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07-SEPTEMBER-2008 03:17:44 - Cryptosporidiosis Cryptosporidiosis Classification and external resources Cryptosporidium muris ICD-10 A07.2 ICD-9 007.4 DiseasesDB 3221 eMedicine med/484 Cryptosporidiosis is a parasitic disease affecting the intestines of mammals and is typically an acute short-term infection that is caused by Cryptosporidium, a protozoan parasite in the phylum Apicomplexa. It is a disease spread through the fecal-oral route; the main symptom is self-limiting diarrhea in people with intact immune systems. In immunocompromised individuals, such as AIDS patients, infection can cause permanent and life-threatening explosive diarrhea also known as the Bangkok Blast or the Thai Fourth of July. Despite not being identified until 1976, it is one of the most common waterborne diseases and is found worldwide. The parasite is transmitted by environmentally hardy cysts oocysts that, once ingested, excyst in the small intestine and result in an infection of intestinal epithelial tissue. Contents 1 Transmission 2 Symptoms 3 Treatment 4 Infectious agents 5 Non-human examples 6 Notable cases 7 References 8 External links Transmission Infection is through contaminated material such as earth, water, uncooked or cross-contaminated food that has been in contact with the feces of an infected individual or animal. Contact must then be transferred to the mouth and swallowed. It is especially prevalent amongst those in regular contact with bodies of fresh water, whether through work or recreation. The source can be recreational water like swimming pools, contaminated water supplies, or contaminated food. Vacationers must be particularly careful about contamination. The high resistance of Cryptosporidium oocysts to disinfectants like chlorine bleach facilitates transmission of the disease.1 Some outbreaks have happened in day care related to diaper changes. Symptoms Symptoms appear from two to ten days after infection and last for up to two weeks. As well as watery diarrhea, there is often stomach pains or cramps and a low fever. Some individuals are asymptomatic have no symptoms but are nevertheless infective, and thus can pass on the infection to others. Even after symptoms have finally subsided an individual is still infective for some weeks. Severe diseases, including pancreatitis, can occur.2 Treatment is primarily supportive. Fluids need to be replaced orally. A lactose free diet should be taken as tolerated. In rare situations, intravenous fluids may be required. Antibiotics are not usually helpful, and are primarily reserved for persons with severe disease and a weak immune system. Sometimes relapses happen. Prevention is through washing hands carefully after going to the bathroom or contacting stool, and before eating. If the water supply is in question, the water can be boiled or carefully filtered before drinking. Treatment There is no reliable treatment for cryptosporidium enteritis -- certain agents such as paromomycin, atovaquone, nitazoxanide, and azithromycin are sometimes used but they usually have only temporary effects. Currently, the best approach is to improve the immune status in immunodeficient individuals. The probiotic Saccharomyces boulardii sold over the counter in pharmacies and health shops Brand name Florastor in US and DiarSafe in UK has been found to be a helpful natural treatment in managing diarrhoea of various infectious origins including cryptosporidium. 3 The majority of immuno-competent individuals suffer a short less than 2 weeks self limiting course that requires supportive care with re-hydration and occasionally anti-diarrhoeal medication. In immuno-incompetent individuals including some with HIV/AIDS anti-retroviral therapy has been associated with improved outcomes. Several drug trials with high dose azithromycin look promising.citation needed Infectious agents A number of species of Cryptosporidium infect mammals. In humans the main causes of disease are C. parvum and C. hominis previously C. parvum genotype 1. C. canis, C. felis, C. meleagridis, and C. muris can also cause disease in humans. Non-human examples In recent years, cryptosporidiosis has plagued many commercial Leopard gecko breeders. Several species of the Cryptosporidium family C. serpentes and others are involved, and outside of geckos it has been found in monitor lizards, iguanas, tortoises as well as several snake species. Notable cases In 1993, a waterborne cryptosporidiosis outbreak occurred in Milwaukee, Wisconsin. An estimated 403,000 people became ill, including 4,400 people hospitalized.4 The UK's biggest outbreak occurred in Torbay in Devon in 1995 when 575 people fell ill. In the summer of 1996, cryptosporidium affected approximately 2,000 people in Cranbrook, British Columbia, Canada. Weeks later, a separate incident occurred in Kelowna, British Columbia where 10,000 to 15,000 people got sick.5 In April of 2001, an outbreak occurred in the city of North Battleford, Saskatchewan, Canada. Between 5800 and 7100 people suffered from diarrheal illness, and 1907 cases of cryptosporidiosis were confirmed. Equipment failures at the city's antiquated water filtration plant following maintenance were found to have caused the outbreak.6 In the summer of 2005, after numerous reports by patrons of gastrointestinal upset, a water park at Seneca Lake State Park, in the Finger Lakes region of upstate New York, was found to have two water storage tanks infected with Cryptosporidium. By early September 2005, over 3,800 people reported symptoms of a Cryptosporidium