Dale AndersonMicrobiologyApril 13, 2009CryptosporidiumCryptosporidium is the genus name to Cryptosporidiosis a diarrheal disease caused by microscopic parasites. Cryptosporidiosis affects the intestines of all mammals to cause diarrhea and dehydration. Cryptosporidiosis has several modes of transmission. The most common is by drinking water that is contaminated with feces. Other modes of transmission are from eating contaminated food, or by coming into contact with the parasite via swimming pools or in lakes. Symptoms of cryptosporidiosis begin two to ten days after becoming infected with the parasite. The most common symptom of cryptosporidiosis is watery diarrhea, but other symptoms include: stomach cramps, fever, vomiting, weight loss, dehydration and nausea. Symptoms usually last about one to two weeks in persons with healthy immune systems. Many people may experience a recurrence of symptoms after a short period of recovery before the illness ends. Symptoms can come and go for up to thirty days after first symptoms arise. There have been some reports that cryptosporidiosis can cause pancreatitis, but no big study has been done to support these reports. People that are immunocompromised as well as very young or very old people can develop more severe symptoms from of cryptosporidiosis and have a longer lasting effect. In people with AIDS or cancer and transplant patients who are taking certain immunosuppressive drugs, cryptosporidiosis can spreads beyond the intestine and it can reach the lungs, middle ear, pancreas, and stomach. The parasite can infect the biliary tract, causing biliary cryptosporidiosis and all this can result in painful inflammation of the gallbladder's wall called cholecystitis and inflammation of the bile ducts called cholangitis. Treatment for getting rid of the parasite cryptosporidiosis is drinking plenty of fluids. Most people that have health immune systems can get rid of the parasite on their own. Some people might chose to take anti-diarrheal medicine like nitazoxanide or loperamide to help slow down the diarrhea. People that are immunocompromised will have to see a health care provider and they might get anti-retroviral therapy. The life cycle of Cryptosporidium is complex. The following is from the Center Disease Control,Following ingestion (and possibly inhalation) by a suitable host, excystation occurs. The sporozoites are released and parasitize epithelial cells of the gastrointestinal tract or other tissues such as the respiratory tract. In these cells, the parasites undergo asexual multiplication (schizogony or merogony) and then sexual multiplication (gametogony) producing microgamonts (male) and macrogamonts (female). Upon fertilization of the macrogamonts by the microgametes, oocysts develop that sporulate in the infected host. Two different types of oocysts are produced, the thick-walled, which is commonly excreted from the host, and the thin-walled oocysts, which is primarily involved in autoinfection. Oocysts are infective upon excretion, thus permitting direct and immediate fecal-oral transmission. (http://www.dpd.cdc.gov/dpdx/HTML/Cryptosporidiosis.htm, 2009)Examination of stool samples is a how the diagnosis of cryptosporidiosis. Cryptosporidiosis can be difficult to detect so patients may be asked to submit several stool samples over several days. Most often, stool specimens are examined microscopically using different techniques like the acid-fast staining which we have done in our own lab. Other techniques used are direct fluorescent antibody, and enzyme immunoassays for detection of Cryptosporidium. Prevention the parasite is easy. There are only a few guidelines you should follow. First, good hand washing and good hygiene practice. Second, avoid water that might be contaminated. If you are unable to avoid contaminated water, boil the water or use a good filtering system before use. Third, avoid food that might be contaminated. Last, sex including oral sex, which involves possible contact with stool, should be avoided.Even though our water and food supply are well maintained through the FDA and state regulatory inspectors there are still out breaks of cryptosporidiosis. The most recent outbreaks of cryptosporidiosis occurred in 2006 in the following states, Colorado, Illinois, Louisiana, South Carolina and Wyoming. All of those outbreaks were due to contaminated water. In October 2003 in Ohio there was a mass break out cryptosporidiosis that was found in some apple cider. One outbreak was more personal to me. It was the outbreak in Milwaukee Wisconsin in 1993. This is the largest documented waterborne disease outbreak in United States history. At the time I lived in Kenosha Wisconsin which is about 30 mile south of Milwaukee. The scare of cryptosporidiosis being in the water even hit our town so bad that there were warnings even for us to boil our water. I also remember the stores and shopping malls turning off all their water fountains. Schools, library, fast food place and public parks also shut off their water. The outbreak occurred at the Howard Avenue Water Purification Plant which was contaminated. Although there were many theories the root cause of the epidemic was never officially identified. Over 100 deaths were connected to the outbreak; these deaths were mostly among the elderly and the immunocompromised. The outbreak lasted in the water treatment plant from March 23, 1993 to April 8, 1993, but of course the affects of the outbreak lasted much longer. One of the most interesting things I found about this outbreak was a study that looks at the cost of this outbreak. In a study done in the journal Emerging Infectious Diseases, Vol 9. No. 4, April 2003 found that the cost of the outbreak in Milwaukee in 1993 was $96.2 million dollars. To assess the cost the study looked at the medical costs and the productivity loss associated with the outbreak of cryptosporidiosis. There was a loss of $31.7 million in medical cost and $64.2 million productivity. In Milwaukee alone there were 403,300 people infected. This particular study also estimated the average total costs per person infected with the pathogen. A person with a mild case of the illness had an average cost of $116. An individual with a moderate case of cryptosporidium had a average cost of $475. A person with a severe case of the illness had an average cost of $7,808. Most of the people in the study did not seek medical intervention; however it still costs those individuals money. People had to buy bottled water, buy over the counter medications to alleviate symptoms, and take time off of work to recover. As you can see from these staggering numbers it is important for us to keep our food and water supplies free from harmful pathogens. Harmful pathogens like cryptosporidiosis can affect us physically and economically.

Cryptosporidium hominis infection of the human respiratory tract.EID (Vol. 13, No. 3 March 2007) Mixed Cryptosporidium infections and HIV.EID (Vol. 12, No. 6 June 2006) Cryptosporidium felis and C. meleagridis in persons with HIV, Portugal.EID (Vol. 10, No. 12 December 2004) Cryptosporidium muris infection in an HIV-infected adult, Kenya.EID (Vol. 8, No. 2 February 2002) http://www.dpd.cdc.gov/dpdx/HTML/Cryptosporidiosis.htm, 2009