Improved diagnosis of cryptosporidiosis in resource limited settings – Eva-luation of a low-cost point-of care cryptosporidiosis test in children in Ethiopia. The CRYPTO-POC study
Principal investigator: Øystein Haarklau Johansen1,5
Co-investigators: Alemseged Abdissa2, Zeleke Mekonnen2, Kurt Hanevik1, Nina Langeland1, Lucy Robertson3, Tsinuel Girma2, Jørgen Kurtzhals4 and Mike Zangenberg4
Collaborating institutions: 1) University of Bergen, 2) Jimma University, 3) Norwegian University of Life Sciences, 4) University of Copenhagen, 5) Vestfold Hospital Trust, Norway.
Background, objective and methods: The protozoan parasite Cryptosporidium is a major cause of childhood diarrhoea and death. There is no vaccine and only one approved drug (nitazoxanide); however there is now considerable interest and research in developing new drugs. A test-and-treat strategy will however require a reliable and affordable point-of-care test that is not availa-ble at present. We propose that light-emitting diode fluorescence microscopes and auramine-phenol stains (LED-AP) that are currently being rolled out in low income countries can serve the dual purpose of tuberculosis and Cryptosporidium point-of-care diagnostic testing. Our primary objective is therefore to estimate the accuracy and feasability of LED-AP for the diagnosis of Cryptosporidium in children with diarrhoea in Ethiopia.
Clinical data and stool samples will be collected and examined by both LED-AP and the gold stan-dard (immunofluorescent antibody test) by different examiners in a blinded manner, allowing estimation of diagnostic accuracy and operational performance.
Funding source: 1) Norwegian research council GLOBVAC fund 2) Bill and Melinda Gates Foun-dation 3) Norwegian association for Medical Microbiology
Study period: June 2016 – June 2018
Study period: January 2009 – ongoing
Future perspectives: A sub-study to assess the longitudinal pattern of Cryptosporidi-um oocyst shedding will include Cryptosporidium-positive children with and without severe acute malnutrition is also planned and is expected to provide valuable insights on the association between oocyst shedding, symptom severity, malnutrition and HIV. A study in the same cohort assessing the cause of diarrhoea in children with both prolonged diarrhoea, persistent diarrhoea and SAM is currently planned and, if fun-ding allows, will start shortly.
PrimoStar iLED microscope being used for LED-AP fluorescence microscopy in Jimma University Hospital.
Cryptosporidium oocysts stained with auramine-phenol (AP) and observed through a fluorescence microscope.
Funding source: Bill and Millinda Gets, Norwegian University of Life Sciences, https://www.nmbu.no/en, Vestfold Hospital Trust, https://www.siv.no/