Neglected risk factors of childhood morbidity and mortality caused by Cryptosporidium infection
Authors: Amir Abdoli, Fatemeh Ghaffarifar, Majid Pirestani
Journal: The Lancet Global Health (2018)

Ibrahim Khalil and colleagues (July, 2018)1Khalil IA Troeger C Rao PC et al.Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analyses study.Lancet Glob Health. 2018; 6: e758-e768Summary Full Text Full Text PDF PubMed Scopus (178) Google Scholar report the estimated childhood morbidity and mortality from Cryptosporidium infection and its long-term consequences. Accordingly, in 2016, the infection was the fifth leading cause of diarrhoea, and acute infection caused more than 4·2 million disability-adjusted life-years (DALYs) lost and more than 48 000 deaths globally. In addition to acute infection, the results from Khalil and colleagues' study1Khalil IA Troeger C Rao PC et al.Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analyses study.Lancet Glob Health. 2018; 6: e758-e768Summary Full Text Full Text PDF PubMed Scopus (178) Google Scholar showed that Cryptosporidium was associated with a decrease in childhood growth that caused 7·85 million DALYs. Despite these statistics, there are some neglected topics in cryptosporidial infections. Similar to other intestinal pathogens, Cryptosporidium is transmitted through the faecal–oral route. As such, co-infection of Cryptosporidium with other intestinal pathogens is common2Zhang S-X Zhou Y-M Xu W et al.Impact of co-infections with enteric pathogens on children suffering from acute diarrhea in southwest China.Infect Dis Poverty. 2016; 5: 64Crossref PubMed Scopus (77) Google Scholar, 3Moyo SJ Kommedal Ø Blomberg B et al.Comprehensive analysis of prevalence, epidemiologic characteristics, and clinical characteristics of monoinfection and coinfection in diarrheal diseases in children in Tanzania.Am J Epidemiol. 2017; 186: 1074-1083Crossref PubMed Scopus (18) Google Scholar, 4Nath J Hussain G Singha B Paul J Ghosh SK Burden of major diarrheagenic protozoan parasitic co-infection among amoebic dysentery cases from North East India: a case report.Parasitology. 2015; 142: 1318-1325Crossref PubMed Scopus (9) Google Scholar and probably increases the morbidity and mortality due to prolonged diarrhoea and malnourishment. In this regard, a recent study regarding the epidemiology and risk factors of cryptosporidial infection in children from eight low-income countries reveals that a third of children with symptomatic cryptosporidiosis had a co-infection with Campylobacter.5Korpe PS Valencia C Haque R et al.Epidemiology and risk factors for cryptosporidiosis in children from eight low-income sites: results from the MAL-ED study.Clin Infect Dis. 2018; (published online April 26.)DOI:10.1093/cid/ciy355Crossref Scopus (34) Google Scholar In patients with amoebic dysentery in northeast India, 14·6% of the cases had co-infection with Cryptosporidium parvum while 34·1% of the cases had co-infection with Giardia duodenalis, 22·0% with Enterocytozoon bieneusi, and 7·3% with Cyclospora cayetanensis.4Nath J Hussain G Singha B Paul J Ghosh SK Burden of major diarrheagenic protozoan parasitic co-infection among amoebic dysentery cases from North East India: a case report.Parasitology. 2015; 142: 1318-1325Crossref PubMed Scopus (9) Google Scholar Hence, co-infections probably increase disease severity of diarrhoea and affect the frequency of morbidity and mortality. Respiratory cryptosporidiosis is another neglected point, especially in children and immunocompromised individuals.6Sponseller JK Griffiths JK Tzipori S The evolution of respiratory cryptosporidiosis: evidence for transmission by inhalation.Clin Microbiol Rev. 2014; 27: 575-586Crossref PubMed Scopus (75) Google Scholar Oocysts of the parasite were found in the trachea, sputum, sinus aspirates, and bronchoalveolar lavage of immunodeficient individuals with intestinal cryptosporidiosis.6Sponseller JK Griffiths JK Tzipori S The evolution of respiratory cryptosporidiosis: evidence for transmission by inhalation.Clin Microbiol Rev. 2014; 27: 575-586Crossref PubMed Scopus (75) Google Scholar As reviewed elsewhere, cryptosporidiosis in the upper respiratory tract might cause inflammation in the sinuses, trachea, larynx, and nasal mucosa that is accompanied by nasal discharge.6Sponseller JK Griffiths JK Tzipori S The evolution of respiratory cryptosporidiosis: evidence for transmission by inhalation.Clin Microbiol Rev. 2014; 27: 575-586Crossref PubMed Scopus (75) Google Scholar Whereas dyspnoea, productive cough, hypoxaemia, and fever are associated with cryptosporidiosis in the lower respiratory tract.6Sponseller JK Griffiths JK Tzipori S The evolution of respiratory cryptosporidiosis: evidence for transmission by inhalation.Clin Microbiol Rev. 2014; 27: 575-586Crossref PubMed Scopus (75) Google Scholar Also, there is evidence for respiratory transmission of Cryptosporidium by inhalation.6Sponseller JK Griffiths JK Tzipori S The evolution of respiratory cryptosporidiosis: evidence for transmission by inhalation.Clin Microbiol Rev. 2014; 27: 575-586Crossref PubMed Scopus (75) Google Scholar Respiratory symptoms were observed in half of children with intestinal cryptosporidiosis in Brazil7Weikel CS Johnston LI De Sousa MA Guerrant RL Cryptosporidiosis in northeastern Brazil: association with sporadic diarrhea.J Infect Dis. 1985; 151: 963-965Crossref PubMed Scopus (49) Google Scholar and the Gaza Strip.8Sallon S El Showwa R El Masri M Khalil M Blundell N Hart C Cryptosporidiosis in children in Gaza.Ann Trop Paediatr. 1991; 11: 277-281Crossref PubMed Scopus (14) Google Scholar Similar results were shown in children with cryptosporidial diarrhoea in Switzerland,9Egger M Mäusezahl D Odermatt P Marti H Tanner M Symptoms and transmission of intestinal cryptosporidiosis.Arch Dis Child. 1990; 65: 445-447Crossref PubMed Scopus (31) Google Scholar who were more likely to have respiratory symptoms, and Bangladesh,10Shahid NS Rahman A Anderson B Mata L Sanyal S Cryptosporidiosis in Bangladesh.BMJ. 1985; 290: 114Crossref PubMed Scopus (41) Google Scholar who were more likely to have unexplained cough. Cryptosporidium co-infection with other intestinal pathogens and respiratory cryptosporidiosis need greater consideration in patients infected with this disease. We declare no competing interests. Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analyses studyOur findings show that the substantial short-term burden of diarrhoea from Cryptosporidium infection on childhood growth and wellbeing is an underestimate of the true burden. Interventions designed to prevent and effectively treat infection in children younger than 5 years will have enormous public health and social development impacts. Full-Text PDF Open Access