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• W2039710005 abstract "•Diagnosis of cryptosporidiosis is currently based on a variety of laboratory methods.•Typing of isolates supports disease investigations, but application is inconsistent.•To harmonise work, there is a need for consensus in multi-locus typing schemes.•Translation of genomic data into improved diagnostic and typing assays will facilitate future harmonisation. The protozoan Cryptosporidium is a major public and animal health concern. Young children, immunocompromised people, and pre-weaning animals are especially vulnerable, but treatment options are limited and there is no vaccine. A laboratory diagnosis is required to confirm cases of cryptosporidiosis, and species and genotype determination is essential in distinguishing human from non-human sources, understanding transmission, and strengthening the epidemiological evidence for causative links in outbreaks. However, testing is not consistent, as demonstrated by investigation of a significant increase in cases in some European countries during 2012. Many methods employed are laborious and time-consuming; recent advances, translated into diagnostic assays, can improve testing and facilitate typing to support clinical and environmental investigations. The protozoan Cryptosporidium is a major public and animal health concern. Young children, immunocompromised people, and pre-weaning animals are especially vulnerable, but treatment options are limited and there is no vaccine. A laboratory diagnosis is required to confirm cases of cryptosporidiosis, and species and genotype determination is essential in distinguishing human from non-human sources, understanding transmission, and strengthening the epidemiological evidence for causative links in outbreaks. However, testing is not consistent, as demonstrated by investigation of a significant increase in cases in some European countries during 2012. Many methods employed are laborious and time-consuming; recent advances, translated into diagnostic assays, can improve testing and facilitate typing to support clinical and environmental investigations. Cryptosporidium causes sporadic cases and outbreaks of gastroenteritis (cryptosporidiosis) through faeces-contaminated drinking and recreational water [1Baldursson S. Karanis P. Waterborne transmission of protozoan parasites: review of worldwide outbreaks – an update 2004–2010.Water Res. 2011; 45: 6603-6614Crossref PubMed Scopus (610) Google Scholar], food and beverages [2Robertson L.J. Chalmers R.M. Foodborne cryptosporidiosis: is there really more in Nordic countries?.Trends Parasitol. 2013; 29: 3-9Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar], person-to-person spread in households and institutions such as daycare settings [3Artieda J. et al.Outbreak of cryptosporidiosis in a child day-care centre in Gipuzkoa, Spain, October to December 2011.Euro Surveill. 2012; 17: pii=20070Google Scholar], farmed animal contact [4Gormley F.J. et al.Zoonotic cryptosporidiosis from petting farms, England and Wales, 1992-2009.Emerg. Infect. Dis. 2011; 17: 151-152Crossref PubMed Scopus (32) Google Scholar], and in livestock, companion, and other animals [5Santín M. Clinical and subclinical infections with Cryptosporidium in animals.N. Z. Vet. J. 2013; 61: 1-10Crossref PubMed Scopus (117) Google Scholar] (Figure 1). Increased morbidity, mortality, and socio-economic implications [6Shirley D.A. et al.Burden of disease from cryptosporidiosis Curr.Opin. Infect. Dis. 2012; 25: 555-563Crossref PubMed Scopus (149) Google Scholar, 7Featherstone C.A. et al.Cryptosporidium species in calves submitted for postmortem examination in England and Wales.Vet. Rec. 2010; 167: 979-980Crossref PubMed Scopus (10) Google Scholar] are recognised by inclusion of Cryptosporidium in the Neglected Diseases Initiative of the World Health Organization (WHO) [8Savioli L. et al.Giardia and Cryptosporidium join the ‘Neglected Diseases Initiative’.Trends Parasitol. 2006; 22: 203-208Abstract Full Text Full Text PDF PubMed Scopus (618) Google Scholar]. Cryptosporidiosis is a laboratory diagnosis because it is not pathognomonic – in other words, the acute signs and symptoms can be similar to other infectious and non-infectious causes of gastroenteritis [9Sreiner T.S. Mandell G.L. Principles and syndromes of enteric infection.in: Mandell G.L. