Human Cryptosporidiosis: An insight into Epidemiology, Modern Diagnostic Tools and Recent Drug Discoveries

Arsalan Zafar, Muhammad Kasib Khan, Zaheer Abbas, Rao Zahid Abbas, Zia ud Din Sindhu, Zafar Iqbal, Muhammad Shafi Hasni, Hasnain Javed, Muhammad Nadeem, Hammad Ur Rehman Bajwa, Muhammad Adnan Sabir Mughal, Fatima Yasin

Abstract


Cryptosporidiosis is an emerging food and water borne zoonotic disease, which is caused by genusCryptosporidium. The first Cryptosporidium spp. was isolated from mice in 1907 and gained importance when it was found in an HIV positive patient. It usually causes self-limiting diarrhea in young children and immunocompetent patients. However, it may lead to chronic diarrhea with life threatening condition in immunocompromised patients. Other complications related to this transmittable infection may include respiratory problems, skin rashes and headache. HIV/AIDS patients are highly susceptible host for this parasite. Cryptosporidium parvum and Cryptosporidium hominis are the known pathogenic species, prevalent among humans and they are being transmitted through contaminated food and water. Usually, the diagnosis of Cryptosporidium spp. is dependent on microscopic technique in many countries, which has a low sensitivity and specificity leading to false positive results. However, for a step forward to successful epidemiological studies, advanced techniques (Serological and DNA-based) provide us the better ways of diagnosis with more sensitivity and specificity. Furthermore, no antiparasitic drug has found to be effective againstCryptosporidium spp. except Nitazoxanide which is FDA-approved and effective only when administered along with antiretroviral therapy. In this regard, present review summarizes the various epidemiological studies conducted around the globe along with modern diagnostic tools and the suitable treatment available now a days. This systemized review will help the scientists to better understand all the aspects of cryptosporidiosis at one platform which may help in designing surveillance studies through selection of sensitive diagnostic techniques. The new drugs mentioned in this review may also help to better control this parasite in humans, especially immunocompromised individuals.


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References


Vanathy K, Parija SC, Mandal J, Hamide A, Krishnamurthy S. Cryptosporidiosis: A mini review. Tropical parasitology, (2017); 7(2): 72.

Jirku M, Valigurová A, Koudela B, Krízek J, Modrý D, et al. New species of Cryptosporidium Tyzzer, 1907 (Apicomplexa) from amphibian host: morphology, biology and phylogeny. Folia parasitologica, (2008); 55(2): 81.

Feng Y, Ryan UM, Xiao L. Genetic diversity and population structure of Cryptosporidium. Trends in parasitology, (2018).

Xiao L, Fayer R, Ryan U, Upton SJ. Cryptosporidium taxonomy: recent advances and implications for public health. Clinical microbiology reviews, (2004); 17(1): 72-97.

Kabir M, Ahmed E, Hossain B, Alam M, Ahmed S, et al. Giardia/Cryptosporidium QUIK CHEK® Assay is more Specific than qPCR for Rapid Point-of-care Diagnosis of Cryptosporidiosis in Infants in Bangladesh. Clinical Infectious Diseases, (2018); 67(12): 1897-1903.

Checkley W, White Jr AC, Jaganath D, Arrowood MJ, Chalmers RM, et al. A review of the global burden, novel diagnostics, therapeutics, and vaccine targets for cryptosporidium. The Lancet Infectious Diseases, (2015); 15(1): 85-94.

Fayer R. Taxonomy and species delimitation in Cryptosporidium. Experimental parasitology, (2010); 124(1): 90-97.

Akinbo FO, Okaka CE, Omoregie R, Dearen T, Leon ET, et al. Molecular characterization of Cryptosporidium spp. in HIV-infected persons in Benin City, Edo State, Nigeria. Fooyin Journal of Health Sciences, (2010); 2(3-4): 85-89.

Abdel-Messih IA, Wierzba TF, Abu-Elyazeed R, Ibrahim AF, Ahmed SF, et al. Diarrhea associated with Cryptosporidium parvum among young children of the Nile River Delta in Egypt. Journal of Tropical Pediatrics, (2005); 51(3): 154-159.

Mbae CK, Nokes DJ, Mulinge E, Nyambura J, Waruru A, et al. Intestinal parasitic infections in children presenting with diarrhoea in outpatient and inpatient settings in an informal settlement of Nairobi, Kenya. BMC Infectious Diseases, (2013); 13(1): 243.

