Cryptosporidiosis
Definition, Description, Causes and symptoms, Diagnosis, Treatment, Prognosis, Prevention
Cryptosporidiosis refers to infection by the spore-forming 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 out-break 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
BOOKS
Davis, Charles E. "Laboratory Diagnosis of Parasitic Infection." In Harrison's Principles of Internal Medicine,ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
Liu, Leo X., and Peter F. Weller. "Therapy for Parasitic Infections." In Harrison's Principles of Internal Medicine,ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
Nash, Theodore E., and Peter F. Weller. "Cryptosporidiosis." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
Owen, Robert L. "Cryptosporidia." In Sleisenger & Fordtran's Gastrointestinal and Liver Disease, ed. Mark Feldman, et al. Philadelphia: W. B. Saunders Co., 1997.
Weller, Peter F. "Protozoal and Helminthic Infection: General Consideration." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
PERIODICALS
Heyworth, Martin F. "Parasitic Diseases in Immunocompromised Hosts." Gastrointestinal Clinics of North America: Parasitic Diseases of the Liver and Intestines (Sept.1996): 691-707.
Lew, Edward A., Machael A. Poles, and Douglas T. Dieterich. "Diarrheal Disease Associated with HIV Infection." Gastroenterology Clinics of North America (June 1997): 259-290.
Vakil, Nimish B., et al. "Biliary Cryptosporidiosis in HIV-Infected People after the Waterborne Outbreak of Cryptosporidiosis in Milwaukee." New England Journal of Medicine 334, no. 1 (1996): 19.
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>.
David Kaminstein, MD
Additional topics
- Culture-Fair Test - Definition, Purpose, Precautions, Description, Preparation, Aftercare, Risks, Normal results, Abnormal results
- Cryptococcosis - Definition, Description, Causes and symptoms, Diagnosis, Treatment, Prognosis, Prevention
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