Cryptosporidiosis and the Ears of the Hippopotamus

Despite the fact that Cryptosporidium was identified 1100 years ago, the first human cases were only reported in 1976, and only a handful of cases were diagnosed before the discovery in 1982 of Cryptosporidium as a major cause of diarrhea in patients with AIDS [1]. During the next 5 years, Cryptosporidium was recognized as an important cause of waterborne episodes of diarrhea, childhood diarrhea both in wealthy and resource-limited countries, and sporadic diarrhea in adults. Among the causes of childhood diarrhea in resource-limited countries, cryptosporidiosis has been particularly linked to persistent diarrhea, which causes malnutrition, increased susceptibility to other pathogens, and chronic sequelae [2, 3]. Still, many physicians only associate cryptosporidiosis with diarrhea in AIDS. With the improvement of antiretroviral therapy, cryptosporidiosis has been disappearing from many physicians’ minds altogether, at least in wealthy countries. By contrast, data suggest that illness due to Cryptosporidium in patients with AIDS accounts for only a tiny portion of the overall burden of illness due to Crypto-