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th edn. Churchill Livingstone, 2009: 1335-1351Google Scholar, 10Ferreira J. et al.Cryptosporidiosis masquerading as a Crohn's flare.Inflamm. Bowel Dis. 2011; 17: E133-E134Crossref PubMed Scopus (4) Google Scholar]. In cases where other parasites are also suspected, or in populations where they are prevalent, multiple faecal samples with and without chemical preservation may be required [11Garcia L.S. Diagnostic Medical Parasitology. ASM Press, 2007Crossref Google Scholar] (Figure 2). Differential diagnosis enables provision of appropriate advice on treatment, control, and management, and at the population level it is required for the identification of outbreaks and for monitoring trends, risk factors, and interventions.Figure 2Workflow for Cryptosporidium diagnosis during investigation of gastroenteritis. Unbroken boxes represent adopted tests [11Garcia L.S. Diagnostic Medical Parasitology. ASM Press, 2007Crossref Google Scholar] (see: http://www.oie.int/international-standard-setting/terrestrial-manual/access-online/); broken lines and boxes represent reference or specialist tests; broken, grey lines and box represents alternative workflow based on multi-pathogen diagnostic PCRs. The optimisation of automated nucleic acid extraction processes and application of multiplex, real-time PCR offers great potential for streamlining diagnostic workflows.View Large Image Figure ViewerDownload (PPT) The ability of Cryptosporidium to break through multiple water-treatment barriers and cause large-scale outbreaks has had huge impact on the water industry and its regulation [12Chalmers R.M. Waterborne cryptosporidiosis outbreaks.Ann. Ist. Super. Sanità. 2012; 48: 429-446Crossref PubMed Scopus (74) Google Scholar], and it has been used as a reference pathogen for the faecal-orally transmitted protozoa in the design and implementation of the WHO Guidelines for Drinking Water Quality [13Medema G. Risk Assessment of Cryptosporidium in Drinking-Water. World Health Organization, 2009Google Scholar, 14World Health Organization Guidelines for Drinking-Water Quality.4th edn. WHO, 2011Google Scholar]. Monitoring for oocysts is part of the surveillance to support water-safety plans [14World Health Organization Guidelines for Drinking-Water Quality.4th edn. WHO, 2011Google Scholar]. During 2012 a significant but unexplained increase in the incidence of human cryptosporidiosis was reported by Fournet and colleagues in the UK, The Netherlands (NL), and Germany to the European Centre for Disease Control [15Fournet N. et al.Simultaneous increase of Cryptosporidium infections in the Netherlands, the United Kingdom and Germany in late summer season, 2012.Euro Surveill. 2013; 18: pii=20348Google Scholar]. This report highlights difficulties in comparing data across countries, derived differently due to variations in laboratory testing and reporting. The lack of widespread, routine Cryptosporidium diagnosis and species identification, or a standardised subtyping scheme, impinges on investigation. These shortcomings also occur in water testing where only the genus is identified. Phylogenetic comparisons of isolates from cases and sources are not undertaken in most settings, impacting on source attribution and risk assessments for drinking water and other exposures [13Medema G. Risk Assessment of Cryptosporidium in Drinking-Water. World Health Organization, 2009Google Scholar]. Techniques for the detection, diagnosis, and characterisation of Cryptosporidium spp. from different sample types have been reviewed previously [16Jex A. et al.Cryptosporidium – biotechnological advances in the detection, diagnosis and analysis of genetic variation.Adv. Parasitol. 2008; 77: 141-173Crossref Scopus (19) Google Scholar, 17Smith H. Nichols R.A. Cryptosporidium: detection in water and food.Exp. Parasitol. 2010; 124: 61-79Crossref PubMed Scopus (108) Google Scholar, 18Xiao L. Molecular epidemiology of cryptosporidiosis: An update.Exp. Parasitol. 