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Alsaady IM. Cryptosporidium and irritable bowel syndrome. Trop Parasitol 2024; 14:8-15. [PMID: 38444793 PMCID: PMC10911187 DOI: 10.4103/tp.tp_10_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 03/07/2024] Open
Abstract
Cryptosporidium is an apicomplexan parasite that causes gastrointestinal disease in a wide variety of hosts and is associated with waterborne outbreaks. Nonetheless, the parasite is underdiagnosed. Cryptosporidium has been proposed as an etiological cause of irritable bowel syndrome (IBS) in several studies. However, the exact mechanism of pathogenesis is unknown, and no direct link has been discovered. This review will discuss several parasite-induced modifications, such as immunological, microbiome, and metabolite modifications, as well as their interactions. To summarize, Cryptosporidium causes low inflammation, dysbiosis, and unbalanced metabolism, which leads to a lack of homeostasis in the intestine in a comparable pattern to postinfectious IBS.
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Affiliation(s)
- Isra Mohammad Alsaady
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- King Fahad Medical Research Centre, Special Infectious Agents Unit, Jeddah, Saudi Arabia
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Jaskiewicz JJ, Dayao DAE, Girouard D, Sevenler D, Widmer G, Toner M, Tzipori S, Sandlin RD. Scalable cryopreservation of infectious Cryptosporidium hominis oocysts by vitrification. PLoS Pathog 2023; 19:e1011425. [PMID: 37289815 PMCID: PMC10284403 DOI: 10.1371/journal.ppat.1011425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/21/2023] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
Cryptosporidium hominis is a serious cause of childhood diarrhea in developing countries. The development of therapeutics is impeded by major technical roadblocks including lack of cryopreservation and simple culturing methods. This impacts the availability of optimized/standardized singular sources of infectious parasite oocysts for research and human challenge studies. The human C. hominis TU502 isolate is currently propagated in gnotobiotic piglets in only one laboratory, which limits access to oocysts. Streamlined cryopreservation could enable creation of a biobank to serve as an oocyst source for research and distribution to other investigators requiring C. hominis. Here, we report cryopreservation of C. hominis TU502 oocysts by vitrification using specially designed specimen containers scaled to 100 μL volume. Thawed oocysts exhibit ~70% viability with robust excystation and 100% infection rate in gnotobiotic piglets. The availability of optimized/standardized sources of oocysts may streamline drug and vaccine evaluation by enabling wider access to biological specimens.
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Affiliation(s)
- Justyna J. Jaskiewicz
- BioMEMS Resource Center, Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, and Shriners Children`s Boston, Boston, Massachusetts, United States of America
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, United States of America
| | - Denise Ann E. Dayao
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, United States of America
| | - Donald Girouard
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, United States of America
| | - Derin Sevenler
- BioMEMS Resource Center, Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, and Shriners Children`s Boston, Boston, Massachusetts, United States of America
| | - Giovanni Widmer
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, United States of America
| | - Mehmet Toner
- BioMEMS Resource Center, Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, and Shriners Children`s Boston, Boston, Massachusetts, United States of America
| | - Saul Tzipori
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, United States of America
| | - Rebecca D. Sandlin
- BioMEMS Resource Center, Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, and Shriners Children`s Boston, Boston, Massachusetts, United States of America
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Health risks of Cryptosporidium and Giardia in the application of surface water and septic tank effluent in Chinese agriculture: Impact on cancer patients identified by quantitative microbial risk assessment. Food Microbiol 2023; 111:104213. [PMID: 36681401 DOI: 10.1016/j.fm.2022.104213] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/05/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
The protozoa Cryptosporidium and Giardia are major causes of diarrhea and are commonly found on vegetables in China. They pose a health risk, particularly to immunocompromised individuals, including cancer patients. A quantitative microbial risk assessment of Chinese data evaluated the risks of Cryptosporidium and Giardia exposure arising from the application of surface water and septic tank effluent to agricultural land. Exposure via agricultural produce consumption (consumers) and agricultural practices (farmers) was considered for subpopulations of cancer patients and immunocompetent people in urban and rural areas, and risk mitigation scenarios were modelled. The cumulative disease burdens attributable to cryptosporidiosis and giardiasis were, respectively, 9.68×10-6 and 5.57×10-5 disability-adjusted life years per person per year (DALYs pppy) for immunocompetent people, and 3.14×10-5 and 1.51×10-4 DALYs pppy for cancer patients. Cancer patients were approximately three times more likely to have an individual disease burden than immunocompetent people. The disease burden was higher for consumers than farmers, and higher in rural areas than urban areas (all exceeding the maximum recommended by the World Health Organization). The highest burdens were in provinces of high population, such as Henan, Guangdong, and Sichuan, while the burden associated with human and livestock fecal effluent application was higher than with surface water irrigation. Of the three vegetables studied, lettuce posed the greatest risk, followed by bok choy, while cucumber posed the least risk. Risk mitigation scenario analysis showed that pre-treatment of surface water and feces, and appropriate post-harvest handling of vegetables, including disinfection, cooking, and adequate surface heat treatment (75 °C for 60 s), should be considered when attempting to reduce disease burdens. The methodology and findings of this study are useful for evaluating and reducing the burden of Cryptosporidium and Giardia infections associated with agricultural irrigation and fertilization practices, particularly on cancer patients.
