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Cryptosporidiosis - Causes, Symptoms and Treatment

What is Cryptosporidiosis?

Cryptosporidiosis is mainly caused by a protozoan named Cryptosporidium parvum. It is a highly infectious enteric microbe that causes anacute, self-limiting diarrheal illness. It is identified in up to 5% of all cases of gastroenteritis in both industrialized and developing countries. At high risk for developing this disease are children-particularly those who are not toilet trained; child care workers; travelers to foreign countries; immunocompromised patients; medical personnel caring for patients with cryptosporidiosis; dairy farmers; persons exposed to human feces via sexual contact; and those who come into contact with any water source contaminated by Cryptosporidium.

In daycare settings, outbreaks of cryptosporidiosis are most common during the late summer and early fall. Cryptosporidiosis has been increasingly recognized as a cause of life-threatening, intractable diarrhea in HIV-infected patients; the annual rate of crytosporidial infection among patients with AIDS may approach 5% to 10%.

What are the Causes of Cryptosporidiosis?

Transmission of cryptosporidia oocytes occurs primarily via the oral-fecal route, including hand contact with the stool of infected humans or animals or with objects contaminated with stool. Ingestion of food or water contaminated with stool, including water in recreational water parks and swimming pools, is also a common mode of transmission. Once ingested, the protozoa replicate intracellularly in the brush border of the small intestine. Infective oocysts are then shed and passed in the feces. The number of oocysts needed to cause infection is very low, perhaps as few as 2 to 10. Stools may contain active oocysts for up to 2 months after symptoms resolve.

Signs and Symptoms of Cryptosporidiosis

Clinical illness occurs in over 80% of infected people. Most patients experience acute onset of watery diarrhea, stomach cramps and, less often, upset stomach and fever. Some infected persons may be asymptomatic. Occasionally, infected persons can have severe diarrhea and weight loss. Symptoms appear 2 to 10 days after infection and persist for I to 2 weeks. The symptoms can be more severe in immunocompromised patients and the infection cannot be cleared unless the underlying immune defect is corrected; intractable diarrhea may continue for life.

Diagnosis for Cryptosporidiosis

Fecal examination is performed to identify oocysts. Acid-fast or immunofluores­cence staining usually confirms identification of oocysts. Intestinal biopsy can also be done.

Other conditions to be considered are amebiasis, giardiasis, and viral gastroenteritis.

Treatment for Cryptosporidiosis

No drug has been found to cure cryptosporidiosis. Paromomycin may reduce symptoms and is used in immunocompromised individuals. Treatment includes supportive care with replacement of fluids and electrolytes and administration of antidiarrheal agents.

Special Considerations and Prevention Tips for Cryptosporidiosis

Follow standard precautions for preventing cryptosporidiosis from occuring or from getting more serious. Stools of patients with cryptosporidiosis are highly infectious. Always wash your hands thoroughly before and after any contact with the patient, and advise others to do the same.

Some other Prevention Tips may be:

1. Help patient maintain adequate hydration. Parenteral rehydration and hyperalimentation may be required in immunocompromised persons.

2. Cleanse the pelineum thoroughly to prevent skin breakdown.

3. Advise parents of children who are not toilet trained to change diapers away from pool areas: the child's genitals should be thoroughly cleansed with soap and water before re-entering the pool.

4. Be aware that chlorine does not kill cryptospolidia. A 3% solution of hydrogen peroxide is an effective disinfectant.

5. Cases of cryptosporidiosis in children who attend daycare should be reported to the local health department; evidence of negative stool cultures may be required prior to their readmission to daycare.

6. Boiling water is the most reliable decontamination method and only filters with absolute pore sizes of 1 micron, that say "reverse osmosis" or that indicate tested and celtified by NSF -an independent testing group.

7. A CD4 cell count of less than 200 signals the likelihood of a severe, long-lasting, and possibly deadly bout of cryptosporidiosis for HIV-infected individuals.

8. Warn those who swim or use hot tubs to avoid swallowing water.

9. Advise travelers to developing countries to avoid foods and drinks such as raw fruits and vegetables, tap water, unpasteulized milk or dairy products, and items purchased from street vendors.

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