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      A review of the global burden, novel diagnostics, therapeutics, and vaccine targets for cryptosporidium.

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          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.

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          Author and article information

          Lancet Infect Dis
          The Lancet. Infectious diseases
          Elsevier BV
          Jan 2015
          : 15
          : 1
          [1 ] 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.
          [2 ] Division of Infectious Diseases, University of Texas Medical Branch, Galveston, TX, USA.
          [3 ] Program in Global Disease Epidemiology and Control, Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
          [4 ] Centers for Disease Control and Prevention, Atlanta, GA, USA.
          [5 ] National Cryptosporidium Reference Unit, Public Health Wales, Swansea, UK.
          [6 ] Department of Medical Microbiology and Immunology, Creighton University, Omaha, NE, USA.
          [7 ] Environmental Microbial Food Safety Laboratory, USDA, Beltsville, MD, USA.
          [8 ] Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA.
          [9 ] Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
          [10 ] Department of Biology and Department of Chemistry, Brandeis University, Waltham, MA, USA.
          [11 ] Division of Infectious Diseases, University of Vermont, Burlington, VT, USA.
          [12 ] Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA.
          [13 ] Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
          [14 ] Department of Pediatrics, Emory University, Atlanta, GA, USA; Atlanta VA Medical Center, Decatur, GA, USA.
          [15 ] Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
          [16 ] Department of Biology, University of Pennsylvania, Philadelphia, PA, USA.
          [17 ] Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, USA.
          [18 ] School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia.
          [19 ] Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center Boston, MA, USA.
          [20 ] Allergy and Infectious Diseases Division, Departments of Medicine, Global Health, and Microbiology, University of Washington, Seattle, WA, USA.
          [21 ] Department of Veterinary Pathobiology, Texas A&M University, College Station, TX, USA.
          S1473-3099(14)70772-8 NIHMS661690
          Copyright © 2015 Elsevier Ltd. All rights reserved.


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