II. Epidemiology
- Cryptosporidium infections in U.S. are more common in summer and fall
- Natural Hosts: Young animals (e.g. calves)
- C. hominis only infects humans
- C. parvum infects both cows, sheep and humans
- Foodbourne illness (fecal-oral route transmission)
- Common cause of Traveler's Diarrhea worldwide
- Contaminated drinking water or uncooked foods
- Foods contaminated by an infected food handler
-
Waterborne Illness outbreaks
- Milwaukee contaminated municipal water (n=400,000)
- Florida Summer Camp with contaminated outdoor faucet
- References
- Sexually transmitted in Men who have Sex with Men
- Effects 10-20% of advanced HIV patients
III. Risk Factors
- Day care center attendance
- Children under age 5 years
- Human Immunodeficiency Virus (HIV) infection
- Men who have Sex with Men
- Exposures
- Dairy Farmers
- Animal contact
- Public swiming pools
- Contaminated water supply
- Travel history
IV. Pathophysiology
- Coccidian Protozoan present in animal feces
- Farm animals
- Domestic pets
- Very low inoculum required: 10 Oocysts
- Incubation Period 7 to 10 days
- Immunocompetent host has only mild Diarrheal illness
- Immunocompromised host has potentially severe or even fatal illness (gastrointestinal and respiratory effects)
V. Symptoms
- Normal Host (typically resolves within 2 weeks)
-
HIV Infection or other Immunocompromised patient (prolonged illness)
- Chronic, persistent, secretory, watery Diarrhea
- Cough
- Abdominal Pain
- Weight loss
- Fatigue
- Joint Pain
VI. Labs
- Specific Ova and Parasite testing
- Cryptosporidium is not typically included on routine Ova and Parasite testing
- Request specific testing if higher index of suspicion
- May require multiple stool samples collected on several different days (intermittent excretion)
- Diagnostic modalities
- PCR (gold standard)
- Microscopy with Immunohistologic testing (immunofluorescence against oocyst wall)
- Test Sensitivity and Test Specificity approaches 100%
- Microscopy (wet mount, stains)
- Sample sources
- Stool
- Duodenal aspirate
- Bile secretions
- Respiratory secretions
- Other tests
- Serum Alkaline Phosphatase
- Increased if biliatry tract involvement
- Abdominal imaging (CT Abdomen, Abdominal Ultrasound)
- May demonstrate gallbladder enlargement and bile duct dilitation
- Serum Alkaline Phosphatase
VII. Course
- Symptom onset delayed 2-10 days from exposure (up to 2 weeks)
- Normal host (self-limited)
- Diarrhea persists for 10 days in normal host (self limited)
- May relapse over weeks to months in some cases
-
Immunocompromised host
- Severe course (may be fatal)
- Stools may exceed 21 stools per day for months (with secondary malabsorption and Failure to Thrive)
VIII. Complications
- Reactive Arthritis (associated with C hominis)
- Extra-intestinal infection (Immunocompromised patients)
- Lungs are commonly affected (with secondary cough), esp. with C. hominis
- Chronic biliary tract disease (sclerosing Cholangitis) in patients with comorbid HIV Infection
- Other involvement
- Conjunctivitis
- Esophagitis
- Appendicitis
- Pancreatitis
- Intestinal perforation
IX. Management
- Symptomatic management
- See Acute Diarrhea
- Most immunocompetent patients recover within 7-14 days without specific treatment
- Maximize hydration
- Immunocompetent patients with severe or prolonged Diarrhea (>7 days)
- Paromomycin and Azithromycin are NOT thought to be effective
- Nitazoxanide (Alinia)
- Child age 1 to 3 years: 100 mg orally twice daily for 3 days
- Child age 4 to 11 years: 200 mg orally twice daily for 3 days
- Adult (or age >11 years): 500 mg orally twice daily for 3 days
- Cure rate 72 to 80% with treatment, and resolves spontaneously in most cases
-
Immunocompromised patients or HIV positive
- Nitazoxanide (Alinia) is no more effective than Placebo in Immunocompromised patients
- However may be trialed in age over 1 year old