Delahoy MJ, Omore R, Ayers TL, Schilling KA, Blackstock AJ, et al. 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). PLoS neglected tropical diseases, (2018); 12(7): e0006640.

Goma F, Geurden T, Siwila J, Phiri I, Gabriël S, et al. The prevalence and molecular characterisation of Cryptosporidium spp. in small ruminants in Zambia. Small Ruminant Research, (2007); 72(1): 77-80.

Mensah G, Bosompem K, Ayeh-Kumi P, Oppong J, Niampoma S. Epidemiology of Cryptosporidium Sp Upstream the Water Treatment Plants in Kpong and Weija, Ghana. Ghana Journal of Science, (2018); 585-11.

Marques SMT. Cryptosporidiosis in Horses of Urban Areas of Porto Alegre, Rio Grande do Sul, Southern Brazil. Journal of equine veterinary science, (2010); 30(7): 356-358.

Iqbal A, Goldfarb DM, Slinger R, Dixon BR. Prevalence and molecular characterization of Cryptosporidium spp. and Giardia duodenalis in diarrhoeic patients in the Qikiqtani Region, Nunavut, Canada. International journal of circumpolar health, (2015); 74(1): 27713.

Gatei W, Barrett D, Lindo JF, Eldemire-Shearer D, Cama V, et al. Unique Cryptosporidium population in HIV-infected persons, Jamaica. Emerging Infectious Diseases, (2008); 14(5): 841.

Alonso‐Fresan M, Garcia‐Alvarez A, Salazar‐Garcia F, Vázquez‐Chagoyán J, Pescador‐Salas N, et al. Prevalence of Cryptosporidium spp. in asymptomatic sheep in family flocks from Mexico State. Journal of Veterinary Medicine, Series B, (2005); 52(10): 482-483.

Giangaspero A, Iorio R, Paoletti B, Traversa D, Capelli G. Molecular evidence for Cryptosporidium infection in dogs in Central Italy. Parasitology Research, (2006); 99(3): 297-299.

Causape A, Quilez J, Sanchez-Acedo C, Del Cacho E. Prevalence of intestinal parasites, including Cryptosporidium parvum, in dogs in Zaragoza city, Spain. Veterinary parasitology, (1996); 67(3-4): 161-167.

Quilez J, Sanchez-Acedo C, Del Cacho E, Clavel A, Causape A. Prevalence of Cryptosporidium and Giardia infections in cattle in Aragon (northeastern Spain). Veterinary Parasitology, (1996); 66(3-4): 139-146.

Chilvers B, Cowan P, Waddington D, Kelly P, Brown T. The prevalence of infection of Giardia spp. and Cryptosporidium spp. in wild animals on farmland, southeastern North Island, New Zealand. International Journal of Environmental Health Research, (1998); 8(1): 59-64.

Winkworth C, Matthaei C, Townsend C. Prevalence of Giardia and Cryptosporidium spp in calves from a region in New Zealand experiencing intensifi cation of dairying. New Zealand veterinary journal, (2008); 56(1): 15-20.

Atwill ER, Sweitzer RA, Pereira M, Gardner IA, Van Vuren D, et al. Prevalence of and associated risk factors for shedding Cryptosporidium parvum oocysts and Giardia cysts within feral pig populations in California. Applied and Environmental Microbiology, (1997); 63(10): 3946-3949.

Wang A, Ruch-Gallie R, Scorza V, Lin P, Lappin MR. Prevalence of Giardia and Cryptosporidium species in dog park attending dogs compared to non-dog park attending dogs in one region of Colorado. Veterinary Parasitology, (2012); 184(2-4): 335-340.

Leach CT, Koo FC, Kuhls TL, Hilsenbeck SG, Jenson HB. Prevalence of Cryptosporidium parvum infection in children along the Texas-Mexico border and associated risk factors. The American journal of tropical medicine and hygiene, (2000); 62(5): 656-661.

Rickard LG, Siefker C, Boyle CR, Gentz EJ. The prevalence of Cryptosporidium and Giardia spp. in fecal samples from free-ranging white-tailed deer (Odocoileus virginianus) in the southeastern United States. Journal of Veterinary Diagnostic Investigation, (1999); 11(1): 65-72.

Petri Jr WA, Haque R, Mondal D, Karim A, Molla IH, et al. Prospective case-control study of the association between common enteric protozoal parasites and diarrhea in Bangladesh. Clinical Infectious Diseases, (2009); 48(9): 1191-1197.

