Challenges and Innovative Strategies to Interrupt Cryptosporidium Transmission in Resource-Limited Settings

Water Disinfection Systems for Pools and Spas: Advantages, Disadvantages, and Consumer Views in the US

Disinfection of swimming pools and hot tubs (pools/spas) are necessary to prevent outbreaks and exposure to waterborne pathogens from water recreation. However, harmful disinfection byproducts (DBPs) from heavy chlorine usage continue to be a growing concern. Chlorine-based disinfectants also react with human inputs like sweat, urine, cosmetics, sunscreen, etc., that are introduced in a pool/spa, further increasing the severity of the DBP problem. We reviewed the current status of water disinfection technologies in the pool/spa industry and summarize the methods, trends, advantages, and disadvantages from a health and consumer viewpoint. Market research and face-to-face interviews were also accomplished with 100 industry experts and end-users in the US. We then integrate the literature findings in parallel with these market insights. Overall, we conclude the future of water recreation is trending away from high dosage chlorine-based solutions to disinfect swimming water and turning to alternatives with better sustainability and safety in mind. Lastly, we discuss the future directions of these technologies with current and past trends, offering insights to where research and development should be focused for both the user's health and overall experience.

Molecular identification and antiprotozoal activity of silver nanoparticles on viability of Cryptosporidium parvum isolated from pigeons, pigeon fanciers and water

Cryptosporidium is a protozoan that causes acute gastroenteritis, abdominal pain, and diarrhea in many vertebrate species, including humans, animals and birds. A number of studies have reported the occurrence of Cryptosporidium in domestic pigeons. Thus, this study aimed to identify Cryptosporidium spp. in samples collected from domestic pigeons, pigeon fanciers, and drinking water, as well as to investigate the antiprotozoal activity of biosynthesized silver nanoparticles (AgNPs) on the viability of isolated Cryptosporidium parvum (C. parvum). Samples were collected from domestic pigeons (n = 150), pigeon fanciers (n = 50), and drinking water (n = 50) and examined for the presence of Cryptosporidium spp. using microscopic and molecular techniques. The antiprotozoal activity of AgNPs was then assessed both in vitro and in vivo. Cryptosporidium spp. was identified in 16.4% of all examined samples, with C. parvum identified in 5.6%. The highest frequency of isolation was from domestic pigeon, rather than from pigeon fanciers or drinking water. In domestic pigeons, there was a significant association between Cryptosporidium spp. positivity and pigeon's age, droppings consistency, housing, hygienic and heath conditions. However, Cryptosporidium spp. positivity was only significantly associated with pigeon fanciers' gender and heath condition. The viability of C. parvum oocysts was reduced using AgNPs at various concentrations and storage times in a descending manner. In an in vitro study, the highest reduction in C. parvum count was observed at the AgNPs concentration of 1000 µg/mL after a 24 h contact time, followed by the AgNPs concentration of 500 µg/mL after a 24 h contact time. However, after a 48 h contact time, a complete reduction was observed at both 1000 and 500 µg/mL concentrations. Overall, the count and viability of C. parvum decreased with increasing the AgNPs concentration and contact times in both the in vitro and in vivo studies. Furthermore, the C. parvum oocyst destruction was time-dependent and increased with increasing the contact time at various AgNPs concentrations.

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.

QSAR and deep learning model for virtual screening of potential inhibitors against Inosine 5' Monophosphate dehydrogenase (IMPDH) of Cryptosporidium parvum

Cryptosporidium parvum (Cp) causes a gastro-intestinal disease called Cryptosporidiosis. C. parvum Inosine 5' monophosphate dehydrogenase (CpIMPDH) is responsible for the production of guanine nucleotides. In the present study, 37 known urea-based congeneric compounds were used to build a 2D and 3D QSAR model against CpIMPDH. The built models were validated based on OECD principles. A deep learning model was adopted from a framework called Deep Purpose. The model was trained with 288 known active compounds and validated using a test set. From the training set of the 3D QSAR, a pharmacophore model was built and the best pharmacophore hypotheses were scored and sorted using a phase-hypo score. A phytochemical database was screened using both the pharmacophore model and a deep learning model. The screened compounds were considered for glide XP docking, followed by quantum polarized ligand docking. Finally, the best compound among them was considered for molecular dynamics simulation study.

