Abstract
Advances in serologic assays for Cryptosporidium parvum have made serology an attractive surveillance tool. The sensitivity, specificity, and predictive value of these new assays for surveillance of immunocompromised populations, however, have not been reported. Using stored serum specimens collected for the San Francisco Men's Health Study, we conducted a case-control study with 11 clinically confirmed cases of cryptosporidiosis. Based on assays using a 27-kDa antigen (CP23), the serum specimens from cases had a median response immunoglobulin (Ig) G level following clinical diagnosis (1,334) and a net response (433, change in IgG level from baseline) that were significantly higher than their respective control values (329 and -32, Wilcoxon p value = 0.01). Receiver operator curves estimated a cutoff of 625 U as the optimal sensitivity (0.86 [0.37, 1.0]) and specificity (0.86 [0.37, 1.0]) for predicting Cryptosporidium infection. These data suggest that the enzyme-linked immunosorbent assay technique can be an effective epidemiologic tool to monitor Cryptosporidium infection in immunocompromised populations.
Full Text
The Full Text of this article is available as a PDF (70.4 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Colford J. M., Jr, Tager I. B., Hirozawa A. M., Lemp G. F., Aragon T., Petersen C. Cryptosporidiosis among patients infected with human immunodeficiency virus. Factors related to symptomatic infection and survival. Am J Epidemiol. 1996 Nov 1;144(9):807–816. doi: 10.1093/oxfordjournals.aje.a009015. [DOI] [PubMed] [Google Scholar]
- Flanigan T., Whalen C., Turner J., Soave R., Toerner J., Havlir D., Kotler D. Cryptosporidium infection and CD4 counts. Ann Intern Med. 1992 May 15;116(10):840–842. doi: 10.7326/0003-4819-116-10-840. [DOI] [PubMed] [Google Scholar]
- Griffiths J. K. Human cryptosporidiosis: epidemiology, transmission, clinical disease, treatment, and diagnosis. Adv Parasitol. 1998;40:37–85. doi: 10.1016/s0065-308x(08)60117-7. [DOI] [PubMed] [Google Scholar]
- Guerrant R. L. Cryptosporidiosis: an emerging, highly infectious threat. Emerg Infect Dis. 1997 Jan-Mar;3(1):51–57. doi: 10.3201/eid0301.970106. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hoxie N. J., Davis J. P., Vergeront J. M., Nashold R. D., Blair K. A. Cryptosporidiosis-associated mortality following a massive waterborne outbreak in Milwaukee, Wisconsin. Am J Public Health. 1997 Dec;87(12):2032–2035. doi: 10.2105/ajph.87.12.2032. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Juranek D. D. Cryptosporidiosis: sources of infection and guidelines for prevention. Clin Infect Dis. 1995 Aug;21 (Suppl 1):S57–S61. doi: 10.1093/clinids/21.supplement_1.s57. [DOI] [PubMed] [Google Scholar]
- Kim L. S., Hadley W. K., Stansell J., Cello J. P., Koch J. Declining prevalence of cryptosporidiosis in San Francisco. Clin Infect Dis. 1998 Sep;27(3):655–656. doi: 10.1086/517147. [DOI] [PubMed] [Google Scholar]
- Manabe Y. C., Clark D. P., Moore R. D., Lumadue J. A., Dahlman H. R., Belitsos P. C., Chaisson R. E., Sears C. L. Cryptosporidiosis in patients with AIDS: correlates of disease and survival. Clin Infect Dis. 1998 Sep;27(3):536–542. doi: 10.1086/514701. [DOI] [PubMed] [Google Scholar]
- Matos O., Tomás A., Aguiar P., Casemore D., Antunes F. Prevalence of cryptosporidiosis in AIDS patients with diarrhoea in Santa Maria Hospital, Lisbon. Folia Parasitol (Praha) 1998;45(2):163–166. [PubMed] [Google Scholar]
