title: Recent diarrhea is associated with elevated salivary IgG responses to Cryptosporidium in residents of an eastern Massachusetts community.
abstract: BACKGROUND
  Serological data suggest that Cryptosporidium infections are common but underreported. The invasiveness of blood sampling limits the application of serology in epidemiological surveillance. We pilot-tested a non-invasive salivary anti-Cryptosporidium antibody assay in a community survey involving children and adults.
  
  
  METHODS
  Families with children were recruited in a Massachusetts community in July; symptoms data were collected at 3 monthly follow-up mail surveys. One saliva sample per person (n = 349) was collected via mail, with the last survey in October. Samples were analyzed for IgG and IgA responses to a recombinant C. hominis gp15 sporozoite protein using a time-resolved fluorometric immunoassay. Log-transformed assay results were regressed on age using penalized B-splines to account for the strong age-dependence of antibody reactions. Positive responses were defined as fluorescence values above the upper 99% prediction limit.
  
  
  RESULTS
  Forty-seven (13.5%) individuals had diarrhea without concurrent respiratory symptoms during the 3-month-long follow-up; eight of them had these symptoms during the month prior to saliva sampling. Two individuals had positive IgG responses: an adult who had diarrhea during the prior month and a child who had episodes of diarrhea during each survey month (Fisher's exact test for an association between diarrhea and IgG response: p = 0.0005 for symptoms during the prior month and p = 0.02 for symptoms during the entire follow-up period). The child also had a positive IgA response, along with two asymptomatic individuals (an association between diarrhea and IgA was not significant).
  
  
  CONCLUSIONS
  These results suggest that the salivary IgG specific to Cryptosporidium antigens warrants further evaluation as a potential indicator of recent infections.
authors.affiliation: National Center for Environmental Assessment, US Environmental Protection Agency, 26 W. Martin Luther King Drive, Mail Stop A110, Cincinnati, OH 45268, USA. egorov.andrey@epa.gov
authors.forename: A I
authors.initials: AI
authors.lastname: Egorov
authors.forename: L M
authors.initials: LM
authors.lastname: Montuori Trimble
authors.forename: L
authors.initials: L
authors.lastname: Ascolillo
authors.forename: H D
authors.initials: HD
authors.lastname: Ward
authors.forename: D A
authors.initials: DA
authors.lastname: Levy
authors.forename: R D
authors.initials: RD
authors.lastname: Morris
authors.forename: E N
authors.initials: EN
authors.lastname: Naumova
authors.forename: J K
authors.initials: JK
authors.lastname: Griffiths
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000913:Antibodies, Protozoan / Q000032:analysis*; D000953:Antigens, Protozoan; D002648:Child; D002675:Child, Preschool; D003458:Cryptosporidium / Q000276:immunology*; D003967:Diarrhea / Q000209:etiology*; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000379:methods; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis*; D007223:Infant; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D012463:Saliva / Q000276:immunology*; D055815:Young Adult
chemical_list: D000913:Antibodies, Protozoan; D000953:Antigens, Protozoan; D007070:Immunoglobulin A; D007074:Immunoglobulin G