Treatment of human intestinal cryptosporidiosis: A review of published clinical trials

The global burden of diarrhea caused by Cryptosporidium parasite is underestimated. In immunocompromised hosts, chronic and severe presentation of intestinal cryptosporidiosis can result in long-term morbidity and high illness costs. The evidence of effective treatments for cryptosporidiosis has been lacking. We reviewed the published clinical trials to bring forward the feasible therapeutic options of human cryptosporidiosis in various populations and settings according to clinical improvement and parasite clearance rates. A total of 42 studies consisting of the use of nitazoxanide, paromomycin, macrolides, somatostatin analogues, letrazuril, albendazole, rifaximin, miltefosine, clofazimine, and colostrum were included in the review. The trials were mostly conducted in small number of individuals infected with human immunodeficiency virus (HIV), and there is inadequate data of controlled trials to suggest the use of these treatment modalities. Nitazoxanide was reported to be highly efficacious only in immunocompetent hosts and was found to be superior to paromomycin in the same group of patients. Macrolides showed no effective results in both clinical and parasitological improvement. Human bovine colostrum should possibly be administered as one of complementary therapeutic modalities along with other antimicrobials to reach optimal parasite eradication. Other trials of therapeutic modalities were terminated due to futility. Currently, available data is intended to aid the development of strategies for improving access to treatments in different clinical settings, as well as to help guide further studies on treatments of human intestinal cryptosporidiosis.

Current pharmacotherapy of cryptosporidiosis: an update of the state-of-the-art

Introduction: Cryptosporidiosis has emerged as a major cause of diarrheal disease worldwide. It has especially serious health consequences for young, malnourished children living in endemic areas and for individuals with highly impaired T-cell function, such as HIV-positive individuals with low CD4 counts or immunosuppressed solid-organ transplant recipients.Areas covered: A selective literature search using PubMed was performed to review the available therapeutics to treat cryptosporidiosis, as well as related advances in drug development.Expert opinion: The only FDA-approved antiparasitic treatment in immunocompetent patients is nitazoxanide; however, it has failed to demonstrate convincing effectiveness among HIV-positive patients, immunosuppressed individuals and malnourished children. Thus, restoring HIV-positive patients' cellular immune response through effective antiretroviral therapy (ART), or reducing or changing immunosuppressive drugs, is important. Several new targets have been identified for chemotherapy, and the development of drugs for these targets has progressed, including parasite kinases, nucleic acid synthesis and processing, proteases and lipid metabolism. Candidate drugs that have been shown to be effective and safe in a neonatal calf model will most likely constitute the next advance for clinical trials in humans. However, developing an effective and inexpensive vaccination, as well as complementing structural preventive measures, would most decisively reduce the global cryptosporidiosis burden.

Identification of adaptive inhibitors of Cryptosporidium parvum fatty acyl-coenzyme A synthetase isoforms by virtual screening

Cryptosporidiosis is a significant cause of gastroenteritis in both humans and livestock in developing countries. The only FDA-approved drug available against the same is nitazoxanide, with questionable efficacy in malnourished children and immunocompromised patients. Recent in vitro studies have indicated the viability of Triacsin C as a potential drug candidate, which targets the parasite's long-chain fatty acyl coenzyme A synthetase enzyme (LC-FACS), a critical component of the fatty acid metabolism pathway. We have used this molecule as a baseline to propose more potent versions thereof. We have applied a combined approach of substructure replacement, literature search, and database screening to come up with 514 analogs of Triacsin C. A virtual screening protocol was carried out which lead us to identify a potential hit compound. This was further subjected to a 100-ns molecular dynamics simulation in complex to determine its stability and binding characteristics. After which, the ADME/tox properties were predicted to assess its viability as a drug. The molecule R134 was identified as the best hit due to its highest average binding affinity, stability in complex when subjected to MD simulations, and reasonable predicted ADMET (Absorption, Distribution, Metabolism, Excretion and Toxicity) properties comparable to those of the Triacsin C parent molecule. We have proposed R134 as a putative drug candidate against the Cryptosporidium parvum LC-FACS enzyme isoforms, following an in silico protocol. We hope the results will be helpful when planning future in vitro experiments for identifying drugs against Cryptosporidium.

Antiprotozoal activity of silver nanoparticles against Cryptosporidium parvum oocysts: New insights on their feasibility as a water disinfectant

Cryptosporidium is a protozoan of extremely medical and veterinary impact; whose oocysts donate a considerable resistant to the water treatment processes. Therefore, this study aimed to explore the impacts of silver nanoparticles (AgNPs) on count and viability of the Cryptosporidium parvum (CP) isolated from different tap water samples. The oocysts were exposed to AgNPs at different dosages of 0.05, 0.1 and 1 ppm for several contact times (30 min to 4 h). The results showed a significant decrease in oocyst count and viability in a dose-dependent manner. Additionally, AgNPs at a conc. of 1 ppm for 30 min and 0.1 ppm for 1 h reduced the oocysts by 97.2 and 94.4%, respectively. Comparatively, there was a noticeable increase in the oocyst's viability at 2 and 4 h, which emphasized that the time of contact between AgNPs and CP was not a major influencing factor for successful application of AgNPs in the nano-water treatment.

Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008-2012: The Global Enteric Multicenter Study (GEMS)

Background

Cryptosporidium is a leading cause of moderate-to-severe diarrhea (MSD) in young children in Africa. We examined factors associated with Cryptosporidium infection in MSD cases enrolled at the rural western Kenya Global Enteric Multicenter Study (GEMS) site from 2008-2012.

Methodology/Principal findings

At health facility enrollment, stool samples were tested for enteric pathogens and data on clinical, environmental, and behavioral characteristics collected. Each child’s health status was recorded at 60-day follow-up. Data were analyzed using logistic regression. Of the 1,778 children with MSD enrolled as cases in the GEMS-Kenya case-control study, 11% had Cryptosporidium detected in stool by enzyme immunoassay; in a genotyped subset, 81% were C. hominis. Among MSD cases, being an infant, having mucus in stool, and having prolonged/persistent duration diarrhea were associated with being Cryptosporidium-positive. Both boiling drinking water and using rainwater as the main drinking water source were protective factors for being Cryptosporidium-positive. At follow-up, Cryptosporidium-positive cases had increased odds of being stunted (adjusted odds ratio [aOR] = 1.65, 95% CI: 1.06–2.57), underweight (aOR = 2.08, 95% CI: 1.34–3.22), or wasted (aOR = 2.04, 95% CI: 1.21–3.43), and had significantly larger negative changes in height- and weight-for-age z-scores from enrollment.

Conclusions/Significance

Cryptosporidium contributes significantly to diarrheal illness in young children in western Kenya. Advances in point of care detection, prevention/control approaches, effective water treatment technologies, and clinical management options for children with cryptosporidiosis are needed.

Cryptosporidium is an important cause of childhood diarrhea. Research on cryptosporidiosis in countries where it is endemic remains limited; few studies have comprehensively examined risk factors for children in Kenya and similar settings. We examined characteristics associated with Cryptosporidium in children with moderate-to-severe diarrhea in rural western Kenya. We found there is little to clinically distinguish cryptosporidiosis from other childhood diarrhea in the absence of point of care diagnostics. Infants had the highest odds of Cryptosporidium infection; it has been previously established that Cryptosporidium infections in infancy can have severe consequences. Prolonged/persistent duration diarrhea and growth shortfalls were significantly more pronounced among cases with Cryptosporidium. Undernutrition and stunting in children in low- and middle-income countries have predicted decreased cognitive and school performance, thus long-term consequences could be appreciable. Using rainwater as the primary drinking water source and boiling drinking water were protective against Cryptosporidium infection, thus certain water sources may contribute to transmission. Like other studies in Kenya, we predominantly identified Cryptosporidium hominis, an anthropogenic species. Advances in point of care detection, prevention and control approaches, effective water treatment technologies, and clinical management options are needed to mitigate the potentially severe and long-term consequences of Cryptosporidium infection in children.

Identification of novel therapeutic candidates in Cryptosporidium parvum: an in silico approach

Unavailability of vaccines and effective drugs are primarily responsible for the growing menace of cryptosporidiosis. This study has incorporated a bioinformatics-based screening approach to explore potential vaccine candidates and novel drug targets in Cryptosporidium parvum proteome. A systematic strategy was defined for comparative genomics, orthology with related Cryptosporidium species, prioritization parameters and MHC class I and II binding promiscuity. The approach reported cytoplasmic protein cgd7_1830, a signal peptide protein, as a novel drug target. SWISS-MODEL online server was used to generate the 3D model of the protein and was validated by PROCHECK. The model has been subjected to in silico docking study with screened potent lead compounds from the ZINC database, PubChem and ChEMBL database using Flare software package of Cresset®. Furthermore, the approach reported protein cgd3_1400, as a vaccine candidate. The predicted B- and T-cell epitopes on the proposed vaccine candidate with highest scores were also subjected to docking study with MHC class I and II alleles using ClusPro web server. Results from this study could facilitate selection of proteins which could serve as drug targets and vaccine candidates to efficiently tackle the growing threat of cryptosporidiosis.