2010; 124: 80-89Crossref PubMed Scopus (837) Google Scholar]. However, not all have been delivered from research to diagnostic settings. Here we examine the current workflows and review advances that have been translated into clinical and environmental investigations. Taxonomic positions are important in understanding the evolution, biology, pathogenesis, sources, and transmission of pathogens as well as focussing efforts for identifying targets for diagnosis and drug therapies. The taxonomy of Cryptosporidium (phylum Apicomplexa, class Coccidea, order Eimeriidae) was disputed, because of life-cycle (Figure 1), phylogenetic, and biological differences observed in comparison with other Eimeriidae (e.g., Cyclospora, Cystoisospora, and Eimeria) [19Barta J.R. Thompson R.C.A. What is Cryptosporidium? Reappraising its biology and phylogenetic affinities.Trends Parasitol. 2006; 22: 463-468Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar]. Traditionally, Apicomplexan species were defined by host-specificity, location of endogenous stages, and morphology. For Cryptosporidium spp., however, host-specificity is variable, and oocyst morphology distinguishes only those with smaller, near-spherical oocysts (4–6 μm in diameter) from those with larger, more oval oocysts (7 × 5 μm) (Table 1). Therefore, a combination of biological and genetic data is recommended for identifying and naming new species: (i) morphological features of the oocyst and demonstration of developmental stages; (ii) natural and experimental host range; (iii) detailed biological characterisation, including localisation and pathology associated with an individual host; (iv) differential diagnosis; (v) genetic characterisation at multiple loci, to include the small subunit ribosomal RNA (SSU rRNA) and other functional genes; (vi) deposition of definitive reference sequences and preserved material for further analyses; and (vii) compliance with International Committee for Zoonotic Nomenclature (ICZN) species-naming rules [20Jirku et al.New species of Cryptosporidium Tyzzer, 1907 (Apicomplexa) from amphibian host: morphology, biology and pylogeny.Folia Parasitol. 2008; 55: 81-94PubMed Google Scholar]. Where mainly genetic data are available, isolates are described as ‘genotypes’ [21Fayer R. Taxonomy and species delimitation in Cryptosporidium.Exp. Parasitol. 2010; 124: 90-97Crossref PubMed Scopus (306) Google Scholar]. The ICZN rules are open to interpretation, especially in the Principle of Priority, leading to conflicting opinions about renaming Cryptosporidium spp. (e.g., Cryptosporidium parvum as Cryptosporidium pestis) [22Xiao L. et al.Cryptosporidium tyzzeri and Cryptosporidium pestis: which name is valid?.Exp. Parasitol. 2012; 130: 308-309Crossref PubMed Scopus (8) Google Scholar]. To avoid confusion and promote stability, here we use C. parvum for the species infective to calves and humans [21Fayer R. Taxonomy and species delimitation in Cryptosporidium.Exp. Parasitol. 2010; 124: 90-97Crossref PubMed Scopus (306) Google Scholar].Table 1Cryptosporidium species and their association with clinical diseaseCryptosporidium species and genotypesaOnly those genotypes found in humans have been included here.Mean oocyst dimensions (μm)bFrom the original papers describing the species or genotype.Major host(s)Association with human cryptosporidiosis 18Xiao L. Molecular epidemiology of cryptosporidiosis: An update.Exp. Parasitol. 2010; 124: 80-89Crossref PubMed Scopus (837) Google ScholarAssociation with animal cryptosporidiosis 5Santín M. Clinical and subclinical infections with Cryptosporidium in animals.N. Z. Vet. J. 2013; 61: 1-10Crossref PubMed Scopus (117) Google Scholar, 21Fayer R. Taxonomy and species delimitation in Cryptosporidium.Exp. Parasitol. 2010; 124: 90-97Crossref PubMed Scopus (306) Google Scholar, 23Xiao L. Feng Y. Zoonotic cryptosporidiosis.FEMS Immunol. Med. Microbiol. 2008; 52: 1-15Crossref Google ScholarAdditional key RefsC. andersoni7.4 × 5.5CattleRarely associated; individual reports from UK, Australia, and Malawi.Usually seen in yearlings and adult cattle; not associated with diarrhoea but linked to reduced milk-yields and weight gain.63Ryan U. Power M. Cryptosporidium species in Australian wildlife and domestic animals.Parasitology. 