Mallinath HK, G Chikkachowdappa P, K Javare Gowda A, E D’Souza P. Studies on the prevalence of cryptosporidiosis in bovines in organized dairy farms in and around Bangalore, South India. Veterinarski arhiv, (2009); 79(5): 461-470.

Bhat S, Juyal P, Singla L. Prevalence of cryptosporidiosis in neonatal buffalo calves in Ludhiana district of Punjab, India. Asian J Anim Vet Adv, (2012); 7(6): 512-520.

Ghoshal U, Jain V, Dey A, Ranjan P. Evaluation of enzyme linked immunosorbent assay for stool antigen detection for the diagnosis of cryptosporidiosis among HIV negative immunocompromised patients in a tertiary care hospital of northern India. Journal of infection and public health, (2018); 11(1): 115-119.

Rahi AA, Magda A, Al-Charrakh AH. Prevalence of Cryptosporidium parvum among children in Iraq. American Journal of Life Sciences, (2013); 1(6): 256-260.

Butty E. Detection of Cryptosporidium and Giardia doudenalis in equines in Nineveh, Iraq. Iraqi Journal of Veterinary Sciences, (2011); 25(2): 43-46.

Ahamed I, Yadav A, Katoch R, Godara R, Saleem T, et al. Prevalence and analysis of associated risk factors for Cryptosporidium infection in lambs in Jammu district. Journal of parasitic diseases, (2015); 39(3): 414-417.

Ghimire P, Sapkota D, Manandhar SP. Cryptosporidiosis: opportunistic infection in HIV/AIDS patients in Nepal. J Trop Med Parasitol, (2004); 277-10.

Nasir A, Avais M, Khan M, Ahmad N. Prevalence of Cryptosporidium parvum infection in Lahore (Pakistan) and its association with diarrhea in dairy calves. Int J Agric Biol, (2009); 11(2): 221-224.

Mumtaz S, Ahmed J, Ali L. Frequency of cryptosporidium infection in children under five years of age having diarrhea in the North West of Pakistan. African Journal of Biotechnology, (2010); 9(8); 1230-1235.

Srisuphanunt M, Karanis P, Charoenca N, Boonkhao N, Ongerth JE. Cryptosporidium and Giardia detection in environmental waters of southwest coastal areas of Thailand. Parasitology research, (2010); 106(6): 1299-1306.

Waldron LS, Dimeski B, Beggs PJ, Ferrari BC, Power ML. Molecular epidemiology, spatiotemporal analysis, and ecology of sporadic human cryptosporidiosis in Australia. Applied and environmental microbiology, (2011); 77(21): 7757-7765.

Power M, Shanker S, Sangster N, Veal D. Evaluation of a combined immunomagnetic separation/flow cytometry technique for epidemiological investigations of Cryptosporidium in domestic and Australian native animals. Veterinary parasitology, (2003); 112(1-2): 21-31.

Ryan U, Samarasinghe B, Read C, Buddle J, Robertson I, et al. Identification of a novel Cryptosporidium genotype in pigs. Applied and Environmental Microbiology, (2003); 69(7): 3970-3974.

Karanis P, Kourenti C, Smith H. Waterborne transmission of protozoan parasites: a worldwide review of outbreaks and lessons learnt. Journal of water and health, (2007); 5(1): 1-38.

Thompson RA, Colwell DD, Shury T, Appelbee AJ, Read C, et al. The molecular epidemiology of Cryptosporidium and Giardia infections in coyotes from Alberta, Canada, and observations on some cohabiting parasites. Veterinary parasitology, (2009); 159(2): 167-170.

Abrahamsen MS, Templeton TJ, Enomoto S, Abrahante JE, Zhu G, et al. Complete genome sequence of the apicomplexan, Cryptosporidium parvum. Science, (2004); 304(5669): 441-445.

Muchiri JM, Ascolillo L, Mugambi M, Mutwiri T, Ward HD, et al. Seasonality of Cryptosporidium oocyst detection in surface waters of Meru, Kenya as determined by two isolation methods followed by PCR. Journal of water and health, (2009); 7(1): 67-75.

Bomfim T, Huber F, Gomes R, Alves L. Natural infection by Giardia sp. and Cryptosporidium sp. in dairy goats, associated with possible risk factors of the studied properties. Veterinary parasitology, (2005); 134(1-2): 9-13.

El-Khodery SA, Osman SA. Cryptosporidiosis in buffalo calves (Bubalus bubalis): prevalence and potential risk factors. Tropical animal health and production, (2008); 40(6): 419-426.