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McKerr C, Chalmers RM, Elwin K, Ayres H, Vivancos R, O’Brien SJ, Christley RM. Cross-sectional household transmission study of Cryptosporidium shows that C. hominis infections are a key risk factor for spread. BMC Infect Dis 2022; 22:114. [PMID: 35105330 PMCID: PMC8807379 DOI: 10.1186/s12879-022-07086-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/07/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Infection with the Cryptosporidium parasite causes over 4000 cases of diagnosed illness (cryptosporidiosis) in England and Wales each year. The incidence of sporadic disease has not been sufficiently established, and how frequently this arises from contact with other infected people is not well documented. This project aimed to explore potential transmission in the home and attempt to identify asymptomatic infections, which might play a role in transmission. Risk factors and characteristics associated with spread of infection in the home were described including any differences between Cryptosporidium species. METHODS The study identified cryptosporidiosis cases from North West England and Wales over a year and invited them and their household to take part. Each household was sent a study pack containing study information and a questionnaire, and stool sample kits to provide samples from consenting household members. Cryptosporidium-positive stool samples, identified by immunofluorescence microscopy, were characterised using molecular methods to help describe any patterns of transmission. Characteristics of households with and without additional cases were described, and compared using odds ratios (OR) and a multivariable logistic regression identified independent risk factors for household transmission. Data collection ran for one year, beginning in September 2018 with an initial pilot phase. RESULTS We enrolled 128 index cases and their households. Additional illness occurred in over a quarter of homes, each reporting an average of two additional cases. The majority of these were undiagnosed and unreported to surveillance. This burden was even greater in households where the index case was infected with C. hominis versus C. parvum, or the index case was under five years old, with mums and siblings most at risk of secondary infection. Only having an index case of C. hominis was independently associated with transmission in the multivariable model (OR 4.46; p = 0.01). CONCLUSIONS Cryptosporidium was a considerable burden in the home. At-risk homes were those where the index was less than five years old and/or infected with C. hominis. Of particular risk were female caregivers and siblings. Hygiene advice should be specifically directed here. This work provides evidence for humans as sources of C. hominis infection and that person-person is a key pathway. We recommend that all stools submitted for the investigation of gastrointestinal pathogens are tested for Cryptosporidium to better capture cases, inclusion of speciation data in routine surveillance, and the consideration of specific clinical advice on prevention for high-risk homes.
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Affiliation(s)
- Caoimhe McKerr
- NIHR Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, The University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Swansea Medical School, Swansea University, Swansea, UK
- Present Address: Public Health Wales, Cardiff, UK
| | - Rachel M. Chalmers
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, UK
- Swansea Medical School, Swansea University, Swansea, UK
- Present Address: Public Health Wales, Cardiff, UK
| | - Kristin Elwin
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, UK
- Present Address: Public Health Wales, Cardiff, UK
| | - Heather Ayres
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, UK
- Present Address: Public Health Wales, Cardiff, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, The University of Liverpool, Liverpool, UK
- Field Epidemiology Services, Public Health England, Liverpool, UK
| | - Sarah J. O’Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, The University of Liverpool, Liverpool, UK
| | - Robert M. Christley
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, The University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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Treatment of human intestinal cryptosporidiosis: A review of published clinical trials. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2021; 17:128-138. [PMID: 34562754 PMCID: PMC8473663 DOI: 10.1016/j.ijpddr.2021.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 12/01/2022]
Abstract
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.
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Ahmed SA, Karanis P. Cryptosporidium and Cryptosporidiosis: The Perspective from the Gulf Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6824. [PMID: 32962045 PMCID: PMC7558405 DOI: 10.3390/ijerph17186824] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022]
Abstract
The present review discusses the burden of cryptosporidiosis in the Gulf Cooperation Council (GCC), which is underreported and underestimated. It emphasizes that the Cryptosporidium parasite is infecting inhabitants and expatriates in the Gulf countries. Children under 5 years are a vulnerable group that is particularly affected by this parasitic disease and can act as carriers, who contribute to the epidemiology of the disease most probably via recreational swimming pools. Various risk factors for cryptosporidiosis in the GCC countries are present, including expatriates, predisposing populations to the infection. Water contamination, imported food, animal contact, and air transmission are also discussed in detail, to address their significant role as a source of infection and, thus, their impact on disease epidemiology in the Gulf countries' populations.