2012; 20: 1-16Google ScholarC. baileyi6.2 × 4.6Chickens, other birdsNo association.Many different bird species can be affected, mainly by infection in the upper respiratory tract which can be fatal; also linked to renal and ocular disease. Severe outbreaks and mortalities in poultry units.C. bovis(previously bovine B genotype)4.9 × 4.6CattleRarely associated; individual reports from Australia and India of cases reporting cattle contact.Shedding is seen mainly in weaned and sometimes pre-weaning calves but infection is considered non-pathogenic.63Ryan U. Power M. Cryptosporidium species in Australian wildlife and domestic animals.Parasitology. 2012; 20: 1-16Google Scholar, 64Khan S.M. et al.Molecular characterization and assessment of zoonotic transmission of Cryptosporidium from dairy cattle in West Bengal, India.Vet. Parasitol. 2010; 171: 41-47Crossref PubMed Scopus (89) Google ScholarC. canis(previously dog genotype)5.0 × 4.7DogEpidemiologically linked to diarrhoea in children in a shanty town in Lima, Peru; occasional sporadic cases in various, especially non-industrialised, countries; some cases report contact with dogs.Diarrhoea usually seen in puppies and younger dogs; asymptomatic shedding of oocysts has been reported in older and immune- competent dogs.C. cuniculus(previously rabbit genotype)5.6 × 5.4Rabbit, humansCaused a waterborne outbreak in UK; occasional, seasonal sporadic cases in UK, individual reports from France and children in Nigeria.Asymptomatic shedding of oocysts in natural and experimental infections in rabbits.65The ANOFEL Cryptosporidium National Network Laboratory-based surveillance for Cryptosporidium in France, 2006–2009.Euro Surveill. 2010; 15: pii=19642Google Scholar, 66Molloy S.F. Identification of a high diversity of Cryptosporidium species genotypes and subtypes in a pediatric population in Nigeria.Am. J. Trop. Med. Hyg. 2010; 82: 608-613Crossref PubMed Scopus (78) Google Scholar, 67Robinson G. et al.Re-description of Cryptosporidium cuniculus Inman and Takeuchi, 1979 (Apicomplexa: Cryptosporidiidae): morphology, biology and phylogeny.Int. J. Parasitol. 2010; 40: 1539-1548Crossref PubMed Scopus (80) Google ScholarC. fayeri(previously marsupial genotype I)4.9 × 4.3MarsupialsRarely associated; individual report from Australia of a person in contact with marsupials.Oocyst shedding is not associated with diarrhoea and no clinical signs are described.63Ryan U. Power M. Cryptosporidium species in Australian wildlife and domestic animals.Parasitology. 2012; 20: 1-16Google ScholarC. felis4.6 × 4.0CatEpidemiologically linked to diarrhoea in children in a shanty town in Lima, Peru; occasional sporadic cases in various countries including developed countries, especially immunocompromised people and those with cat contact.More common in kittens and younger cats and is then associated with diarrhoea. Often only low numbers of oocysts detectable.68Elwin K. et al.The epidemiology of sporadic human infections with unusual cryptosporidia detected during routine typing in England and Wales, 2000 to 2008.Epidemiol. Infect. 2011; 140: 673-683Crossref PubMed Scopus (118) Google ScholarC. fragile6.2 × 5.5Black spined toadNo association.Infection appears to be host-specific because infections of four amphibian and one fish species failed.C. galli8.3 × 6.3ChickenNo association.Infection of the proventriculus can lead to diarrhoea and fatalities; shedding can be prolonged and is not necessarily associated with diarrhoea.C. hominis(previously referred to as C. parvum human genotype, genotype I, and genotype H)4.9 × 5.2HumansCommon cause of diarrhoeal disease in sporadic cases and outbreaks. Infectivity data from experimental infections in adults extrapolated to dose–response indicate that ingestion of a single oocyst carries a discrete probability of infection. Transmitted either directly person-to-person (especially in daycare centres, household contacts, toileting, or nappy changing), or indirectly via contaminated drinking water, recreational water, food, or fomites. High parasite genetic heterogeneity in non-industrialised countries; more homogenous in industrialised countries. Children in Brazil shed more oocysts, had more frequent presence of faecal lactoferrin, and greater growth shortfalls than those infected with C. parvum, even in the absence of symptoms. HIV-positive persons in Lima, Peru, experienced more severe symptoms than those infected with other species. High virulence was evident within gp60 subtype family Id but was absent