufficient and no approved vaccines are available, the best approach to control this parasite is by following firm hygienic measures. Many vaccine attempts were performed using hyperimmune colostrum, live or attenuated vaccines, recombinant and Deoxyribonucleic acid vaccines. Also, Clustered Regularly Interspaced Short Palindromic Repeats/Cas9 technology could help in Cryptosporidium genome editing to improve drug and vaccine discovery. Another approach that could be useful for assigning drug targets is metabolomics. Probiotics were also used successfully in the treatment of acute diarrhea and they proved a limiting effect on cryptosporidiosis in animal models. In addition, nanotherapy-based approaches could provide a good strategy for improving the potency of any type of drugs against Cryptosporidium and give good anti-cryptosporidial effects. In conclusion, accurate diagnosis using advanced techniques is the key to the control and prevention of cryptosporidiosis.

Development and Preliminary Evaluation of a Nanoparticle-Assisted PCR Assay for the Detection of Cryptosporidium parvum in Calves

C. parvum is an important diarrheal pathogen in humans and animals, especially in young hosts. To accurately and rapidly detect C. parvum infection in calves, we established a nano-PCR assay targeting the cgd3_330 gene for the specific detection of C. parvum. This nano-PCR assay was ten times more sensitive than that of the normal PCR assay by applying the same primers and did not cross-react with C. andersoni, C. bovis, C. ryanae, Balantidium coli, Enterocytozoon bieneusi, Giardia lamblia, and Blastocystis sp. To further test the nano-PCR in clinical settings, a total of 20 faecal samples from calves were examined by using the nano-PCR, the normal PCR, and the nested PCR assays. The positive rates were 30% (6/20), 30% (6/20), and 25% (5/20) for the nano-PCR, the normal PCR, and the nested PCR assays, respectively, indicating that the nano-PCR and the normal PCR assays had the same positive rate (30%). Taken together, the present study could provide a candidate method for the specific detection of C. parvum infection in calves in clinical settings.

Development of Indirect ELISA and its evaluation in Comparison with KOH hydrolysis and Fungal culture for the immuno diagnosis of Trichophyton rubrum and Trichophyton mentagrophytes infection in Humans

Trichophyton is a keratinophilic fungus that can invade keratinized tissues of humans and cause superficial mycoses called dermatophytosis. The objective of this study was to develop and evaluate indirect ELISA in comparison with gold standard methods such as direct microscopic examination of KOH mounts and fungal culture for the diagnosis of Trichophyton infection in humans. The present investigation reports the production and partial purification of T. rubrum mycelial antigens and production of specific polyclonal antibodies. It also reports the development and optimization of indirect ELISA and evaluation of its potential in comparison with gold standard methods for the diagnosis of Trichophyton infection in humans. The diagnostic sensitivity and specificity of Trichophyton indirect ELISA was 93.75% and 93.33 % respectively. The positive and negative predictive values were high as well, found to be 93.75% and 90.00% respectively indicating usefulness of the assay. In all comparisons, the correlation coefficient (r) value was >0.5 indicating strong correlation between KOH hydrolysis test, fungal culture method and indirect ELISA. A significant correlation coefficient of 0.856 (P < 0.0001) was obtained between indirect ELISA and fungal culture method. This shows a good agreement between fungal culture method and indirect ELISA. The present study clearly shows diagnostic performance of Trichophyton indirect ELISA developed in this study is efficient as fungal culture method for the diagnosis of Trichophyton infection in humans.

On-chip-based electrochemical biosensor for the sensitive and label-free detection of Cryptosporidium

Cryptosporidium, an intestinal protozoan pathogen, is one of the leading causes of death in children and diarrhea in healthy adults. Detection of Cryptosporidium has become a high priority to prevent potential outbreaks. In this paper, a simple, easy to fabricate, and cost-effective on-chip-based electrochemical biosensor has been developed for the sensitive and label-free detection of Cryptosporidium oocysts in water samples. The sensor was fabricated using standard lithography using a mask with a 3-electrode design and modified by self-assembling a hybrid of a thiolated protein/G and the specific anti-Cryptosporidium monoclonal antibodies (IgG3). The electrochemical impedance spectroscopy (EIS) was employed to quantitate C. parvum in the range of 0 to 300 oocysts, with a detection limit of approximately 20 oocysts/5 µL. The high sensitivity and specificity of the developed label-free electrochemical biosensor suggest that this novel platform is a significant step towards the development of fast, real-time, inexpensive and label-free sensing tool for early warning and immediate on-site detection of C. parvum oocysts in water samples, as compared to the traditional methods (such as PCR and microscopy). Furthermore, under optimized conditions, this label-free biosensor can be extended to detect other analytes and biomarkers for environmental and biomedical analyses.

Comprehensive review of conventional and state-of-the-art detection methods of Cryptosporidium

Cryptosporidium is a critical waterborne protozoan pathogen found in water resources that have been a major cause of death and serious illnesses worldwide, costing millions of dollars annually for its detection and treatment. Over the past several decades, substantial efforts have been made towards developing techniques for the detection of Cryptosporidium. Early diagnostic techniques were established based on the existing tools in laboratories, such as microscopes. Advancements in fluorescence microscopy, immunological, and molecular techniques have led to the development of several kits for the detection of Cryptosporidium spp. However, these methods have several limitations, such as long processing times, large sample volumes, the requirement for bulky and expensive laboratory tools, and the high cost of reagents. There is an urgent need to improve these existing techniques and develop low-cost, portable and rapid detection tools for applications in the water quality industry. In this review, we compare recent advances in nanotechnology, biosensing and microfluidics that have facilitated the development of sophisticated tools for the detection of Cryptosporidium spp.Finally, we highlight the advantages and disadvantages, of these state-of-the-art detection methods compared to current analytical methodologies and discuss the need for future developments to improve such methods for detecting Cryptosporidium in the water supply chain to enable real-time and on-site monitoring in water resources and remote areas.

Comparison of current methods used to detect Cryptosporidium oocysts in stools

In this review all of the methods that are currently in use for the investigation of Cryptosporidium in stool material are highlighted and critically discussed. It appears that more qualifications and background knowledge in this field regarding the diagnosis of the Cryptosporidium parasite is required. Furthermore, there is no standardization for the protocols that are commonly used to either detect oocysts in faeces or to diagnose the Cryptosporidium infection. It is therefore necessary to initiate further education and research that will assist in improving the accuracy of the diagnosis of Cryptosporidium oocysts in the faecal micro-cosmos. Where ambient concentrations of oocysts are low in stool material, detection becomes a formidable task. Procedures for ring tests and the standardization of multi-laboratory testing are recommended. It is also necessary to enhance the routine surveillance capacity of cryptosporidiosis and to improve the safety against it, considering the fact that this disease is under diagnosed and under reported. This review is intended to stimulate research that could lead to future improvements and further developments in monitoring the diagnostic methodologies that will assist in harmonizing Cryptosporidium oocysts in stool diagnosis.