Natural History of Cryptosporidiosis in a Longitudinal Study of Slum-Dwelling Bangladeshi Children: Association with Severe Malnutrition

Abstract

BackgroundCryptosporidiosis is a common cause of infectious diarrhea in young children worldwide, and is a significant contributor to under-five mortality. Current treatment options are limited in young children. In this study, we describe the natural history of Cryptosporidium spp. infection in a birth cohort of children in Bangladesh and evaluate for association with malnutrition.Methodology/Principal FindingsThis is a longitudinal birth cohort study of 392 slum-dwelling Bangladeshi children followed over the first two years of life from 2008 to 2014. Children were monitored for diarrheal disease, and stool was tested for intestinal protozoa. Anthropometric measurements were taken at 3-month intervals. A subset of Cryptosporidium positive stools were genotyped for species and revealed that C. hominis was isolated from over 90% of samples. In the first two years of life, 77% of children experienced at least one infection with Cryptosporidium spp. Non-diarrheal infection (67%) was more common than diarrheal infection (6.3%) although 27% of children had both types of infection. Extreme poverty was associated with higher rates of infection (chi-square, 49.7% vs 33.3%, p = 0.006). Malnutrition was common in this cohort, 56% of children had stunted growth by age two. Children with Cryptosporidium spp. infection had a greater than 2-fold increased risk of severe stunting at age two compared to uninfected children (odds ratio 2.69, 95% CI 1.17, 6.15, p = 0.019) independent of sex, income, maternal body-mass index, maternal education and weight for age adjusted z (WAZ) score at birth.Conclusions/SignificanceCryptosporidium infection is common (77%) in this cohort of slum-dwelling Bangladeshi children, and both non-diarrheal and diarrheal infections are significantly associated with a child’s growth at 2 years of age.

Prevalence and Determinants of Cryptosporidium Infection in an Underdeveloped Rural Region of Southwestern China

“…Overcrowding has been associated with Cryptosporidium infection, specifically with Cryptosporidium huminis. 26 A high secondary infection rate (39%) was reported in households with children diagnosed with Cryptosporidium infection. 27 In the present study, we found a significant association between having more than five family members and Cryptosporidium infection.…”

Household Transmission Study of Cryptosporidiosis in Bangladesh

“…All specimens testing positive for Cryptosporidium were further speciated using the LIB3 assay to distinguish C. hominis from non-C. hominis isolates (12). The polymorphic region within the gp60 gene was used to genotype Cryptosporidium positive samples using previously described methods at the University of Virginia with the modifications of Alves et al (9,11). Serum samples were tested for the presence of anti-Cryptosporidium IgG, using enzyme-linked immunosorbent assay with whole Cryptosporidium coated plates (2.5x10*6 oocysts/ml) (WATERBORNE Inc., New Orleans, LA), as described in (13).…”

“…In prior studies, we have described infection rates as high as 80% with cryptosporidiosis during the first two years of life (9). However, the route of transmission of cryptosporidiosis remains elusive since Cryptosporidium spp.…”

A Cell Culture Platform for the Cultivation of Cryptosporidium parvum

“…In humans, Cryptosporidium parvum and C. hominis are the main causative agents of cryptosporidiosis, which is the second major cause of death in children under 5 years old with diarrhea in developing countries (Kotloff et al., ). In addition, infection with Cryptosporidium has been shown to cause stunted growth in children (Kirkpatrick et al., ; Korpe et al., ; Kotloff et al., ). Despite the significance and the consequences that this parasite has for both human and animal health, until recently there have been no tools to study the biology of Cryptosporidium in the laboratory, and most research has been dependent on animal models (Sharling et al., ).…”