Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analyses study

Abstract

SummaryBackgroundThe protozoan Cryptosporidium is a leading cause of diarrhoea morbidity and mortality in children younger than 5 years. However, the true global burden of Cryptosporidium infection in children younger than 5 years might have been underestimated in previous quantifications because it only took account of the acute effects of diarrhoea. We aimed to demonstrate whether there is a causal relation between Cryptosporidium and childhood growth and, if so, to quantify the associated additional burden.MethodsThe Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2016 was a systematic and scientific effort to quantify the morbidity and mortality associated with more than 300 causes of death and disability, including diarrhoea caused by Cryptosporidium infection. We supplemented estimates on the burden of Cryptosporidium in GBD 2016 with findings from a systematic review of published and unpublished cohort studies and a meta-analysis of the effect of childhood diarrhoea caused by Cryptosporidium infection on physical growth.FindingsIn 2016, Cryptosporidium infection was the fifth leading diarrhoeal aetiology in children younger than 5 years, and acute infection caused more than 48 000 deaths (95% uncertainty interval [UI] 24 600–81 900) and more than 4·2 million disability-adjusted life-years lost (95% UI 2·2 million–7·2 million). We identified seven data sources from the scientific literature and six individual-level data sources describing the relation between Cryptosporidium and childhood growth. Each episode of diarrhoea caused by Cryptosporidium infection was associated with a decrease in height-for-age Z score (0·049, 95% CI 0·014–0·080), weight-for-age Z score (0·095, 0·055–0·134), and weight-for-height Z score (0·126, 0·057–0·194). We estimated that diarrhoea from Cryptosporidium infection caused an additional 7·85 million disability-adjusted life-years (95% UI 5·42 million–10·11 million) after we accounted for its effect on growth faltering—153% more than that estimated from acute effects alone.InterpretationOur 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.FundingThe Bill & Melinda Gates Foundation.

A One Health Approach to Tackle Cryptosporidiosis

“…Burden of disease studies, focussed on acute illness, estimate 4.2 million disability adjusted life years lost in children under 5 years [64], with longer term sequelae, including growth faltering and cognitive defects. Disease impact studies in high-income countries found longer term impacts following acute infection involving persistent abdominal pain, myalgia/arthralgia and fatigue [78], irritable bowel syndrome [79], and a recent study has shown a strong association between Cryptosporidium infection and human colon cancer [80].…”

“…The impact of the disease is far reaching and recent studies have highlighted the longterm consequences of clinical disease in both humans and livestock animals (Box 1). The true burden of disease in both public [64] and veterinary health is unknown, as many incidences of infection and disease go undiagnosed or unreported. With livestock farming moving towards increasingly efficient and sustainable production to minimise impact on the environment, there is much to be gained from tackling cryptosporidiosis.…”

Gene silencing in Cryptosporidium: A rapid approach to identify novel targets for drug development

“…Cryptosporidium is a leading cause of moderate-to-severe diarrhea in children under two years old and the leading pathogen associated with death in toddlers (ages 12 to 23 months 1 ). Nitazoxanide is only one FDA approved medicine available for cryptosporidiosis, but it has limited efficacy in the population at the highest risk for poor outcomes.…”

Genome-wide association study of cryptosporidiosis in infants implicatesPRKCA

“…(3–6) The majority of human infections are caused by the C. hominis, C. meleagridis, and C. parvum species, members of the phylum Apicomplexa. (5, 7, 8) As cryptosporidiosis is transmitted fecal-orally, contact with any reservoir with possible fecal contamination could serve as point of transmission. In the developed world, cryptosporidia are an important cause of diarrhea in individuals living with HIV and is the most common pathogen causing waterborne outbreaks.…”

“…In the developed world, cryptosporidia are an important cause of diarrhea in individuals living with HIV and is the most common pathogen causing waterborne outbreaks. (8)…”