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Cryptosporidium spp.

By on August 18, 2016

Cryptosporidium spp. the small water-borne parasite that causes gastroenteritis

Cryptosporidiosis is a parasitic disease caused by a water-borne amoeba, Cryptosporidium, a genus of protozoan parasites around 3-6µm in diameter and infects a range of animals from humans, mice, cows, sheep, goats and reptiles such as tortoises and monitor lizards.

It is an important cause of diarrhoeal illness worldwide, particularly in young children and immunocompromised patients (such as untreated HIV positive people). It is one of the most common waterborne diseases and is found worldwide. [1]

In 2004, Cryptosporidium was listed by the World Health Organization (WHO) on a list of diseases that “exhibit a considerable and increasing global burden and impair the ability of those infected to achieve their full potential, both developmentally and socio-economically”. [7]

But how does such small parasites cause diarrhoea?

The parasite is transmitted by environmentally hardy microbial cysts (oocysts) when ingested are immediately infectious at quite low doses (10 to 30 oocysts are required to produce human disease). Oocysts attach to cells of the small bowel and invade the cells of the intestine. The diarrhoea; the main symptom of the disease is a host response to infection. [2]

It is more common for the infection to affect the distal small intestine and can affect the respiratory tract in both immunocompetent and immunocompromised (e.g., persons with HIV/AIDS) individuals, resulting in watery diarrhoea with or without an unexplained cough. [3]

Signs and Symptoms

Intestinal cryptosporidiosis [4][5]

Common signs and symptoms of intestinal cryptosporidiosis include:

  • Moderate to severe watery diarrhoea, sometimes contains mucus and rarely contains blood.
  • In very severe cases, diarrhoea may be profuse and cholera-like with malabsorption (decrease in water absorbed by the kidney), and hypovolemia (decrease in the volume of blood)
  • Fever
  • Abdominal cramps
  • Dehydration
  • Weight loss
  • Fatigue
  • Nausea and vomiting
  • Abdominal tenderness

Respiratory cryptosporidiosis [4][5]

Common signs and symptoms of upper respiratory cryptosporidiosis include:

  • Inflammation of the nasal mucosa, sinuses, larynx, or trachea (through invasion of the underlying epithelia tissues).
  • Nasal discharge
  • Voice change (e.g., hoarseness)

Symptoms of lower respiratory cryptosporidiosis include:

  • Cough
  • Shortness of breath
  • Fever
  • Hypoxemia

Transmission

  1. Livestock: such as cattle. This is particularly common on farms and petting zoos especially from the dung of young Ruminants.
  2. Food-borne: through the consumption of uncooked or cross-contaminated food that has been in contact with the faeces of an infected individual or animal.[6]
  3. Water-borne:
    • Contaminated water supply.
    • Contamination of swimming pools (and other water-based recreational sites).
    • Travel to less developed countries.
  4. Contact: from personal contact with infected individuals. This is particularly common with changing of nappies, from infected patients in hospitals and

The following groups have an elevated risk of being exposed to Cryptosporidium [6]

  • Child care workers
  • Parents of infected children
  • People who take care of other people with cryptosporidiosis
  • International travellers
  • Backpackers, hikers, and campers who drink unfiltered, untreated water
  • People, including swimmers, who swallow water from contaminated sources
  • People who handle infected cattle
  • People exposed to human faeces through sexual contact

Pathology: incidence of symptoms

The incubation period is dose-dependent (the number of oocysts ingested), and is typically between 5-10 days. However, it can be less (as low as 3 days) and longer in immunocompromised people (up to 28 days).

In developing countries it can be asymptomatic (showing no symptoms) whereas in developed countries it is rarely so.

In healthy subjects it presents with:[8]

  • Mild fever (59% of consulting patients).
  • General malaise progressing rapidly to further symptoms.
  • Watery diarrhoea (often green and offensive, sometimes with blood) (98% of patients).
  • Abdominal cramps (95%).
  •  Nausea and anorexia (65%).

Symptoms can be prolonged and last on average for two weeks but can persist for up to one month. Relapse of symptoms, indicating persistent infection – occurs in over a third of cases.

Illness can be severe enough to necessitate admission to hospital (14% of patients in one study).[1]

In 2010, it was attributed to around 100,000 deaths worldwide (down from 220,000 deaths in 1990).[10]

Diagnosis

There are many assays that can be used to detect and identify Cryptosporidium. These are:

  • Microscopy: identify oocytes in faecal matter;
  • Staining: immunoflourescent staining
  • Detection of antibodies e.g. ELISA testing
  • PCR (Polymerase Chain Reaction)

Cryptosporidium spp.

