Cryptosporidiosis stimulates an inflammatory intestinal response in malnourished Haitian children

The mechanisms by which Cryptosporidium parvum cause persistent diarrhea and increased morbidity and mortality are poorly understood. Three groups of Haitian children <18 months old were studied: case patients, children with diarrhea not due to Cryptosporidium, and healthy control subjects. Compared with both control groups, children with acute cryptosporidiosis were more malnourished (including measures of stunting [P = .03] and general malnutrition [P = .01]), vitamin A deficient (P = .04), and less often breast-fed (P = .04). Markers of a proinflammatory immune response, interleukin (IL)-8 and tumor necrosis factor-α receptor I, were significantly elevated in the case population (P = .02 and P < .01, respectively), as was fecal lactoferrin (P = .01) and the T helper (Th)-2 cytokine IL-13 (P = .03). The counter-regulatory cytokine IL-10 was exclusively elevated in the case population (P < .01). A Th1 cytokine response to infection was not detected. This triple cohort study demonstrates that malnourished children with acute cryptosporidiosis mount inflammatory, Th-2, and counter-regulatory intestinal immune responses.