infection.7 The Sprayground was ordered closed for the season on August 15. In October 2005 Gwynedd and Anglesey areas of North Wales UK suffered an outbreak of Cryptosporidiosis. The outbreak may have been linked to the drinking water supply from Llyn Cwellyn but this is not yet confirmed. As a result, over 200 people fell ill and the company Welsh Water Dwr Cymru advised 61000 people to boil their water before use. In March 2007, a suspected outbreak occurred in Galway, Ireland, after the source of water for much of the county, Lough Corrib, was suspected to be contaminated with the parasite. A large population 90,000 people including areas of both Galway City and County were advised to boil water for drinking, food preparation and for brushing teeth. On 21 March 2007, it was confirmed that the city and county's water supply was contaminated with the parasite. The area's water supply was finally given the all-clear on 20 August 2007; five months after it was first detected. Around 240 people contracted the disease, however experts say the true figure could range up to 5,000. 8 Hundreds of public pools in 20 Utah counties were closed to young children in 2007, as children under 5 are most likely to spread the disease, especially children wearing diapers. As of September 10, 2007 the Utah State health department had reported 1302 cases of cryptosporidiosis in the year; a more usual number would be 30. On September 25, the pools were re-opened to those not requiring diapers, but hyperchlorination requirements were not lifted. On September 21, 2007, Cryptosporidium outbreak attacked the Western United States: 230 Idaho residents, with hundreds across the Rocky Mountain area; in the Boise and Meridian areas; Utah, 1,600 illnesses; Colorado and other western states - Montana, decrease.9 On 25 June 2008, Cryptosporidium was found in water supplies in Northampton, Daventry and some surrounding areas supplied from the Pitsford Reservoir as reported on the BBC. People in the affected areas were warned not to drink tap water unless it had been boiled. Anglian Water confirmed that 108,000 housholds were affected, the equivalent of some 250,000 consumers. They advised that water may not be fit for human consumption for many weeks. 10 The boil notice was lifted for all the affected customers on 4 July 2008.11 Throughout the Summer of 2008; many public swimming areas, water parks, and public pools in the Dallas/Fort Worth Metroplex of Texas suffered an outbreak of Cryptosporidium. Burger's Lake in Fort Worth was the first to report such an outbreak. This prompted some if not all city-owned private pools to close and hyperchlorinate. To date, there have been 400 reported cases of Cryptosporidium12 1998 Sydney water crisis 2002 Glasgow floods Cryptosporidium in Galway Milwaukee Cryptosporidium outbreak References ^ Carpenter C, Fayer R, Trout J, Beach M 1999. Chlorine disinfection of recreational water for Cryptosporidium parvum. Emerg Infect Dis 5 4: 579-84. PMID 10458969. ^ Hawkins S, Thomas R, Teasdale C 1987. Acute pancreatitis: a new finding in cryptosporidium enteritis. Br Med J Clin Res Ed 294 6570: 483-4. PMID 3103738. ^ Management of children with infection-associated persistent diarrhea. Seminars in Pediatric Infectious Diseases , Volume 15 , Issue 4 , Pages 229 - 236 T . Ochoa , E . Salazar-Lindo , T . Cleary ^ Corso P, Kramer M, Blair K, Addiss D, Davis J, Haddix A 2003. Cost of illness in the 1993 waterborne Cryptosporidium outbreak, Milwaukee, Wisconsin. Emerg Infect Dis 9 4: 426-31. PMID 12702221. ^ CBC News Indepth: Health - Cryptosporidium ^ Waterborne Cryptosporidiosis Outbreak, North Battleford, Ssaskatchewan, Spring 2001. Public Health Agency of Canada 2001-11-15. Retrieved on 2008-01-25. ^ State Health Department Issues Update on Seneca Lake State Park Gastrointestinal Outbreak. New York State Health Dept. Retrieved on 2006-09-29. ^ RTÉ News - Galway water now safer than ever - HSE ^ Yahoo.com, Cryptosporidium outbreak hits the West ^ Northampton Chronicle and Echo ^ Anglian Water-lifting of boil notice ^ Crypto spreads to private pools - WFAA-TV retrieved August 13, 2008. External links Monroe County Health Dept. Fact Sheet NYSDOH Crypto Fact Sheet NYS Dept. of State Parks Update, 8/26/05 Treatment of Cryptosporidiosis from the AidsMeds site Azithromycin information Summary of treatment results with Azithromycin Galway City Council notice Boil Check: Postcode checker for contaminated areas v d e Infectious diseases - Parasitic disease: protozoan infection A06-A07, B50-B64 Apicomplexa Coccidia Cryptosporidiosis, Isosporiasis, Cyclosporiasis, Toxoplasmosis Malaria Blackwater fever Babesiosis Sarcomastigophora Excavata/ Mastigophora Trypanosomiasis Sleeping sickness, Chagas disease Leishmaniasis Cutaneous leishmaniasis, Visceral leishmaniasis - Trichomoniasis Giardia lamblia Giardiasis Sarcodina Entamoeba histolytica Amoebiasis - Dientamoeba fragilis Dientamoebiasis - Naegleria fowleri Primary amoebic meningoencephalitis Other Blastocystis Blastocystosis Balantidium coli Balantidiasis Zygomycota, Microsporidia Microsporidiosis Mesomycetozoea, Rhinosporidium seeberi Rhinosporidiosis Retrieved from http://en..org/wiki/Cryptosporidiosis Categories: Apicomplexa | Parasitic diseasesHidden categories: All articles with statements | Articles with statements since August 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Česky Deutsch Español Français Bahasa Indonesia 日本語 Polski Português 中文 This page was last modified on 26 August 2008, at 06:4
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