Tian L-G, Chen J-X, Wang T-P, Cheng G-J, Steinmann P, et al. Co-infection of HIV and intestinal parasites in rural area of China. Parasites & vectors, (2012); 5(1): 36.

Adjei AA, Armah H, Rodrigues O, Renner L, Borketey P, et al. Cryptosporidium spp., a frequent cause of diarrhea among children at the Korle-Bu Teaching Hospital, Accra, Ghana. Japanese journal of infectious diseases, (2004); 57(5): 216-219.

Wumba R, Longo-Mbenza B, Menotti J, Mandina M, Kintoki F, et al. Epidemiology, clinical, immune, and molecular profiles of microsporidiosis and cryptosporidiosis among HIV/AIDS patients. International journal of general medicine, (2012); 5603.

Smith H (2007) Diagnostics. Cryptosporidium and Cryptosporidiosis, Second Edition: CRC Press. pp. 181-215.

Smith H, Caccio S, Cook N, Nichols R, Tait A. Cryptosporidium and Giardia as foodborne zoonoses. Veterinary parasitology, (2007); 149(1-2): 29-40.

Uppal B, Singh O, Chadha S, Jha AK. A comparison of nested PCR assay with conventional techniques for diagnosis of intestinal cryptosporidiosis in AIDS cases from northern India. Journal of parasitology research, (2014); 2014.

Nyamwange CI (2013) Epidemiology and Molecular Characterization of Cryptosporidium Species among Children and HIV Infected Individuals in the North Rift Region of Kenya. PhD Thesis. Jomo Kenyatta University of Agriculture and Technology

Bednarska M, Bajer A, Sinski E, Girouard AS, Tamang L, et al. Fluorescent in situ hybridization as a tool to retrospectively identify Cryptosporidium parvum and Giardia lamblia in samples from terrestrial mammalian wildlife. Parasitology research, (2007); 100(3): 455-460.

Blake D, Smith A, Shirley M. Amplified fragment length polymorphism analyses of Eimeria spp.: an improved process for genetic studies of recombinant parasites. Parasitology research, (2003); 90(6): 473-475.

Mallon M, MacLeod A, Wastling J, Smith H, Reilly B, et al. Population structures and the role of genetic exchange in the zoonotic pathogen Cryptosporidium parvum. Journal of Molecular Evolution, (2003); 56(4): 407-417.

Grinberg A, Lopez-Villalobos N, Pomroy W, Widmer G, Smith H, et al. Host-shaped segregation of the Cryptosporidium parvum multilocus genotype repertoire. Epidemiology & Infection, (2008); 136(2): 273-278.

Jex AR, Whipp M, Campbell BE, Cacciò SM, Stevens M, et al. A practical and cost‐effective mutation scanning‐based approach for investigating genetic variation in Cryptosporidium. Electrophoresis, (2007); 28(21): 3875-3883.

Xiao L. Molecular epidemiology of cryptosporidiosis: an update. Experimental parasitology, (2010); 124(1): 80-89.

Chalmers RM, Katzer F. Looking for Cryptosporidium: the application of advances in detection and diagnosis. Trends in parasitology, (2013); 29(5): 237-251.

Schindler AR, EL-Osta YGA, Stevens M, Sinclair MI, Gasser RB. Capillary electrophoretic analysis of fragment length polymorphism in ribosomal markers of Cryptosporidium from humans. Molecular and cellular probes, (2005); 19(6): 394-399.

Cabada MM, White Jr AC. Treatment of cryptosporidiosis: do we know what we think we know? Current opinion in infectious diseases, (2010); 23(5): 494-499.

Rossignol JF, Kabil SM, El–Gohary Y, Younis AM. Effect of nitazoxanide in diarrhea and enteritis caused by Cryptosporidium species. Clinical Gastroenterology and Hepatology, (2006); 4(3): 320-324.

Wang RJ, Li JQ, Chen YC, Zhang LX, Xiao LH. Widespread occurrence of Cryptosporidium infections in patients with HIV/AIDS: Epidemiology, clinical feature, diagnosis, and therapy. Acta tropica, (2018); 187:257-263.

Waywa D, Silpasakorn S, Phungthaisong A, Suputtamongkol Y. Intestinal Parasitic Infections in Thai Patients: Five-Year Experiences at Siriraj Hospital. Siriraj Medical Journal, (2018); 58(11): 1107-1109.


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