in subtype families Ia and IecSee [18] for an explanation of gp60 subtyping and nomenclature..There is no defined animal host for this species, although low density of the parasite has been detected occasionally in cattle, sheep and goat faeces.Experimental infection can be maintained in piglets and calves. Immunosuppressed Mongolian gerbils provide an asymptomatic small mammal model for infection.13Medema G. Risk Assessment of Cryptosporidium in Drinking-Water. World Health Organization, 2009Google ScholarC. macropodum (previously marsupial genotype II)5.4 × 4.9Eastern grey kangarooNo association.Infection is limited to marsupials, which can excrete large numbers of oocysts without any clinical signs.63Ryan U. Power M. Cryptosporidium species in Australian wildlife and domestic animals.Parasitology. 2012; 20: 1-16Google ScholarC. meleagridis5.2 × 4.6Homoeo-thermic birds; mammalsInfectivity data from experimental infections in adults indicate mild illness. Sporadic cases are reported more frequently in some populations, for example infections are as common as for C. parvum (10–20% of cryptopsoridiosis cases) in Bangkok, Thailand and Lima, Peru; travel to endemic countries; possible outbreak on a farm in Sweden.Associated with enteritis, diarrhoea and death in birds. Severe outbreaks and mortalities reported in poultry units and game birds. Asymptomatic infections and growth reductions have also been reported. Readily transmissible between birds and mammals.33Chappell C.L. et al.Cryptosporidium meleagridis: infectivity in healthy adult volunteers.Am. J. Trop. Med. Hyg. 2011; 85: 238-242Crossref PubMed Scopus (46) Google Scholar, 68Elwin K. et al.The epidemiology of sporadic human infections with unusual cryptosporidia detected during routine typing in England and Wales, 2000 to 2008.Epidemiol. Infect. 2011; 140: 673-683Crossref PubMed Scopus (118) Google Scholar, 69Silverlås C. et al.Zoonotic transmission of Cryptosporidium meleagridis on an organic Swedish farm.Int. J. Parasitol. 2012; 42: 963-967Crossref PubMed Scopus (49) Google ScholarC. molnaridCurrently, Cryptosporidium is the only genus in the Family Cryptosporidiidae, but piscine species show considerable genetic distance, ultrastructural and developmental differences in comparison with other Cryptosporidium species, and a new genus, Piscicryptosporidium, has been proposed, pending study of additional piscine isolates [81].4.7 × 4.5Sea breamNo association.Infection is seasonal, mostly in younger fish in the spring.70Sitjà-Bobadilla A. et al.Epidemiology of Cryptosporidium molnari in Spanish gilthead sea bream (Sparus aurata L.) and European sea bass (Dicentrarchus labrax L.) cultures: from hatchery to market size.Appl. Environ. Microbiol. 2005; 71: 131-139Crossref PubMed Scopus (41) Google ScholarC. muris7.0 × 5.0RodentsRarely associated; individual reports from various developing countries.Clinical signs are not usually reported; infection and oocyst shedding has been reported in other animal species.C. parvum(also sometimes previously called bovine genotype, genotype II, and genotype B)5.0 × 4.5Humans, mammalsCommon in sporadic cases and outbreaks; zoonotic transmission, either directly animal-to-person through recreational or occupational farm animal contact (especially young ruminants), or indirectly through contaminated drinking water, recreational water, environmental contact, food, or fomites. Person-to-person spread also occurs. Infectivity data from experimental infections in adults extrapolated to dose–response indicate that ingestion of a single oocyst carries a discrete probability of infection. The infectious dose with C. parvum in neonatal ruminants is similar. High heterogeneity; some subtypes (e.g., gp60 IIc) appear host-adapted to humanscSee [18] for an explanation of gp60 subtyping and nomenclature..Common cause of diarrhoea in pre-weaning calves, lambs, and goats; infection can be fatal. Also reported in foals, alpaca, llama. Occasional respiratory symptoms. Disease is age-dependent, where older animals are usually asymptomatic. Some subtypes (e.g., gp60 IIc) have no defined animal host.Asymptomatic infectivity models include neonatal, immunosuppressed and immunocompromised mice.13Medema G. Risk Assessment of Cryptosporidium in Drinking-Water. World Health Organization, 2009Google Scholar, 71Blewett D.A. et al.Infective dose size studies on Cryptosporidium parvum using gnotobiotic lambs.Water Sci. Technol. 