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2.
PLoS Negl Trop Dis ; 15(3): e0009057, 2021 03.
Article in English | MEDLINE | ID: mdl-33705395

ABSTRACT

Cryptosporidium is a widely distributed enteric parasite that has an increasingly appreciated pathogenic role, particularly in pediatric diarrhea. While cryptosporidiosis has likely affected humanity for millennia, its recent "emergence" is largely the result of discoveries made through major epidemiologic studies in the past decade. There is no vaccine, and the only approved medicine, nitazoxanide, has been shown to have efficacy limitations in several patient groups known to be at elevated risk of disease. In order to help frontline health workers, policymakers, and other stakeholders translate our current understanding of cryptosporidiosis into actionable guidance to address the disease, we sought to assess salient issues relating to clinical management of cryptosporidiosis drawing from a review of the literature and our own field-based practice. This exercise is meant to help inform health system strategies for improving access to current treatments, to highlight recent achievements and outstanding knowledge and clinical practice gaps, and to help guide research activities for new anti-Cryptosporidium therapies.


Subject(s)
Antiparasitic Agents/therapeutic use , Cryptosporidiosis/drug therapy , Cryptosporidiosis/epidemiology , Cryptosporidium/drug effects , Nitro Compounds/therapeutic use , Thiazoles/therapeutic use , Child, Preschool , Cryptosporidium/immunology , Diarrhea/parasitology , Disease Outbreaks , Fluid Therapy , Humans , Immunocompromised Host/immunology , Infant , Infant, Newborn
3.
Am J Trop Med Hyg ; 104(1): 229-232, 2021 01.
Article in English | MEDLINE | ID: mdl-33078702

ABSTRACT

Cryptosporidiosis is common in early childhood, and both diarrheal and subclinical infections are associated with adverse developmental outcomes. Improved therapeutic medications may help reduce the burden of cryptosporidial diarrhea; however, an effective vaccine would be better able to prevent the detrimental impact of both diarrheal and subclinical disease. A more complete understanding of naturally occurring immunity may further inform strategies to develop an effective vaccine. In this prospective cohort study of Bangladeshi children, greater fecal IgA at 12 months, but not plasma IgG, directed against two sporozoite-expressed, immunodominant and vaccine candidate antigens was associated with delayed time to subsequent cryptosporidiosis to 3 years of life. These findings extend prior work and further support the role of mucosal antibody responses in naturally developing protective immunity to Cryptosporidium.


Subject(s)
Antibodies, Protozoan/chemistry , Antigens, Protozoan/immunology , Cryptosporidium/immunology , Feces/parasitology , Immunoglobulin A/immunology , Antibodies, Protozoan/blood , Bangladesh/epidemiology , Child, Preschool , Cryptosporidiosis , Cryptosporidium/metabolism , Female , Humans , Immunoglobulin G/blood , Infant , Male
5.
Clin Infect Dis ; 70(2): 323-326, 2020 01 02.
Article in English | MEDLINE | ID: mdl-31131855

ABSTRACT

In this prospective cohort study of Bangladeshi children, greater fecal immunoglobulin A, but not plasma immunoglobulin G, directed against the Cryptosporidium sporozoite-expressed antigen Cp23 at 12 months of age was associated with delayed time to subsequent cryptosporidiosis. This finding suggests a protective role for mucosal antibody-mediated immunity in naturally exposed children.


Subject(s)
Cryptosporidiosis , Cryptosporidium , Animals , Antibodies, Protozoan , Bangladesh/epidemiology , Child , Cryptosporidiosis/diagnosis , Cryptosporidiosis/epidemiology , Humans , Immunoglobulin A , Prospective Studies , Sporozoites
6.
Clin Infect Dis ; 67(9): 1347-1355, 2018 10 15.
Article in English | MEDLINE | ID: mdl-29897482

ABSTRACT

Background: Cryptosporidiosis is a major cause of childhood diarrhea in low- and middle-income countries and has been linked to impairment of child growth. This study investigated the burden of cryptosporidiosis and its impact on child growth in both a rural and an urban site in Bangladesh. Methods: Pregnant women in the second trimester were identified at 2 sites in Bangladesh, 1 urban and 1 rural. Their offspring were enrolled at birth into the study (urban, n = 250; rural, n = 258). For 2 years, the children were actively monitored for diarrhea and anthropometric measurements were obtained every 3 months. Stool samples were collected monthly and during diarrheal episodes with Cryptosporidium infection and causative species determined by quantitative polymerase chain reaction assays. Results: Cryptosporidium infections were common at both sites and mostly subclinical. In the urban site, 161 (64%) children were infected and 65 (26%) had ≥2 infections. In the rural site, 114 (44%) were infected and 24 (9%) had multiple infections. Adjusted for potential confounders, cryptosporidiosis was associated with a significantly greater drop in the length-for-age z score (LAZ) at 24 months from LAZ at enrollment (Δ-LAZ), an effect greatest in the children with multiple episodes of cryptosporidiosis. The most common species in Mirpur was Cryptosporidium hominis, whereas Cryptosporidium meleagridis predominated in Mirzapur. Conclusions: Cryptosporidiosis is common in early childhood and associated with early growth faltering in Bangladeshi children. Predominant Cryptosporidium species differed between the 2 sites, suggesting different exposures or modes of transmission but similar consequences for child growth. Clinical Trials Registration: NCT02764918.