General preventative measures include:

The boiling of drinking water to kill oocysts (this is especially important in less developed countries and when contamination of water supply is notified.[12]

When in foreign countries only drink tap-water from sources with special filtration or that has been boiled. The Department of Health in England advises that those with compromised T-cell function should boil all drinking water (including bottled water) to reduce the risk of infection.[13][14]

In particular, avoid new-born animals, including pets, especially in the immunocompromised.

Healthcare workers and childcare workers should prevent faecal-oral spread with wearing of gloves and with hand washing.

Specific preventative advice for patients diagnosed with cryptosporidiosis:[11]

As diarrhoea tends to last longer than most other causes of gastroenteritis and a great rick of possible relapses, patients are strongly advised to:

  • Observe strict personal hygiene measures (careful hand washing and no towel sharing).
  • Avoid swimming pools for two weeks after cessation of diarrhoea. ⦁ Avoid nursery attendance;
  • Food-handling occupations;
  • Care of vulnerable adults for 48 hours after cessation of diarrhoea.

Treatment

Treatment is based on the rehydration of a patient and the replacement of electrolytes lost through diarrhoea. This usually ends with a full recovery.

However, some people (usually immunocompromised people) may require anti-parasitic medication.

Have you Suffered from Sickness whilst on a Package Holiday?

If you have suffered from holiday sickness whilst on an all-inclusive packaged holiday get in touch with a member of our team.  Holiday Sickness Claims will be happy to help you through the process of securing a No Win No Fee solicitor to represent your claim for Holiday Sickness and get the compensation you deserve.

Give us a call on 0800-8-654321 to see if you fit our panel solicitors criteria. It is a simple process and we will let you know if you are eligible, we don’t want to waste your time or ours.

If you can locate your booking confirmation and ATOL certificate that your travel agent or tour operator provided when you booked your holiday, this will speed up the process. Usually sent to your email or if you booked in a store would usually be provided in paper format. If you cannot locate a copy we can help.

Keywords: Cryptosporidium, Cryptosporidiosis, immunocompromised people, diarrhoea, water-borne parasites

Further Reading and Referencing

⦁ Chalmers R; Diagnostic tests for Cryptosporidium, UK Cryptosporidium Reference Unit
⦁ Putignani L et al; Global Distribution, Public Health and Clinical Impact of the Protozoan Pathogen Cryptosporidium, Interdisciplinary Perspectives on Infectious Diseases, Volume 2010.
⦁ Sponseller JK, Griffiths JK, Tzipori S (2014). “The evolution of respiratory Cryptosporidiosis: evidence for transmission by inhalation”. Clin. Microbiol. Rev. 27 (3): 575–86.
⦁ Cabada MM; White AC; Venugopalan P; Sureshbabu J (18 August 2015). Bronze MS, ed. “Cryptosporidiosis Clinical Presentation”.
⦁ “Cryptosporidium: Illness & Symptoms”. United States Centers for Disease Control and Prevention. 20 February 2015.
⦁ “Cryptosporidium: Sources of Infection & Risk Factors”. United States Centers for Disease Control and Prevention. 1 April 2015.
⦁ Cryptosporidium, WHO Guidelines for Drinking Water Quality; World Health Organization (2006)
⦁ Alexander C; Update on Clinical Parasitology Developments, Scottish Parasite Diagnostic and Reference Laboratory, 2012.
⦁ Hunter PR, Hughes S, Woodhouse S, et al; Health sequelae of human cryptosporidiosis in immunocompetent patients.; Clin Infect Dis. 2004 Aug 15;39(4):504-10. Epub 2004 Aug 2.
⦁ Lozano, R (15 December 2012). “Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.”. Lancet 380 (9859): 2095–128.
⦁ Cryptosporidium Factsheets; Public Health England, 2008
⦁ Hunter PR, Nichols G; Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients.; Clin Microbiol Rev. 2002 Jan;15(1):145-54.
⦁ Lund BM, O’Brien SJ; The occurrence and prevention of foodborne disease in vulnerable people. Foodborne Pathog Dis. 2011 Sep;8(9):961-73. doi: 10.1089/fpd.2011.0860. Epub 2011 May 11.
⦁ Goh S, Reacher M, Casemore DP, et al; Sporadic cryptosporidiosis decline after membrane filtration of public water supplies, England, 1996-2002.; Emerg Infect Dis. 2005 Feb;11(2):251-9.