- Paromomycin and Azithromycin may be trialed in refractory cases (but low efficacy)
- Highly Active Antiretroviral Therapy in HIV eradicates intestinal Cryptosporidium (especially if CD4 >150 cells/mm3)
- Protease Inhibitors may have additional activity against Cryptosporidium
- Nitazoxanide (Alinia) is no more effective than Placebo in Immunocompromised patients
X. Prevention
- Avoid swimming for 1-2 weeks after exposure
- Oocyst sheddling continues after resolution
- Water sterilization
- Water microfilters (1 micron pore)
- Water boiling (for >1 minute) reduces infection risk
- Some guidelines recommend boiling for 10 minutes
- Freeze water
- Ammonia or formalin in high concentration purifies water
- Cryptosporidium is very resistant to halogens (e.g. chlorination, Iodine)
- Swimming pool chlorination does NOT prevent transmission
- Cryptosporidium oocysts survive >10 days in swimming pools chlorinated to CDC recommended levels
- Shields (2008) J Water Health 6(4): 513-20 [PubMed]
XI. Resources
- Cryptosporidium
XII. References
- Wang and Nguyen (2017) Crit Dec Emerg Med 31(9):13-8
- Checkley (2015) Lancet Infect Dis 15(1): 85-94 [PubMed]
- Perkins (2017) Am Fam Physician 95(9):554-60 [PubMed]
- Pyzocha (2023) Am Fam Physician 108(5): 487-93 [PubMed]
- Weller (2001) BMJ 322:1350-4 [PubMed]
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Related Studies
Definition (MSH) | Intestinal infection with organisms of the genus CRYPTOSPORIDIUM. It occurs in both animals and humans. Symptoms include severe DIARRHEA. |
Definition (MEDLINEPLUS) |
Cryptosporidiosis (crypto) is an illness caused by a parasite. The parasite lives in soil, food and water. It may also be on surfaces that have been contaminated with waste. You can become infected if you swallow the parasite. The most common symptom of crypto is watery diarrhea. Other symptoms include
Most people with crypto get better with no treatment, but crypto can cause serious problems in people with weak immune systems such as in people with HIV/AIDS. To reduce your risk of crypto, wash your hands often, avoid water that may be infected, and wash or peel fresh fruits and vegetables before eating. Centers for Disease Control and Prevention |
Definition (MSHCZE) | Střevní onemocnění způsobené prvokem Cryptosporidium parvum. Přenáší se fekálně-orální cestou (např. kontaminovaná voda), zdrojem bývají zvířata. Projevuje se vodnatými průjmy bez příměsí podobnými choleře. Závažný průběh je u imunokompromitovaných osob vč. nemocných s AIDS, u nichž má nemoc chronický průběh (enteritida, malabsorpce). Léčebně se ev. podávají některá antibiotika (např. paronomycin, spiramycin, nitrazoxanid), důležitá je symptomatická léčba, zejm. intenzivní rehydratace. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
Definition (CSP) | intestinal infection with protozoa of the genus Cryptosporidium; occurs in both animals and humans; symptoms include severe diarrhea. |
Concepts | Disease or Syndrome (T047) |
MSH | D003457 |
ICD9 | 007.4 |
ICD10 | A07.2 |
SnomedCT | 186126003, 240370009, 58777003 |
LNC | LA10448-1 |
English | Cryptosporidioses, Cryptosporidiosis infection, cryptosporidiosis (diagnosis), cryptosporidiosis, Cryptosporidiosis, Cryptosporidia infections, Cryptosporidiosis [Disease/Finding], cryptosporidiasis, cryptosporidium infection, Intestinal cryptosporidiosis, Crypto, Cryptosporidiasis, Cryptosporidiosis (disorder), Infection by Cryptosporidium (disorder), Infection by Cryptosporidium, gastroenteritis; Cryptosporidium, infection; Cryptosporidium, Cryptosporidium; gastroenteritis, Cryptosporidium; infection, Infection by Cryptosporidium, NOS |
Italian | Infezioni da Cryptosporidi, Infezione da Criptosporidi, Criptosporidiosi |
Swedish | Kryptosporidios |
Czech | kryptosporidióza, Kryptosporidióza, Kryptosporidiózy |
Spanish | Criptosporidiosis infección, criptosporidiasis, criptosporidiosis (trastorno), criptosporidiosis, infección por Cryptosporidium (trastorno), infección por Cryptosporidium, Infecciones por cryptosporidium, Criptosporidiosis |
