cryptosporidiosis


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Related to cryptosporidiosis: giardiasis, toxoplasmosis

Cryptosporidiosis

 

Definition

Cryptosporidiosis refers to infection by the sporeforming protozoan known as Cryptosporidia. Protozoa are a group of parasites that infect the human intestine, and include the better known Giardia. Cryptosporidia was first identified in 1976 as a cause of disease in humans.

Description

Cryptosporidia are normally passed in the feces of infected persons and animals in the form of cysts. The cysts can remain in the ground and water for months, and when ingested produce symptoms after maturing in the intestine and the bile ducts. When viewed under the microscope, they appear as small bluish-staining round bodies. Most common sources of infection are other humans, water supplies, or reservoirs. These are contaminated by animals that defecate in these areas. An outbreak in Milwaukee in 1993 in which over 400,000 persons were affected was traced to the city's water supply. Cysts of Cryptosporidia are extremely resistant to the disinfectants that are commonly used in most water treatment plants and are incompletely removed by filtration.
Most persons who experience significant symptoms have an altered immune system, and suffer from diseases such as AIDS and cancer. However, as shown in the Milwaukee outbreak, even those with normal immunity can experience symptoms.

Causes and symptoms

Cysts of Cryptosporidia mature in the intestine and bile ducts within three to five days of ingestion. As noted, large-scale infections from contaminated water supplies has been documented. However, human to human transmission (such as occurs in day care centers or through sexual behavior) is also an important cause.
Many individuals can be infected without any illness, but the major symptom is diarrhea, which is often watery and incapacitating. Dehydration, low-grade fever, nausea, and abdominal cramps are frequent.
In those with a normal immune system, the disease usually lasts about 10 days. For patients with altered immunity (immunocompromised), the story is quite different, with diarrhea becoming chronic, debilitating, and even fatal.

Complications

Dehydration and malnutrition are the most common effects of infection. In about 20% of AIDS patients, bile duct infection also occurs and causes symptoms similar to gallbladder attacks. Eighty percent or more of those with infection of the bile ducts die from the disease. The lungs and pancreas are also sometimes involved. Cryptosporidia are just one cause of the diarrhea wasting syndrome in AIDS, which results in severe weight loss and malnutrition.

Diagnosis

This is based on either finding the characteristic cysts in stool specimens, or on biopsy of an infected organ, such as the intestine.

Treatment

The first aim of treatment is to avoid dehydration. Oral Rehydration Solution (ORS) or intravenous fluids may be needed. Medications used to treat diarrhea by decreasing intestinal motility (Anti-Motility Agents), such as loperamide or diphenoxylate, are also useful, but should only be used with the advice of a physician.
Treatment aimed directly at Cryptosporidia is only partially effective, and rarely eliminates the organism. The medication most commonly used is paromomycin (Humatin), but others are presently under evaluation.

Prognosis

Cryptosporidia rarely cause a serious disease in persons with normal immune systems. Replacement of fluids is all that is usually needed. On the other hand, those with altered immune systems often suffer for months to years. Paramomycin and other drugs have been able to improve symptoms in over half of those treated. Unfortunately, many organisms are resistant, and recurrence is frequent.

Prevention

The best way to prevent cryptosporidiosis is to minimize exposure to cysts from infected humans and animals. Proper hand washing technique, especially in day care centers, is recommended.

Resources

Organizations

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.

Other

"Cryptosporidiosis." Centers for Disease Control. http://www.cdc.gov/ncidod/diseases/crypto/crypto.htm.
Vakil, Nimish B., et al. "Biliary Cryptosporidiosis in HIV-Infected People after the Waterborne Outbreak of Cryptosporidiosis in Milwaukee." New England Journal of Medicine Online. http://content.nejm.org.

