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New
Drugs and Treatment for Cryptosporidiosis
There is a history of inadequate treatments
for cryptosporidiosis
and a lack of understanding of the species that cause human disease.
Against this background, Irish researchers review the efficacy of
antiparasitic agents, particularly nitazoxanide,
which has led to increased treatment options, the potential for
immunotherapy,
and consider the role of HAART in reducing the incidence of this
opportunistic infection.
Nitazoxanide
is effective for cryptosporidiosis in immunocompetent and probably
immunocompromised patients (with an alteration in the duration of
treatment or the dosing regimen).
HIV-infected
patients on HAART have a dramatically lower incidence of cryptosporidiosis,
attributable to the effects of intestinal immune reconstitution
as well as the effect on the CD4 cell count.
Protease
inhibitors have a direct inhibitory effect on Cryptosporidium infection,
suggesting a further reason for the reduction in the incidence of
cryptosporidiosis and implying a further possible therapeutic modality.
However,
Cryptosporidiosis remains a significant public health threat. Risk
avoidance guidance could be viewed in the more relative terms of
risk management depending on the degree of immunosuppression.
Of
established efficacy in immunocompetent patients, nitazoxanide is
also useful for immunocompromised patients. Better prevention and
treatment options mean that, in the immunocompromised, this disease
is now less common.
The
authors conclude, “Immune
reconstitution is the key to prevention. Further
database mining of the Cryptosporidium genome will assist in the
discovery of new genes, biochemical pathways and protective antigens
that can be targeted to develop novel therapies for cryptosporidiosis.”
Scottish
Parasite Diagnostic Laboratory, Stobhill Hospital, Glasgow UK and
Department of Microbiology, Cork University Hospital, Wilton, Cork,
Ireland.
01/24/05
Reference
H
V Smith and G D Corcoran. New drugs and treatment for cryptosporidiosis.
Current Opinion in Infectious Diseases 7(6): 557-564. December
2004.
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