Dutch | cryptosporidiosis, cryptosporidiosisinfectie, Cryptosporidium; gastro-enteritis, Cryptosporidium; infectie, gastro-enteritis; Cryptosporidium, infectie; Cryptosporidium, Cryptosporidiosis, Cryptosporidia-infecties, Cryptosporidiose |
Portuguese | Infecção criptosporidiósica, Infecções a criptosporídios, Criptosporidiose |
German | Kryptosporidiose-Infektion, Cryptosporidia-Infektionen, Kryptosporidiose |
Japanese | クリプトスポリジウム症, クリプトスポリジウム感染, クリプトスポリジウムショウ, クリプトスポリジウムカンセン |
Finnish | Kryptosporidioosi |
Russian | KRIPTOSPORIDIOZ, КРИПТОСПОРИДИОЗ |
Korean | 와포자충증 |
Croatian | KRIPTOSPORIDIOZA |
Polish | Kryptosporidioza, Kryptosporydoza, Kryptosporydioza |
Hungarian | Cryptosporidiosis fertőzés, Cryptosporidiosis, Cryptosporidialis fertőzések |
Norwegian | Kryptosporidiose, Cryptosporidiose |
French | Infections à Cryptosporidium, Cryptosporidiose |
Ontology: Cryptosporidium parvum (C0085319)
Definition (MSHCZE) | Prvok patřící k střevním kokcidiím, původce střevní kryptosporidiózy. Kosmopolitně rozšířený mikroorganismus o velikosti cca 2–6 μm s velmi odolnými oocystami. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
Definition (MSH) | A species of parasitic protozoa that infects humans and most domestic mammals. Its oocysts measure five microns in diameter. These organisms exhibit alternating cycles of sexual and asexual reproduction. |
Concepts | Eukaryote (T204) |
MSH | D016785 |
SnomedCT | 51504002 |
LNC | LP35695-3 |
English | Cryptosporidium parvum, parvums, Cryptosporidium, parvum, Cryptosporidium, Cryptosporidium parvums, parvum cryptosporidium, cryptosporidium parvum, CRYPTOSPORIDIUM PARVUM, Cryptosporidium parvum (organism) |
Swedish | Cryptosporidium parvum |
Czech | Cryptosporidium parvum |
Finnish | Cryptosporidium parvum |
Russian | KRIPTOSPORIDIIA MALAIA, CRYPTOSPORIDIUM PARVUM, КРИПТОСПОРИДИЯ МАЛАЯ |
Polish | Cryptosporidium parvum |
Norwegian | Cryptosporidium parvum |
Spanish | Cryptosporidium parvum (organismo), Cryptosporidium parvum |
French | Cryptosporidium parvum |
German | Cryptosporidium parvum |
Italian | Cryptosporidium parvum |
Dutch | Cryptosporidium parvum |
Portuguese | Cryptosporidium parvum |
Ontology: Cryptosporidium hominis (C1489235)
Concepts | Eukaryote (T204) |
SnomedCT | 417722006 |
LNC | LP35796-9 |
Spanish | Cryptosporidium hominis, Cryptosporidium hominis (organismo) |
English | Cryptosporidium hominis, Cryptosporidium hominis (organism) |
Ontology: Cryptosporidium (C1744526)
Definition (MSHCZE) | Prvok patřící k střevním kokcidiím, původce střevní kryptosporidiózy. Kosmopolitně rozšířený mikroorganismus o velikosti cca 2–6 μm s velmi odolnými oocystami. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
Definition (NCI) | A genus of parasitic protozoa that is the cause of cryptosporidiosis. |
Definition (MSH) | A genus of coccidian parasites of the family CRYPTOSPORIDIIDAE, found in the intestinal epithelium of many vertebrates including humans. |
Definition (CSP) | genus of coccidian parasites of the family Cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. |
Concepts | Eukaryote (T204) |
MSH | D003458 |
SnomedCT | 83821001 |
LNC | LP20006-0, MTHU008557 |
Swedish | Cryptosporidium |
English | Cryptosporidium, Cryptosporidiums, Cryptosporidium Tyzzer, 1907, Genus: Cryptosporidium, Cryptosporidium (organism), Cryptosporidium, NOS, Genus Cryptosporidium |
Czech | Cryptosporidium |
Finnish | Cryptosporidium |
Croatian | CRYPTOSPORIDIUM |
Polish | Cryptosporidium |
Norwegian | Cryptosporidium |
Spanish | Cryptosporidium (organismo), Cryptosporidium, SAI, criptosporidio, género: Cryptosporidium, Cryptosporidium |
French | Cryptosporidium |
German | Cryptosporidium, Kryptosporidium |
Italian | Cryptosporidium |
Russian | CRYPTOSPORIDIUM |
Dutch | Cryptosporidium |
Portuguese | Cryptosporidium |