Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-23T03:48:02.711Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment and prevention of cryptosporidiosis: what options are there for a country like Zambia?

Published online by Cambridge University Press:  15 February 2011

PAUL KELLY
PAUL KELLY*
Affiliation:
Barts and The London School of Medicine, Queen Mary University of London, London; Tropical Gastroenterology and Nutrition group, University of Zambia School of Medicine, Lusaka, Zambia
*
Corresponding author: Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine, Queen Mary University of London, Turner Street, London E1 2AD. Tel: 020 7882 2643. Fax: 020 7882 7192. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

Cryptosporidiosis is a major infection of humans, leading to diarrhoea and growth failure in children, diarrhoea and malnutrition in immunocompromised adults, and is associated with increased mortality in all age groups. Using the country of Zambia as an example, I review the possible approaches to treatment and prevention in a tropical setting. The current optimal therapy for cryptosporidiosis is nitazoxanide which works well in HIV uninfected children, but treatment in patients with HIV infection remains remarkably difficult. No single drug has demonstrated efficacy in a randomised trial. No vaccine is available, so the best option for prevention for the moment is filtration and clean storage of drinking water. This would be expected to reduce cryptosporidiosis dramatically, but this needs to be demonstrated directly. Water filtration would have the added benefit of protection against many other pathogens, but the paucity of alternative approaches highlights the need for a better understanding of this important human pathogen.