 

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By on August 18, 2016

Cryptosporidium spp. the small water-borne parasite that causes gastroenteritis

 

Cryptosporidiosis is a parasitic disease caused by a water-borne amoeba, Cryptosporidium, a genus of protozoan parasites around 3-6µm in diameter and infects a range of animals from humans, mice, cows, sheep, goats and reptiles such as tortoises and monitor lizards.

It is an important cause of diarrhoeal illness worldwide, particularly in young children and immunocompromised patients (such as untreated HIV positive people). It is one of the most common waterborne diseases and is found worldwide. [1]

 

In 2004, Cryptosporidium was listed by the World Health Organization (WHO) on a list of diseases that “exhibit a considerable and increasing global burden and impair the ability of those infected to achieve their full potential, both developmentally and socio-economically”. [7]

 

But how does such small parasites cause diarrhoea?

 

The parasite is transmitted by environmentally hardy microbial cysts (oocysts) when ingested are immediately infectious at quite low doses (10 to 30 oocysts are required to produce human disease). Oocysts attach to cells of the small bowel and invade the cells of the intestine. The diarrhoea; the main symptom of the disease is a host response to infection. [2]

It is more common for the infection to affect the distal small intestine and can affect the respiratory tract in both immunocompetent and immunocompromised (e.g., persons with HIV/AIDS) individuals, resulting in watery diarrhoea with or without an unexplained cough. [3]

 

Signs and Symptoms

 

Intestinal cryptosporidiosis [4][5]

Common signs and symptoms of intestinal cryptosporidiosis include:

  • Moderate to severe watery diarrhoea, sometimes contains mucus and rarely contains blood.
  • In very severe cases, diarrhoea may be profuse and cholera-like with malabsorption (decrease in water absorbed by the kidney), and hypovolemia (decrease in the volume of blood)
  • Fever
  • Abdominal cramps
  • Dehydration
  • Weight loss
  • Fatigue
  • Nausea and vomiting
  • Abdominal tenderness

Respiratory cryptosporidiosis [4][5]

Common signs and symptoms of upper respiratory cryptosporidiosis include:

  • Inflammation of the nasal mucosa, sinuses, larynx, or trachea (through invasion of the underlying epithelia tissues).
  • Nasal discharge
  • Voice change (e.g., hoarseness)

Symptoms of lower respiratory cryptosporidiosis include:

  • Cough
  • Shortness of breath
  • Fever
  • Hypoxemia

Transmission

  1. Livestock: such as cattle. This is particularly common on farms and petting zoos especially from the dung of young Ruminants.
  2. Food-borne: through the consumption of uncooked or cross-contaminated food that has been in contact with the faeces of an infected individual or animal.[6]
  3. Water-borne:
    • Contaminated water supply.
    • Contamination of swimming pools (and other water-based recreational sites).
    • Travel to less developed countries.
  4. Contact: from personal contact with infected individuals. This is particularly common with changing of nappies, from infected patients in hospitals and

The following groups have an elevated risk of being exposed to Cryptosporidium [6]

  • Child care workers
  • Parents of infected children
  • People who take care of other people with cryptosporidiosis
  • International travellers
  • Backpackers, hikers, and campers who drink unfiltered, untreated water
  • People, including swimmers, who swallow water from contaminated sources
  • People who handle infected cattle
  • People exposed to human faeces through sexual contact

 

Pathology: incidence of symptoms

The incubation period is dose-dependent (the number of oocysts ingested), and is typically between 5-10 days. However, it can be less (as low as 3 days) and longer in immunocompromised people (up to 28 days).

In developing countries it can be asymptomatic (showing no symptoms) whereas in developed countries it is rarely so.

In healthy subjects it presents with:[8]

  • Mild fever (59% of consulting patients).
  • General malaise progressing rapidly to further symptoms.
  • Watery diarrhoea (often green and offensive, sometimes with blood) (98% of patients).
  • Abdominal cramps (95%).
  •  Nausea and anorexia (65%).

Symptoms can be prolonged and last on average for two weeks but can persist for up to one month. Relapse of symptoms, indicating persistent infection – occurs in over a third of cases.

