Cryptosporidiosis

Pronounced as :KRIP-toe-spo-rid-ee-OH-sis

Other Name:Crypto

Definition:-
Cryptosporidiosis is a parasitic disease caused by Cryptosporidium, a protozoan parasite in the phylum Apicomplexa. It affects the intestines of mammals and is typically an acute short-term infection. It is 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.

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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 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.

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.

The most common symptom of crypto is watery diarrhea. Other symptoms include

*Dehydration
*Weight loss
*Stomach cramps or pain
*Fever
*Nausea
*Vomiting

Some people with Crypto will have no symptoms at all.

Symptoms usually last about 1 to 2 weeks (with a range of a few days to 4 or more weeks) in persons with healthy immune systems. Occasionally, people may experience a recurrence of symptoms after a brief period of recovery before the illness ends. Symptoms can come and go for up to 30 days.

While the small intestine is the site most commonly affected, Cryptosporidium infections could possibly affect other areas of the digestive tract or the respiratory tract.

People with weakened immune systems may develop serious, chronic, and sometimes fatal illness. Examples of people with weakened immune systems include:

*people with AIDS;
*those with inherited diseases that affect the immune system; and
*cancer and transplant patients who are taking certain immunosuppressive drugs.

The risk of developing severe disease may differ depending on each person’s degree of immune suppression.

Severe diseases, including pancreatitis, can occur.

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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 safety of the water supply is questionable, it can be boiled. It is not necessary to boil water for lengthy periods e.g. 15 minutes: simply bringing the water to the boil will kill any cryptosporidium oocysts in it. Suspect water supplies can also be carefully filtered before drinking, though boiling water is easier and requires no special equipment.

Causes:-
The parasite Cryptosporidium parvum is found in the feces of infected animals and people. Persons, dogs and cats become infected when they swallow this parasite. This is one reason why hands should be washed after contact with pets. Hands also should be washed after changing a child’s diaper and after using the toilet. Other activities that bring a person in contact with feces of another person can result in exposure. The parasite, which can be present in sewage or runoff from feed lots, can contaminate water sources, and several large waterborne outbreaks have occurred. Outbreaks also have occurred in child day care centers. In Illinois, 75-100 cases of cryptosporidiosis are reported annually.

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Diagnosis:
The patient’s physician can order a special test to detect the presence of Cryptosporidium in a stool specimen. Routine stool examinations will not detect this parasite.

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.

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.

Risk Factors:
Symptoms can last for up to 30 days in persons who are otherwise healthy. In persons with weakened immune systems, including people with HIV/AIDS and cancer, transplant patients taking immunosuppressive drugs and people with genetically weakened immune systems, symptoms can persist indefinitely. Persistent diarrhea due to cryptosporidiosis in these persons can lead to death.

Prevention:
*Wash hands after handling pets or other animals.
*Wash hands after handling items that might be contaminated with the feces of other persons.
*Wash hands before preparing or handling food.
*Wash hands after gardening or other contact with soil.
*Wash produce thoroughly before eating.
*Avoid unpasteurized milk or milk products.
*Avoid exposure to calves and lambs and places where these animals are raised.
*Avoid sexual contact with other persons that involves exposure to their feces. Follow “safer sex” guidelines.
*Avoid drinking water directly from rivers, lakes and streams.

Correct Way of Washing Hands:
*Use a running stream of warm water.
*Lather hands vigorously with soap for at least 15 seconds.
*Rinse hands under running warm water so that the water flows from the wrist to the fingertips.
*Dry hands.
*If in a public place, turn off water faucet with a disposable paper towel after drying hands.

Choices if doctor advises not to drink regular tap water for infected areas:-

*Boil water before drinking or before using it for cooking by bringing it to a rolling boil for three minutes.

*Use a “point-of-use” (personal use, end-of-tap, under sink) filter. Only point-of-use filters that remove particles one micrometer or less in diameter should be considered. Filters in this category that provide the greatest assurance of Cryptosporidium removal include those that use reverse osmosis, those labeled as “absolute” one micrometer filters, or those certified by NSF (National Sanitation Foundation) International under Standard 53 for “cyst removal.” The “nominal” one micrometer filter rating is not standardized and many filters in this category may not reliably remove Cryptosporidium. As with all filters, people should follow the manufacturer’s instructions for filter use and replacement. (“Point-of-use” filters meeting the above criteria may not necessarily remove organisms other than Cryptosporidium that could pose a health hazard for severely immunocompromised individuals.)

*Use bottled water. Water sources (wells, springs, municipal tap water) and bottled water treatment processes vary considerably. Therefore, individuals should not presume that all bottled waters are absolutely free of Cryptosporidium. Bottled waters derived from protected well and spring water sources are less likely to be contaminated by Cryptosporidium than bottled municipal drinking water because municipal drinking water is typically derived from less protected sources, such as rivers and lakes. Cryptosporidiosis has been acquired from contaminated well water, but water treated by distillation or reverse osmosis before bottling assures Cryptosporidium removal. Water passed through a filter that meets the above criteria for a “point-of-use” device before bottling will provide nearly the same level of Cryptosporidium removal as distillation or reverse osmosis. Bottled waters meeting the above criteria may not necessarily be free of organisms other than Cryptosporidium that could pose a health hazard for severely immunocompromised individuals.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Cryptosporidiosis
http://www.nlm.nih.gov/medlineplus/cryptosporidiosis.html
http://www.cdc.gov/crypto/disease.html
http://www.idph.state.il.us/public/hb/hbcrypto.htm

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