- Morin C. A., Roberts C. L., Mshar P. A., Addiss D. G., Hadler J. L. What do physicians know about cryptosporidiosis? A survey of Connecticut physicians. Arch Intern Med. 1997 May 12;157(9):1017–1022. [PubMed] [Google Scholar]
- Moss D. M., Bennett S. N., Arrowood M. J., Wahlquist S. P., Lammie P. J. Enzyme-linked immunoelectrotransfer blot analysis of a cryptosporidiosis outbreak on a United States Coast Guard cutter. Am J Trop Med Hyg. 1998 Jan;58(1):110–118. doi: 10.4269/ajtmh.1998.58.110. [DOI] [PubMed] [Google Scholar]
- Moss D. M., Chappell C. L., Okhuysen P. C., DuPont H. L., Arrowood M. J., Hightower A. W., Lammie P. J. The antibody response to 27-, 17-, and 15-kDa Cryptosporidium antigens following experimental infection in humans. J Infect Dis. 1998 Sep;178(3):827–833. doi: 10.1086/515377. [DOI] [PubMed] [Google Scholar]
- Pedersen C., Danner S., Lazzarin A., Glauser M. P., Weber R., Katlama C., Barton S. E., Lundgren J. D. Epidemiology of cryptosporidiosis among European AIDS patients. Genitourin Med. 1996 Apr;72(2):128–131. doi: 10.1136/sti.72.2.128. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pozio E., Rezza G., Boschini A., Pezzotti P., Tamburrini A., Rossi P., Di Fine M., Smacchia C., Schiesari A., Gattei E. Clinical cryptosporidiosis and human immunodeficiency virus (HIV)-induced immunosuppression: findings from a longitudinal study of HIV-positive and HIV-negative former injection drug users. J Infect Dis. 1997 Oct;176(4):969–975. doi: 10.1086/516498. [DOI] [PubMed] [Google Scholar]
- Priest J. W., Kwon J. P., Moss D. M., Roberts J. M., Arrowood M. J., Dworkin M. S., Juranek D. D., Lammie P. J. Detection by enzyme immunoassay of serum immunoglobulin G antibodies that recognize specific Cryptosporidium parvum antigens. J Clin Microbiol. 1999 May;37(5):1385–1392. doi: 10.1128/jcm.37.5.1385-1392.1999. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Roberts C. L., Morin C., Addiss D. G., Wahlquist S. P., Mshar P. A., Hadler J. L. Factors influencing Cryptosporidium testing in Connecticut. J Clin Microbiol. 1996 Sep;34(9):2292–2293. doi: 10.1128/jcm.34.9.2292-2293.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sorvillo F., Beall G., Turner P. A., Beer V. L., Kovacs A. A., Kraus P., Masters D., Kerndt P. R. Seasonality and factors associated with cryptosporidiosis among individuals with HIV infection. Epidemiol Infect. 1998 Aug;121(1):197–204. doi: 10.1017/s0950268898001009. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ungar B. L., Nash T. E. Quantification of specific antibody response to Cryptosporidium antigens by laser densitometry. Infect Immun. 1986 Jul;53(1):124–128. doi: 10.1128/iai.53.1.124-128.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Weber R., Bryan R. T., Bishop H. S., Wahlquist S. P., Sullivan J. J., Juranek D. D. Threshold of detection of Cryptosporidium oocysts in human stool specimens: evidence for low sensitivity of current diagnostic methods. J Clin Microbiol. 1991 Jul;29(7):1323–1327. doi: 10.1128/jcm.29.7.1323-1327.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Winkelstein W., Jr, Samuel M., Padian N. S., Wiley J. A., Lang W., Anderson R. E., Levy J. A. The San Francisco Men's Health Study: III. Reduction in human immunodeficiency virus transmission among homosexual/bisexual men, 1982-86. Am J Public Health. 1987 Jun;77(6):685–689. doi: 10.2105/ajph.77.6.685. [DOI] [PMC free article] [PubMed] [Google Scholar]