1993; 27: 61Google ScholarC. ryanae(previously deer-like genotype)3.7 × 3.2CattleNo association.Infection is host-specific and shedding is seen in weaned calves but is thought to be asymptomatic.C. scophthalmidCurrently, Cryptosporidium is the only genus in the Family Cryptosporidiidae, but piscine species show considerable genetic distance, ultrastructural and developmental differences in comparison with other Cryptosporidium species, and a new genus, Piscicryptosporidium, has been proposed, pending study of additional piscine isolates [81].4.4 × 3.9TurbotNo association.Infection occurs in the intestine and is seen seasonally in younger fish; has been linked to reduced growth rates.72Alvarez-Pellitero P. et al.Host and environmental risk factors associated with Cryptosporidium scophthalmi (Apicomplexa) infection in cultured turbot, Psetta maxima (L.) (Pisces, Teleostei).Vet. Parasitol. 2009; 165: 207-215Crossref PubMed Scopus (15) Google ScholarC. scrofarum (previously pig genotype II)5.2 × 4.8PigRarely associated; individual report from Czech Republic involving contact with pigs.Infection is seen in pigs aged more than 6 weeks resulting in low levels of oocyst shedding and no association with diarrhoea.73Němejc K. et al.Occurrence of Cryptosporidium suis and Cryptosporidium scrofarum on commercial swine farms in the Czech Republic and its associations with age and husbandry practices.Parasitol. Res. 2013; 112: 1143-1154Crossref PubMed Scopus (32) Google ScholarC. serpentis6.2 × 5.3ReptilesNo association.Infection is common. In snakes, infection manifests as anorexia, persistent postprandial regurgitation, lethargy, mid-body swelling, and chronic weight-loss, which is usually protracted and almost always fatal. In lizards infection is usually asymptomatic.C. suis(previously pig genotype I)4.6 × 4.2PigRarely associated; individual reports from UK and Peru involving contact with pigs.Infection is usually seen in pre-weaning pigs but is not associated with diarrhoea.73Němejc K. et al.Occurrence of Cryptosporidium suis and Cryptosporidium scrofarum on commercial swine farms in the Czech Republic and its associations with age and husbandry practices.Parasitol. Res. 2013; 112: 1143-1154Crossref PubMed Scopus (32) Google ScholarC. tyzzeri (previously mouse genotype I)4.6 × 4.2MiceRarely associated; individual report from Czech republic involving contact with wild mice.Infection is usually most intense in the ileum but no clinical signs were recorded in experimental infections.74Ren X. et al.Cryptosporidium tyzzeri n. sp. (Apicomplexa: Cryptosporidiidae) in domestic mice (Mus musculus).Exp. Parasitol. 2012; 130: 274-281Crossref PubMed Scopus (75) Google Scholar, 75Rasková V. et al.Case of human cryptosporidiosis caused by Cryptosporidium tyzzeri and C. parvum presumably transmitted from wild mice.J. Clin. Microbiol. 2013; 51: 360-362Crossref PubMed Scopus (38) Google ScholarC. ubiquitum(previously cervine genotype)5.0 × 4.7Various mammalsSporadic cases in various countries, especially developed countries, possibly involving untreated water supplies contaminated by animal hosts in the catchment.Broad host-range and a common parasite of weaned lambs. No association of oocyst shedding and clinical symptoms in experimentally infected lambs.C. viatorum5.4 × 4.7HumansSporadic cases emerging in the UK and Sweden are linked to visits to the Indian subcontinent, South America, and Kenya.No animal host is known for this species.76Elwin K. et al.Cryptosporidium viatorum n. sp. (Apicomplexa: Cryptosporidiidae) among travellers returning to the United Kingdom from the Indian Subcontinent.Int. J. Parasitol. 2012; 42: 675-682Crossref PubMed Scopus (91) Google Scholar, 77Insulander M. et al.Molecular epidemiology and clinical manifestations of human cryptosporidiosis in Sweden.Epidemiol. Infect. 2012; 9: 1-12Google ScholarC. varanii(syn. C. saurophilum)4.8 × 4.7ReptilesNo association.Infection is seen in lizards and snakes. Clinical signs include anorexia, progressive weight-loss, abdominal swelling, and death, particularly in young animals.C. wrairi5.4 × 4.6Guinea pigNo association.Disease not described.78Lv C. et al.Cryptosporidium spp. in wild, laboratory, and pet rodents in China: prevalence and molecular characterization.Appl. Environ. Microbiol. 