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Affiliation(s)
- Shahira A. Ahmed
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt;
| | - Panagiotis Karanis
- Medical Faculty and University Hospital, University of Cologne, 50937 Cologne, Germany
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, CY-1700 Nicosia 24005, Cyprus
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Carter BL, Chalmers RM, Davies AP. Health sequelae of human cryptosporidiosis in industrialised countries: a systematic review. Parasit Vectors 2020; 13:443. [PMID: 32887663 PMCID: PMC7650228 DOI: 10.1186/s13071-020-04308-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cryptosporidium is a protozoan parasite which is a common cause of gastroenteritis worldwide. In developing countries, it is one of the most important causes of moderate to severe diarrhoea in young children; in industrialised countries it is a cause of outbreaks of gastroenteritis associated with drinking water, swimming pools and other environmental sources and a particular concern in certain immunocompromised patient groups, where it can cause severe disease. However, over recent years, longer-term sequelae of infection have been recognised and a number of studies have been published on this topic. The purpose of this systematic review was to examine the literature in order to better understand the medium- to long-term impact of cryptosporidiosis. METHODS This was a systematic review of studies in PubMed, ProQuest and Web of Science databases, with no limitations on publication year or language. Studies from any country were included in qualitative synthesis, but only those in industrialised countries were included in quantitative analysis. RESULTS Fifteen studies were identified for qualitative analysis which included 3670 Cryptosporidium cases; eight studies conducted in Europe between 2004-2019 were suitable for quantitative analysis, including five case-control studies. The most common reported long-term sequelae were diarrhoea (25%), abdominal pain (25%), nausea (24%), fatigue (24%) and headache (21%). Overall, long-term sequelae were more prevalent following infection with Cryptosporidium hominis, with only weight loss and blood in stool being more prevalent following infection with Cryptosporidium parvum. Analysis of the case-control studies found that individuals were 6 times more likely to report chronic diarrhoea and weight loss up to 28 months after a Cryptosporidium infection than were controls. Long-term abdominal pain, loss of appetite, fatigue, vomiting, joint pain, headache and eye pain were also between 2-3 times more likely following a Cryptosporidium infection. CONCLUSIONS This is the first systematic review of the long-term sequelae of cryptosporidiosis. A better understanding of long-term outcomes of cryptosporidiosis is valuable to inform the expectations of clinicians and their patients, and public health policy-makers regarding the control and prevention of this infection. Systematic review registration PROSPERO Registration number CRD42019141311.
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Affiliation(s)
- Bethan L Carter
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK
| | - Rachel M Chalmers
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK.,Cryptosporidium Reference Unit, Public Health Wales Microbiology, Singleton Hospital, Sketty Lane, Swansea, Wales, UK
| | - Angharad P Davies
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK. .,Cryptosporidium Reference Unit, Public Health Wales Microbiology, Singleton Hospital, Sketty Lane, Swansea, Wales, UK.
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Pineda CO, Leal DAG, Fiuza VRDS, Jose J, Borelli G, Durigan M, Pena HFJ, Bueno Franco RM. Toxoplasma
gondii
oocysts,
Giardia
cysts and
Cryptosporidium
oocysts in outdoor swimming pools in Brazil. Zoonoses Public Health 2020; 67:785-795. [DOI: 10.1111/zph.12757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Carolina Ortiz Pineda
- Laboratório de Protozoologia Departamento de Biologia Animal Instituto de Biologia Universidade Estadual de Campinas (UNICAMP) Campinas Brazil
| | - Diego Averaldo Guiguet Leal
- Laboratório de Parasitologia Ambiental Departamento de Patologia Básica, Setor de Ciências Biológicas Universidade Federal do Paraná (UFPR) Curitiba Brazil
| | - Vagner Ricardo da Silva Fiuza
- Instituto de Biociências, Parasitologia Animal Universidade Federal do Mato Grosso do Sul (UFMS) Campo Grande Brazil
| | - Juliana Jose
- Laboratório de Genômica e Expressão Departamento de Genética Evolução e Bioagentes Instituto de Biologia Universidade Estadual de Campinas (UNICAMP) Campinas Brazil
| | - Guilherme Borelli
- Laboratório de Genômica e Expressão Departamento de Genética Evolução e Bioagentes Instituto de Biologia Universidade Estadual de Campinas (UNICAMP) Campinas Brazil
| | | | - Hilda Fátima Jesus Pena
- Laboratório de Doenças Parasitárias Departamento de Medicina Veterinária Preventiva e Saúde Animal Faculdade de Medicina Veterinária e Zootecnia Universidade de São Paulo (USP) São Paulo Brazil
| | - Regina Maura Bueno Franco
- Laboratório de Protozoologia Departamento de Biologia Animal Instituto de Biologia Universidade Estadual de Campinas (UNICAMP) Campinas Brazil
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