title: A review of the global burden, novel diagnostics, therapeutics, and vaccine targets for cryptosporidium.
abstract: Cryptosporidium spp are well recognised as causes of diarrhoeal disease during waterborne epidemics and in immunocompromised hosts. Studies have also drawn attention to an underestimated global burden and suggest major gaps in optimum diagnosis, treatment, and immunisation. Cryptosporidiosis is increasingly identified as an important cause of morbidity and mortality worldwide. Studies in low-resource settings and high-income countries have confirmed the importance of cryptosporidium as a cause of diarrhoea and childhood malnutrition. Diagnostic tests for cryptosporidium infection are suboptimum, necessitating specialised tests that are often insensitive. Antigen-detection and PCR improve sensitivity, and multiplexed antigen detection and molecular assays are underused. Therapy has some effect in healthy hosts and no proven efficacy in patients with AIDS. Use of cryptosporidium genomes has helped to identify promising therapeutic targets, and drugs are in development, but methods to assess the efficacy in vitro and in animals are not well standardised. Partial immunity after exposure suggests the potential for successful vaccines, and several are in development; however, surrogates of protection are not well defined. Improved methods for propagation and genetic manipulation of the organism would be significant advances.
authors.affiliation: Program in Global Disease Epidemiology and Control, Department of International Health, Johns Hopkins University, Baltimore, MD, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD, USA. Electronic address: wcheckl1@jhmi.edu.
authors.forename: William
authors.initials: W
authors.lastname: Checkley
authors.affiliation: Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: A Clinton
authors.initials: AC
authors.lastname: White
authors.affiliation: Program in Global Disease Epidemiology and Control, Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Devan
authors.initials: D
authors.lastname: Jaganath
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Arrowood
authors.affiliation: National Cryptosporidium Reference Unit, Public Health Wales, Swansea, UK.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Chalmers
authors.affiliation: Department of Medical Microbiology and Immunology, Creighton University, Omaha, NE, USA.
authors.forename: Xian-Ming
authors.initials: XM
authors.lastname: Chen
authors.affiliation: Environmental Microbial Food Safety Laboratory, USDA, Beltsville, MD, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Fayer
authors.affiliation: Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA.
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Griffiths
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Guerrant
authors.affiliation: Department of Biology and Department of Chemistry, Brandeis University, Waltham, MA, USA.
authors.forename: Lizbeth
authors.initials: L
authors.lastname: Hedstrom
authors.affiliation: Division of Infectious Diseases, University of Vermont, Burlington, VT, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Huston
authors.affiliation: Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Kotloff
authors.affiliation: Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Kang
authors.affiliation: Department of Pediatrics, Emory University, Atlanta, GA, USA; Atlanta VA Medical Center, Decatur, GA, USA.
authors.forename: Jan R
authors.initials: JR
authors.lastname: Mead
authors.affiliation: Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Miller
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Petri
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Priest
authors.affiliation: Department of Biology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Roos
authors.affiliation: Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, USA.
authors.forename: Boris
authors.initials: B
authors.lastname: Striepen
authors.affiliation: School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia.
authors.forename: R C Andrew
authors.initials: RC
authors.lastname: Thompson
authors.affiliation: Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center Boston, MA, USA.
authors.forename: Honorine D
authors.initials: HD
authors.lastname: Ward
authors.affiliation: Allergy and Infectious Diseases Division, Departments of Medicine, Global Health, and Microbiology, University of Washington, Seattle, WA, USA.
authors.forename: Wesley A
authors.initials: WA
authors.lastname: Van Voorhis
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Lihua
authors.initials: L
authors.lastname: Xiao
authors.affiliation: Department of Veterinary Pathobiology, Texas A&M University, College Station, TX, USA.
authors.forename: Guan
authors.initials: G
authors.lastname: Zhu
authors.affiliation: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Houpt
mesh_terms: D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D003457:Cryptosporidiosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D003955:Diagnostic Tests, Routine / Q000379:methods*; D003967:Diarrhea / Q000453:epidemiology* / Q000469:parasitology; D014943:Global Health; D006801:Humans; D016052:Protozoan Vaccines / Q000276:immunology / Q000302:isolation & purification*
chemical_list: D000981:Antiprotozoal Agents; D016052:Protozoan Vaccines