Illness can be severe enough to necessitate admission to hospital (14% of patients in one study).[1]

In 2010, it was attributed to around 100,000 deaths worldwide (down from 220,000 deaths in 1990).[10]

 

Diagnosis

 

There are many assays that can be used to detect and identify Cryptosporidium. These are:

  • Microscopy: identify oocytes in faecal matter;
  • Staining: immunoflourescent staining
  • Detection of antibodies e.g. ELISA testing
  • PCR (Polymerase Chain Reaction)

Prevention

General preventative measures include:

The boiling of drinking water to kill oocysts (this is especially important in less developed countries and when contamination of water supply is notified.[12]

When in foreign countries only drink tap-water from sources with special filtration or that has been boiled. The Department of Health in England advises that those with compromised T-cell function should boil all drinking water (including bottled water) to reduce the risk of infection.[13][14]

In particular, avoid new-born animals, including pets, especially in the immunocompromised.

Healthcare workers and childcare workers should prevent faecal-oral spread with wearing of gloves and with hand washing.

Specific preventative advice for patients diagnosed with cryptosporidiosis:[11]

As diarrhoea tends to last longer than most other causes of gastroenteritis and a great rick of possible relapses, patients are strongly advised to:

  • Observe strict personal hygiene measures (careful hand washing and no towel sharing).
  • Avoid swimming pools for two weeks after cessation of diarrhoea. ⦁ Avoid nursery attendance;
  • Food-handling occupations;
  • Care of vulnerable adults for 48 hours after cessation of diarrhoea.

Treatment

Treatment is based on the rehydration of a patient and the replacement of electrolytes lost through diarrhoea. This usually ends with a full recovery.

However, some people (usually immunocompromised people) may require anti-parasitic medication.

 

Have you Suffered from Sickness whilst on a Package Holiday?

 

If you have suffered from holiday sickness whilst on an all-inclusive packaged holiday get in touch with a member of our team.  Holiday Sickness Claims will be happy to help you through the process of securing a No Win No Fee solicitor to represent your claim for Holiday Sickness and get the compensation you deserve.

Give us a call on 0800-8-654321 to see if you fit our panel solicitors criteria. It is a simple process and we will let you know if you are eligible, we don’t want to waste your time or ours.

If you can locate your booking confirmation and ATOL certificate that your travel agent or tour operator provided when you booked your holiday, this will speed up the process. Usually sent to your email or if you booked in a store would usually be provided in paper format. If you cannot locate a copy we can help.

Keywords: Cryptosporidium, Cryptosporidiosis, immunocompromised people, diarrhoea, water-borne parasites

 

Further Reading and Referencing

⦁ Chalmers R; Diagnostic tests for Cryptosporidium, UK Cryptosporidium Reference Unit
⦁ Putignani L et al; Global Distribution, Public Health and Clinical Impact of the Protozoan Pathogen Cryptosporidium, Interdisciplinary Perspectives on Infectious Diseases, Volume 2010.
⦁ Sponseller JK, Griffiths JK, Tzipori S (2014). “The evolution of respiratory Cryptosporidiosis: evidence for transmission by inhalation”. Clin. Microbiol. Rev. 27 (3): 575–86.
⦁ Cabada MM; White AC; Venugopalan P; Sureshbabu J (18 August 2015). Bronze MS, ed. “Cryptosporidiosis Clinical Presentation”.
⦁ “Cryptosporidium: Illness & Symptoms”. United States Centers for Disease Control and Prevention. 20 February 2015.
⦁ “Cryptosporidium: Sources of Infection & Risk Factors”. United States Centers for Disease Control and Prevention. 1 April 2015.
⦁ Cryptosporidium, WHO Guidelines for Drinking Water Quality; World Health Organization (2006)
⦁ Alexander C; Update on Clinical Parasitology Developments, Scottish Parasite Diagnostic and Reference Laboratory, 2012.
⦁ Hunter PR, Hughes S, Woodhouse S, et al; Health sequelae of human cryptosporidiosis in immunocompetent patients.; Clin Infect Dis. 2004 Aug 15;39(4):504-10. Epub 2004 Aug 2.
⦁ Lozano, R (15 December 2012). “Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.”. Lancet 380 (9859): 2095–128.
⦁ Cryptosporidium Factsheets; Public Health England, 2008
⦁ Hunter PR, Nichols G; Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients.; Clin Microbiol Rev. 2002 Jan;15(1):145-54.
⦁ Lund BM, O’Brien SJ; The occurrence and prevention of foodborne disease in vulnerable people. Foodborne Pathog Dis. 2011 Sep;8(9):961-73. doi: 10.1089/fpd.2011.0860. Epub 2011 May 11.
⦁ Goh S, Reacher M, Casemore DP, et al; Sporadic cryptosporidiosis decline after membrane filtration of public water supplies, England, 1996-2002.; Emerg Infect Dis. 2005 Feb;11(2):251-9.

 

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