Key terms

Anti-motility medications — Medications such as loperamide (sold as Imodium), dephenoxylate (sold as Lomotil), or medications containing codeine or narcotics that decrease the ability of the intestine to contract. This can worsen the condition of a patient with dysentery or colitis.
Cyst — A protective sac that includes either fluid or the cell of an organism. The cyst enables many organisms to survive in the environment for long periods of time without need for food or water.
Immunocompromised — A change or alteration of the immune system that normally serves to fight off infections and other illnesses. This can involve changes in antibodies that the body produces (hygogammaglobulinemia), or defect in the cells that partake in the immune response. Diseases such as AIDS and cancer exhibit changes in the body's natural immunity.
Oral Rehydration Solution (ORS) — A liquid preparation developed by the World Health Organization that can decrease fluid loss in persons with diarrhea. Originally developed to be prepared with materials available in the home, commercial preparations have recently come into use.
Parasite — An organism that lives on or in another and takes nourishment (food and fluids) from that organism.
Protozoa — Group of extremely small single cell (unicellular) or acellular organisms that are found in moist soil or water. They tend to exist as parasites, living off other life forms.
Spore — A resistant form of certain species of bacteria, protozoa, and other organisms.

cryptosporidiosis

 [krip″to-spo-rid″e-o´sis]
infection with protozoa of the genus Cryptosporidium, which may be associated with or contribute to enteric disease in calves, lambs, foals, and piglets. Human infection occurs both in immunocompetent persons, in whom it causes a self-limited diarrhea syndrome, and in immunocompromised patients, in whom it is much more serious, being manifested clinically as prolonged debilitating diarrhea, weight loss, fever, and abdominal pain, with occasional spread to the trachea and bronchial tree.

cryp·to·spo·rid·i·o·sis

(krip'tō-spō-rid'ē-ō'sis),
An enteric disease that is tranferred by waterborne or fecal contamination routes; caused by protozoan parasites of the genus Cryptosporidium; characterized pathologically by villous atrophy and fusion and clinically by diarrhea in humans, calves, lambs, and other animals; disease in immunocompetent people is usually manifest as a self-limiting diarrhea, whereas in immunocompromised people it is manifest as a prolonged severe diarrhea that can be fatal.

cryptosporidiosis

/cryp·to·spo·rid·i·o·sis/ (krip″to-spo-rid″e-o´sis) infection with protozoa of the genus Cryptosporidium; in the immunocompetent it is a rare self-limited diarrhea syndrome, but in the immunocompromised it is a severe syndrome of prolonged diarrhea, weight loss, fever, and abdominal pain, sometimes spreading to the trachea and bronchial tree.

cryptosporidiosis

(krĭp′tō-spə-rĭd′ē-ō′sĭs)
n.
An intestinal parasitic infection of some vertebrates caused by protozoa of the genus Cryptosporidium, characterized in some humans by chronic diarrhea.

cryptosporidiosis

an opportunistic infection caused by the intestinal parasites Cryptosporidium parvum, a very common parasite in animals, and C. hominis. The disease was relatively unknown as a human pathogen before a 1993 epidemic in the Milwaukee, Wisconsin area, where 400,000 persons were stricken with diarrhea after drinking water contaminated with the parasite. Other sources of infection include raw or undercooked foods contaminated with Cryptosporidium oocysts, direct contact with infected humans or animals, and contact with recreational water. Symptoms of watery diarrhea, abdominal cramps, nausea, vomiting, and low-grade fever may appear 2 to 10 days after infection. They may lead to dehydration and weight loss. The symptoms may last 1 or 2 weeks and may be life-threatening to persons with suppressed immune systems. Treatment emphasizes rest, replenishment of body fluids and electrolytes, and medications to control diarrhea. Paromomycin may be partially effective in the treatment of cryptosporidiosis in persons with HIV infection. There is no known safe and effective cure for cryptosporidiosis. A new drug, nitzoxanide, has been approved for the treatment of diarrhea caused by cryptosporidiosis, but it should be used only in patients with healthy immune systems. Fecal material from patients suffering from crytosporidiosis is infectious and should be handled accordingly. Care should be taken to avoid infection of immunocompromised patients by means of contact with symptomatic patients in a hospital environment.