Keywords

CryptosporidiosisCryptosporidiumvaccinediarrhoeal diseasenitazoxanideparomomycinAfricawater filtration
Type
Research Article
Information
Parasitology , Volume 138 , Special Issue 12: Symposia of the British Society for Parasitology Volume 47 , October 2011 , pp. 1488 - 1491
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Abubakar, I., Aliyu, S. H., Arumugam, C., Hunter, P. R. and Usman, N. K. (2007). Prevention and treatment of cryptosporidiosis in immunocompromised patients. Cochrane Database of Systematic Reviews 24, CD004932.Google Scholar
Adamu, H., Petros, B., Hailu, A. and Petry, F. (2010). Molecular characterisation of Cryptosporidium isolates from humans in Ethiopia. Acta Tropica 115, 77–83.CrossRefGoogle ScholarPubMed
Amadi, B. C., Kelly, P., Mwiya, M., Mulwazi, E., Sianongo, S., Changwe, F., Thomson, M., Hachungula, J., Watuka, A., Walker-Smith, J. A. and Chintu, C. (2001). Intestinal and systemic infection, HIV and mortality in Zambian children with persistent diarrhoea and malnutrition. Journal of Pediatric Gastroenterology and Nutrition 32, 550–554.Google ScholarPubMed
Amadi, B. C., Mwiya, M., Musuku, J., Watuka, A., Sianongo, S., Ayoub, A. and Kelly, P. (2002). Effect of nitazoxanide on morbidity and mortality in Zambian children with cryptosporidiosis: a randomised controlled trial. Lancet 360, 1375–1380.CrossRefGoogle ScholarPubMed
Amadi, B., Mwiya, M., Sianongo, S., Payne, L., Watuka, A., Katubulushi, M. and Kelly, P. (2009). High dose prolonged treatment with nitazoxanide is not effective for cryptosporidiosis in HIV positive Zambian children: a randomised controlled trial. BMC Infectious Diseases 9, 195.CrossRefGoogle Scholar
Fayer, R. (2010). Taxonomy and species delimitation in Cryptosporidium. Experimental Parasitology 124, 90–97.CrossRefGoogle ScholarPubMed
Gargala, G., Le Goff, L., Ballet, J.-J., Favennec, L., Stachulski, A. V. and Rossignol, J. F. (2010). Evaluation of new thiazolide/thiadiazolide derivatives reveals nitro group-independent efficacy against in vitro development of Cryptosporidium parvum. Antimicrobial Agents and Chemotherapy 54, 1315–1318.CrossRefGoogle ScholarPubMed
Hewitt, R. G., Yiannoutsos, C. T., Higgs, E. S., Carey, J. T., Geiseler, P. J., Soave, R., Rosenberg, R., Vazquez, G. J., Wheat, L. J., Fass, R. J., Antoninievic, Z., Walawander, A. L., Flanigan, T. P. and Bender, J. F. (2000). Paromomycin: no more effective than placebo for the treatment of cryptosporidiosis in patients with advanced HIV infection. AIDS Clinical Trial Group. Clinical Infectious Disease 31, 1084–1092.CrossRefGoogle ScholarPubMed
Huang, D. B. and Zhou, J. (2007). Effect of intensive handwashing in the prevention of diarrhoeal illness among patients with AIDS: a randomized controlled study. Journal of Medical Microbiology 56, 659–663.CrossRefGoogle ScholarPubMed
Kelly, P., Nchito, M., Baboo, K. S., Ndubani, P., Okeowo, N. P., Luo, N. P., Feldman, R. A. and Farthing, M. J. G. (1997). Cryptosporidiosis in adults in Lusaka, Zambia, and its relationship to oocyst contamination of drinking water. Journal of Infectious Diseases 176, 1120–1123.CrossRefGoogle ScholarPubMed
Kelly, P., Todd, J., Sianongo, S., Mwansa, J. C. L., Sinsungwe, H., Katubulushi, M., Farthing, M. J. G. and Feldman, R. A. F. (2009). Susceptibility to intestinal infection and diarrhoea in Zambian adults in relation to HIV status and CD4 count. BMC Gastroenterology 9, 7.CrossRefGoogle ScholarPubMed
Lucca, P., De Gaspari, E. N., Bozzoli, L. M., Funada, M. R., Silva, S. O., Iuliano, W. and Soares, R. M. (2009). Molecular characterization of Cryptosporidium spp. from HIV infected patients from an urban area of Brazil. Revista Instituto Medica Tropica Sao Paulo 51, 341–343.CrossRefGoogle ScholarPubMed
MacKenzie, W. R., Hoxie, N. J., Proctor, M. E., Gradus, M. S., Blair, K. A., Peterson, D. E., Kazmierczak, J. J., Addiss, D. G., Fox, K. R. and Rose, J. B. (1994). A massive outbreak in Milwaukee of Cryptosporidium infection transmitted through the public water supply. New England Journal of Medicine 331, 161–167.CrossRefGoogle Scholar
McDonald, V. and Shirley, M. W. (2009). Past and future: vaccination against Eimeria. Parasitology 136, 1477–1489.CrossRefGoogle ScholarPubMed
Molloy, S. F., Smith, H. V., Kirwan, P., Nichols, R. A., Asaolu, S. O., Connelly, L. and Holland, C. V. (2010). Identification of a high diversity of Cryptosporidium species genotypes and subtypes in a pediatric population in Nigeria. American Journal of Tropical Medicine and Hygiene 82, 608–613.CrossRefGoogle Scholar
Molbak, K., Andersen, M., Aaby, P., Højlyng, N., Jakobsen, M., Sodemann, M. and da Silva, A. P. (1997). Cryptosporidium infection in infancy as a cause of malnutrition: a community study from Guinea-Bissau, West Africa. American Journal of Clinical Nutrition 65, 149–152.CrossRefGoogle ScholarPubMed
Molbak, K., Hojlyng, N., Gottschau, A., Sá, J. C., Ingholt, L., da Silva, A. P. and Aaby, P. (1993). Cryptosporidiosis in infancy and childhood mortality in Guinea Bissau. British Medical Journal 307, 417–420.CrossRefGoogle ScholarPubMed
Mor, S. M. and Tzipori, S. (2008). Cryptosporidiosis in children in sub-Saharan Africa: a lingering challenge. Clinical Infectious Diseases 47, 915–921.CrossRefGoogle ScholarPubMed
Nchito, M., Kelly, P., Sianongo, S., Luo, N. P., Feldman, R. A., Farthing, M. J. G. and Baboo, K. S. (1998). Cryptosporidiosis in urban Zambian children: an analysis of risk factors. American Journal of Tropical Medicine and Hygiene 59, 435–437.CrossRefGoogle ScholarPubMed
Newman, R. F. D., Sears, C. L., Moore, S. R., Nataro, J. P., Wuhib, T., Agnew, D. A., Guerraut, R. L. and Lima, A. A. (1999). Longitudinal study of Cryptosporidium infection in children in Northeastern Brazil. Journal of Infectious Diseases 180, 167–175.CrossRefGoogle ScholarPubMed
Nord, J., Ma, P., DiJohn, D., Tzipori, S. and Tacket, C. O. (1990). Treatment with bovine hyperimmune colostrum of cryptosporidial diarrhea in AIDS patients. AIDS 4, 581–584.CrossRefGoogle ScholarPubMed
Pantenburg, B., Cabada, M. M. and White, A. C. (2009). Treatment of cryptosporidiosis. Expert Reviews of Anti Infective Therapy 7, 385–391.CrossRefGoogle ScholarPubMed
Rossignol, J. F. (2009). Thiazolides: a new class of antiviral drugs. Expert Opinion in Drug Metabolism and Toxicology 5, 667–674.CrossRefGoogle ScholarPubMed
Sinkala, E., Katubulushi, M., Sianongo, S., Obwaller, A. and Kelly, P. (2011). Extreme metabolic disturbances contribute to high mortality in Zambian patients with HIV-related cryptosporidiosis treated with miltefosine. Annals of Tropical Medicine and Parasitology, in press.CrossRefGoogle ScholarPubMed
Siwila, J., Phiri, I. G. K., Vercruysse, J., Goma, F., Gabriel, S., Claerebout, E. and Geurden, T. (2007). Asymptomatic cryptosporidiosis in Zambian dairy farm workers and their household members. Transactions of the Royal Society of Tropical Medicine 101, 733–734.CrossRefGoogle ScholarPubMed