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.

Effect of cryptosporidial and giardial diarrhoea on social maturity, intelligence and physical growth in children in a semi-urban slum in south India.

BACKGROUND: Early childhood diarrhoea is a major cause of infant morbidity and mortality in developing countries. Recurrent and persistent diarrhoea affect growth and cognition in children as young as 6 years. OBJECTIVES: To evaluate the effect of early childhood cryptosporidial and giardial diarrhoea on growth and development in children in a semi-urban slum in India. This is the first report of such assessment at 3 years of age. METHODS: This study was undertaken on 116 children who were part of an ongoing birth cohort study (n=452) of rotaviral and cryptosporidial diarrhoea between June and December 2005. Social quotients (SQ) assessed by the Vineland Social Maturity Scale, intelligence quotients (IQ) assessed by the Seguin Form Board Test, physical growth parameters and sociodemographic data in 84 children with a history of cryptosporidial or giardial diarrhoea were compared with those of 32 without diarrhoea. RESULTS: Children with a past history of giardial diarrhoea showed a trend towards lower SQ (p=0.09) and had significantly lower IQ (p=0.04) and increased wasting (p=0.04). Cryptosporidial diarrhoea was not associated with poor IQ, SQ or physical growth. CONCLUSION: This study demonstrates the long-term effect of protozoan diarrhoea, especially that caused by giardia, on both intelligence and physical growth in Indian children as early as 3 years of age and re-inforces the need for early detection and prevention of early childhood protozoan diarrhoea.

Perceived causes of sporadic cryptosporidiosis and their relation to sources of information.

BACKGROUND: The importance of a person's perceptions about the causes of their disease has been emphasised by research on various diseases. Several studies have found perception may be linked to protective behaviours. OBJECTIVE: This study intends to identify the main perceived causes of sporadic cryptosporidiosis, and to analyse some of the factors that may influence respondent's perception. The role of respondents' attributions, the scientific plausibility of perceptions, and the importance of specific information sources are also explored. DESIGN: Quantitative and qualitative analyses of data from a case-control study. SETTING: General population in Wales and north west England. PARTICIPANTS: The study is based on a sample of 411 respondents from Wales and north west of England, whose cryptosporidiosis diagnosis was confirmed by a laboratory. RESULTS: The results show that the most frequent perceived causes are water (by drinking it or swimming), contagion (mostly from children), and contaminated food. Perceived causes are qualitatively similar to the ones described in scientific literature, but some quantitative differences are evident. Respondents' certainty in relation to the cause of illness is directly related with plausibility. The most frequent information sources used by respondents were test stool results, environmental health officers, and doctors or nurses. Results suggest that information sources may influence the perception of the causes of cryptosporidiosis. Qualitative data provided a few clues about situations where sporadic and outbreak cases may be confused. CONCLUSION: In contrast with outbreaks, various information sources in addition to the media are used by people with sporadic cryptosporidiosis that in turn affects the perception of aetiology. This has implications for the dissemination of information about control measures for cryptosporidiosis and surveillance activities.

[Bioterrorism, parasites as potential bioterrorism agents and biosecurity studies]. / Biyoterörizm, potansiyel biyoterörizm ajani olan parazitler ve biyogüvenlik çalismalari.

A variety of agents have a potential risk for being use as weapons of biological terrorism. However, the use of parasites as bioterrorism agents has not received so much attention. Parasites could contribute to the installation of fear in human population upon intentional addition to their food and water supplies. On the other hand, vector-borne parasites can also constitute risk of bioterrorism. Biosecurity issues are gaining importance as a consequence of globalization. Surveillance is critical in maintaining biosecurity and early detection of infectious disease agents is essential. In this review article, bioterrorism, the role of parasites as potential bioterrorism agents, studies on biosecurity and laboratory design for biosafety have been discussed under the light of recent literature.

Association of early childhood diarrhea and cryptosporidiosis with impaired physical fitness and cognitive function four-seven years later in a poor urban community in northeast Brazil.

To determine potential, long-term deficits associated with early childhood diarrhea and parasitic infections, we studied the physical fitness (by the Harvard Step Test) and cognitive function (by standardized tests noted below) of 26 children who had complete surveillance for diarrhea in their first 2 years of life and who had continued surveillance until 6-9 years of age in a poor urban community (favela) in Fortaleza in northeast Brazil. Early childhood diarrhea at 0-2 years of age correlated with reduced fitness by the Harvard Step Test at 6-9 years of age (P = 0.03) even after controlling for anthropometric and muscle area effects, anemia, intestinal helminths, Giardia infections, respiratory illnesses, and socioeconomic variables. Early childhood cryptosporidial infections (6 with diarrhea and 3 without diarrhea) were also associated with reduced fitness at 6-9 year of age, even when controlling for current nutritional status. Early diarrhea did not correlate with activity scores (P = 0.697), and early diarrhea remained significantly correlated with fitness scores (P = 0.035) after controlling for activity scores. Early diarrhea burdens also correlated in pilot studies with impaired cognitive function using a McCarthy Draw-A-Design (P = 0.01; P = 0.017 when controlling for early helminth infections), Wechsler Intelligence Scale for Children coding tasks (P = 0.031), and backward digit span tests (P = 0.045). These findings document for the first time a potentially substantial impact of early childhood diarrhea and cryptosporidial infections on subsequent functional status. If confirmed, these findings have major implications for calculations of global disability adjusted life years and for the importance and potential cost effectiveness of targeted interventions for early childhood diarrhea.

Public reliance on risk communication channels in the wake of a cryptosporidium outbreak.

In the spring of 1993, about 39% of Milwaukee-area residents suffered through a nationally publicized illness brought about by cryptosporidium, a parasite that had infested the metropolitan drinking water supply. Our study, based on a telephone survey of 610 local adult residents, indicates that worry about becoming ill in the future with cryptosporidiosis relates more strongly and consistently to public reliance on, and use of, media for cryptosporidium information than do a range of risk perception and experience variables. We propose that more studies should take an audience-centered approach to understanding risk communication.

Helicobacter felis as a cofactor alone or together with stress in cryptosporidial activation in mice.

Cryptosporidiosis is caused by a protozoan parasite, mainly found in animals, which usually results in transient, mild gastroenteritis in humans but can cause severe and prolonged disease in immunocompromised individuals. Immunocompetent mice, naturally infected with Cryptosporidium muris, were used to investigate the effects of inoculation with Helicobacter felis and of stress on the activity of the C. muris infection, as indicated by histopathological examination of their stomachs. The results indicate that both H. felis inoculation and/or stress activate C. muris and cause gastric inflammation. The extent of the activation of C. muris depends on the duration of the stress.