cryptosporidiosis

Crypto, cryptosporidium enterocolitis An opportunistic infection caused by Cryptosporidium parvum, an animal parasite Epidemiology Oral-fecal transmission; it grows in the intestines and bile ducts especially immunocompromised and HIV-infected Pts Clinical Cryptosporidium enterocolitis causes watery diarrhea, abdominal pain, flatulence, fever; CDC considers chronic intestinal cryptosporidiosis ≥ 1 month an AIDS-defining condition Management No standard therapy Proposed therapy Paromomycin–humatin, azithromycin, letrazuril, concentrates of cow and chicken antibodies

cryp·to·spo·rid·i·o·sis

(krip'tō-spōr-i-dē-ō'sis)
An enteric disease caused by waterborne protozoan parasites of the genus Cryptosporidium; disease in immunocompetent people is seen as a self-limiting diarrhea, whereas in immunocompromised people it is manifest as a prolonged severe diarrhea that can be fatal.

Cryptosporidiosis

An infection with the protozoal organism Cryptosporidium parvum first described in humans in 1976. It is now known to be a common cause of self-limiting acute gastroenteritis occurring in otherwise healthy people, especially children. It is a common cause of travellers' diarrhoea. In those with AIDS or other causes of immune deficiency, however, it may be a life-threatening infection with a mortality of 50 per cent. Infection is direct or indirect via drinking water, from humans or animals. Cryptosporidium is one of the more common bowel pathogens. When treatment is necessary this may involve fluid infusion for dehydration and the use of drugs such as paromomycin (Humatin), somatostatin, azidothymidine, diloxanide furoate, furazolidone, amprolium, and the macrolide antibiotics. Unfortunately, none of the current antimicrobial dugs are reliably effective.

cryptosporidiosis

infection with Cryptosporidium spp. In all species causes diarrhea in the newborn although infection is common in neonates without clinical diarrhea. The protozoan may depend on the prior presence of another pathogen, e.g. rotavirus, or other risk factors, such as failure of passive transfer of immunoglobulins, to exert its pathogenicity. The critical lesion in the disease is villous atrophy causing a malabsorption defect. Also infects trachea, cloaca, bursa of Fabricius, and conjunctival sacs of birds, the stomach of mice and snakes, the bile duct of monkeys, and immunodeficient foals. See also cryptosporidium.
References in periodicals archive ?
7) Cryptosporidium parvum is also one of the main causes of cryptosporidiosis in people, along with Cryptosporidium hominis, (8) Cryptosporidium serpentis is well known in snakes, in which it causes hypertrophic gastritis, often characterized by weight loss, regurgitation, and inappetance, (9) whereas Cryptosporidium muris predominantly affects rodents but does not cause disease in snakes.
During the meeting, Beth Wells from Moredun and Suzi Bell of the Animal Plant and Health Agency will illustrate what is currently known about the factors that predispose calves to cryptosporidiosis and calf scour.
Between January and May 2013 there were 11 outbreaks of cryptosporidiosis associated with petting farms across England affecting around 150 people.
The global incidence of cryptosporidiosis is largely unknown, although the disease was recently identified as one of the major causes of moderate to severe diarrhea in children <5 years of age in low-income countries (7).
For all cases, NRPH used a cryptosporidiosis questionnaire to determine potential risk factors, including exposure to swimming pools, splash pads, water parks, restaurants (including those at the water park), drinking water, other recreational water sources, and travel.
Dr Gwen Lowe, consultant in communicable disease control for Public Health Wales, said: "Following a recent school trip, Cryptosporidiosis is caused by cryptosporidium, a singlecelled parasite that lives in the intestines.
In recent years, the public has become aware of severe cryptosporidiosis because of its incidence in AIDS patients and because of massive outbreaks of cryptosporidial enteritis among the general populace worldwide from contaminated drinking water.
The illness, cryptosporidiosis, caused Louie to lose half a stone in weight.
Presented in July at the International Conference on Emerging Infectious Diseases, the study estimated the hospitalization costs of Legionnaires' disease, cryptosporidiosis and giardiasis.
Modest investments in preventing the three most common waterborne diseases in the United States--Legionnaires' disease, cryptosporidiosis, and giardiasis--would cut the disease rates and lead to significant health care cost savings, concluded study coauthor Michael Beach, Ph.