cryptosporidiosis

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.

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.

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.

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.

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

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.

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.

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.

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

"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.

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.