Subject(s)
Asymptomatic Infections/epidemiology , Child Development , Cryptosporidiosis/complications , Cryptosporidiosis/epidemiology , Cryptosporidium/isolation & purification , Adult , Bangladesh/epidemiology , Child, Preschool , Cost of Illness , Cryptosporidium/classification , Diarrhea/complications , Diarrhea/epidemiology , Diarrhea/parasitology , Feces/parasitology , Female , Humans , Infant , Infant, Newborn , Longitudinal Studies , Male , Parturition , Pregnancy , Prospective Studies , Rural Population , Urban Population , Young Adult
7.
Virology ; 425(1): 23-30, 2012 Mar 30.
Article in English | MEDLINE | ID: mdl-22280894

ABSTRACT

In utero priming to malaria antigens renders cord blood mononuclear cells (CBMC) more susceptible to productive HIV infection in vitro in the absence of exogenous stimulation. This provides a unique model to better understand mechanisms affecting lymphocyte susceptibility to HIV infection in vivo. Effector memory CD3(+)CD4(+) T cells (T(EM)) were the exclusive initial targets of HIV with rapid spread to central memory cells. HIV susceptibility correlated with increased expression of CD25 and HLA-DR on T(EM). Virus entered all samples equally, however gag/pol RNA was only detected in HIV susceptible samples, suggesting regulation of proviral gene transcription. Targeted analysis of human genes in memory T cells showed greater expression of IFNG, NFATc1, IRF1, FOS, and PPIA and decreased expression YY1 and TFCP2 in HIV susceptible samples. Thus fetal priming to exogenous antigens enhances specific proviral gene transcription pathways in effector memory cells that may increase risk of vertical transmission of HIV.


Subject(s)
CD4-Positive T-Lymphocytes/immunology , Fetal Blood/immunology , Gene Expression Regulation , HIV Infections/transmission , HIV-1/immunology , Immunologic Memory/immunology , Lymphocyte Activation/immunology , CD3 Complex/metabolism , CD4-Positive T-Lymphocytes/metabolism , CD4-Positive T-Lymphocytes/virology , Disease Susceptibility/immunology , Female , HIV Infections/immunology , HIV Infections/virology , HLA-DR Antigens/genetics , HLA-DR Antigens/metabolism , Humans , Infectious Disease Transmission, Vertical , Interleukin-2 Receptor alpha Subunit/genetics , Interleukin-2 Receptor alpha Subunit/metabolism , Pregnancy
8.
J Exp Med ; 201(7): 1125-34, 2005 Apr 04.
Article in English | MEDLINE | ID: mdl-15795236

ABSTRACT

Linker for activation of T cells (LAT) is a scaffolding adaptor protein that is critical for T cell development and function. A mutation of LAT (Y136F) that disrupts phospholipase C-gamma1 activation and subsequent calcium influx causes a partial block in T cell development and leads to a severe lymphoproliferative disease in homozygous knock-in mice. One possible contribution to the fatal disease of LAT Y136F knock-in mice could be from autoreactive T cells generated in these mice because of altered thymocyte selection. To examine the impact of the LAT Y136F mutation on thymocyte positive and negative selection, we bred this mutation onto the HY T cell receptor (TCR) transgenic, recombination activating gene-2 knockout background. Female mice with this genotype showed a severe defect in positive selection, whereas male mice exhibited a phenotype resembling positive selection (i.e., development and survival of CD8(hi) HY TCR-specific T cells) instead of negative selection. These results support the hypothesis that in non-TCR transgenic, LAT Y136F knock-in mice, altered thymocyte selection leads to the survival and proliferation of autoreactive T cells that would otherwise be negatively selected in the thymus.


Subject(s)
Adaptor Proteins, Signal Transducing/genetics , Lymphoproliferative Disorders/genetics , Membrane Proteins/genetics , Muscle Proteins/metabolism , Mutation/genetics , Phosphoproteins/genetics , Signal Transduction/immunology , T-Lymphocytes/physiology , Thymus Gland/immunology , Type C Phospholipases/metabolism , Adaptor Proteins, Signal Transducing/metabolism , Animals , Apoptosis/immunology , Binding Sites/genetics , Calcium/metabolism , Cell Proliferation , DNA Primers , Enzyme-Linked Immunosorbent Assay , Flow Cytometry , Membrane Proteins/metabolism , Mice , Mice, Inbred C57BL , Mice, Mutant Strains , Phospholipase C gamma , Phosphoproteins/metabolism , Receptors, Antigen, T-Cell/genetics , Reverse Transcriptase Polymerase Chain Reaction , Signal Transduction/genetics , T-Lymphocytes/immunology , Thymus Gland/cytology
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