2009; 75: 7692-7699Crossref PubMed Scopus (107) Google ScholarC. xiaoi(previously Cryptosporidium bovis-like genotype or C. bovis from sheep)3.9 × 3.4SheepNo association.In sheep, asymptomatic carriage; no association of oocyst shedding and clinical symptoms in experimentally infected lambs. Infection in goat kids can be associated with diarrhoea.79Rieux A. Molecular characterization of Cryptosporidium spp. in pre-weaned kids in a dairy goat farm in western France.Vet. Parasitol. 2013; 192: 268-272Crossref PubMed Scopus (40) Google ScholarChipmunk genotype INot reportedChipmunk; possibly other SciuridaeRarely associated; individual reports from the USA, France, Sweden.No association of clinical signs with shedding oocysts.Horse genotype4.6 × 4.2HorsesRarely associated; individual reports from the UK and USANo association of oocyst shedding with diarrhoea.80Burton A.J. et al.The prevalence of Cryptosporidium, and identification of the Cryptosporidium horse genotype in foals in New York State.Vet. Parasitol. 2010; 174: 139-144Crossref PubMed Scopus (43) Google ScholarC. hominis monkey genotypeNot reportedMonkey, humanRarely associated; individual reports from UK and Malawi.No association of oocyst shedding with diarrhoea recorded.Skunk genotypeNot reportedSkunk; possibly other mustelidsRarely associated; an individual report from the UK where skunks are not found outside zoos.No association of oocyst shedding with diarrhoea recorded.a Only those genotypes found in humans have been included here.b From the original papers describing the species or genotype.c See 18Xiao L. Molecular epidemiology of cryptosporidiosis: An update.Exp. Parasitol. 2010; 124: 80-89Crossref PubMed Scopus (837) Google Scholar for an explanation of gp60 subtyping and nomenclature.d Currently, Cryptosporidium is the only genus in the Family Cryptosporidiidae, but piscine species show considerable genetic distance, ultrastructural and developmental differences in comparison with other Cryptosporidium species, and a new genus, Piscicryptosporidium, has been proposed, pending study of additional piscine isolates 81Palenzuela O. et al.Molecular characterization of Cryptosporidium molnari reveals a distinct piscine clade.Appl. Environ. Microbiol. 2010; 76: 7646-7649Crossref PubMed Scopus (32) Google Scholar. Open table in a new tab At time of writing 26 Cryptosporidium species have been named (Table 1). There is good evidence for six as important causes of human cryptosporidiosis: most commonly Cryptosporidium hominis and C. parvum, followed by Cryptosporidium meleagridis and occasionally Cryptosporidium cuniculus, Cryptosporidium felis, and Cryptosporidium canis [18Xiao L. Molecular epidemiology of cryptosporidiosis: An update.Exp. Parasitol. 2010; 124: 80-89Crossref PubMed Scopus (837) Google Scholar]. Infection is transmitted by oocysts and acquired mainly by the faecal–oral route, with very rare instances of respiratory infection following inhalation or aspiration [6Shirley D.A. et al.Burden of disease from cryptosporidiosis Curr.Opin. Infect. Dis. 2012; 25: 555-563Crossref PubMed Scopus (149) Google Scholar]. Despite occasional reports in livestock, C. hominis appears to be transmitted anthroponotically. Immunocompromised patients have provided sentinel alert to some new infections [23Xiao L. Feng Y. Zoonotic cryptosporidiosis.FEMS Immunol. Med. Microbiol. 2008; 52: 1-15Crossref Google Scholar]. In animals, the clinically and economically important gastrointestinal species are C. parvum (pre-weaning ruminants), C. meleagridis (birds), C. canis (puppies), C. felis (kittens), Cryptosporidium serpentis (snakes), and Cryptosporidium varanii (reptiles) [5Santín M. Clinical and subclinical infections with Cryptosporidium in animals.N. Z. Vet. J. 2013; 61: 1-10Cro" @default.
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• W2039710005 title "Looking for Cryptosporidium: the application of advances in detection and diagnosis" @default.
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• W2039710005 doi "https://doi.org/10.1016/j.pt.2013.03.001" @default.
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