The evolution of respiratory Cryptosporidiosis: evidence for transmission by inhalation

Abstract

The protozoan parasite Cryptosporidium infects all major vertebrate groups and causes significant diarrhea in humans, with a spectrum of diseases ranging from asymptomatic to life-threatening. Children and immunodeficient individuals are disproportionately affected, especially in developing countries, where cryptosporidiosis contributes substantially to morbidity and mortality in preschool-age children. Despite the enormous disease burden from cryptosporidiosis, no antiprotozoal agent or vaccine exists for effective treatment or prevention. Cryptosporidiosis involving the respiratory tract has been described for avian species and mammals, including immunocompromised humans. Recent evidence indicates that respiratory cryptosporidiosis may occur commonly in immunocompetent children with cryptosporidial diarrhea and unexplained cough. Findings from animal models, human case reports, and a few epidemiological studies suggest that Cryptosporidium may be transmitted via respiratory secretions, in addition to the more recognized fecal-oral route. It is postulated that transmission of Cryptosporidium oocysts may occur by inhalation of aerosolized droplets or by contact with fomites contaminated by coughing. Delineating the role of the respiratory tract in disease transmission may provide necessary evidence to establish further guidelines for prevention of cryptosporidiosis.

FIG 1

Scanning electron micrograph of cryptosporidia in the human bronchial mucosa. Magnification, ×1,000. (Reprinted from reference with kind permission from Springer Science and Business Media.)

FIG 2

Similarity of cryptosporidial forms adherent to the luminal epithelium of a bronchial mucous gland and organisms lining the surface of the gastric epithelium (inset) (hematoxylin-eosin staining). Magnification, ×1,000. (Reprinted from reference with permission of the publisher. Copyright 1991 American Medical Association. All rights reserved.)

FIG 3

Extracellular (black arrows) and intracellular (white arrow) cryptosporidial forms in BAL fluid (Giemsa stain). Magnification, ×1,250. (Reprinted from reference with permission.)