Cryptosporidiosis (crypto) is a serious disease caused by a one cell cryptosporidium parvum parasite that leads to serious diarrhea. The disease is hard to diagnose because it is often overlooked unless observed under an extremely powerful microscope. Over the last 20 years, cryptosporidiosis has become known as one of the leading causes of recreational and drinking waterborne illnesses involving Americans. Tens of thousands of cases of crypto are diagnosed in the United States every year.
The disease affects the small intestine and usually produces nothing more than a serious case of diarrhea. However, in immunologically impaired people, including those with as an HIV, the symptoms can lead to severe debilitation and even death. The symptoms tend to be acute, meaning the infection lasts only a brief time. However, it is highly infectious and can be spread through fecal-oral transmission.
- How Cryptosporidiosis Is Spread
- Who Is at Risk for Cryptosporidiosis?
- Common Symptoms
- Diagnosing Cryptosporidiosis
- Treating the Condition
- Prognosis (Outlook)
How Cryptosporidiosis Is Spread
Crypto has a protective outer shell that allows the parasite to defend itself for extended periods against chlorine-based disinfectants. The parasite has been identified in every region of the US and has been found in the intestines of infected animals and humans worldwide. A single bowel movement containing crypto can spread millions of cryptosporidiosis germs. Common ways to spread cryptosporidiosis include:
- Swallowing the parasite in contaminated water food
- Swallowing parasite-contaminated recreational water found in hot tubs, swimming pools, rivers, lakes, streams, ponds, springs, and fountains.
- Contact with animal or human feces or sewage water
- Swallowing contaminated beverages that contain the crypto parasite
- Consuming uncooked or undercooked contaminated food
- Contaminated-hand to mouth contact that involves diaper pails, diaper changing tables, bathroom fixtures, toys or other surfaces contaminated by infected people or animals
- Sexual contact involving exposure to contaminated human feces
The cryptosporidium parvum parasite is not spread through contact or exposure to human or animal blood.
Who Is at Risk for Cryptosporidiosis?
Individuals most at risk for acquiring cryptosporidiosis are those that are exposed to the parasitic organism through contact with an infected animal or human. However, those with a compromised immune system, including those who suffer from cancer, AIDS, HIV, or have undergone a recent organ transplant are at greater risk of acquiring the condition and associated symptoms.
In addition, these individuals tend to suffer more severe symptoms compared to others without immune system issues. Other individuals who have a heightened risk of acquiring cryptosporidiosis include:
- Children and workers attending day care centers that cater to diaper-aged toddlers
- Siblings and other family members who live with individuals infected with the one cell cryptosporidium parvum parasite
- International Travelers
- Health care workers providing care and services to individuals infected with cryptosporidiosis
- Individuals who drink from unprotected wells
- Animal handlers around infected herds
- Swimmers in contaminated waters
- Those exposed to infected human feces by sexual contact
The most common symptoms associated with cryptosporidiosis involve:
- Stomach pain
- Stomach cramps
- Unexpected weight-loss
- Watery diarrhea
That said, some individuals infected with cryptosporidiosis display no symptoms at any point during the infectious period. While the parasite commonly affects only the small intestine, some individuals suffer respiratory tract or digestive tract infections caused by crypto. Usually, the infection cycle lasts approximately 14 days. However, the infection may cycle, meaning that the individual feels much better for a day or two, before feeling much worse as the symptoms finally subside.
Early diagnosis of cryptosporidiosis can be difficult and is usually not part of a typical physical examination and blood/stool/urine tests. This is because the incubation period for the organism is approximately one to twelve days. At that point, the doctor can have a stool sample tested under laboratory conditions that can identify the presence of the parasitic organism and rule out any other cause or pathogen. An accurate confirmation of a diagnosis of cryptosporidiosis usually requires and antigen-detection assay where the antigen is identified that triggers the body's immune response to a foreign or toxic substance.
As a part of the physical examination and diagnosis of the condition, the doctor will likely recommend of various other tests that include:
- Immunofluorescence assay
- Immunochromatographic assay
- Enzyme-linked immunosorbent assay
- Ultrasound test to identify cryptosporidiosis that has affected the body's bile system that causes a thickened gallbladder or irregular/dilated bile ducts
- ERCP (Endoscopic Retrograde Cholangiopancreatography) that uses a lighted, flexible tube inserted into the mouth, stomach and small intestine to accurately confirm the diagnosis
Treating the Condition
Medical science has yet to find a specific treatment to cure cryptosporidiosis. Instead, recovery is usually based on the patient's immune system health. Unless the individual suffers from a serious immune system condition, it usually takes two weeks to fully recover from the condition without receiving any medical attention.
However, individuals with a compromised immune system usually suffer substantial malnutrition and dehydration, where the body can waste away without some medical intervention. The doctor usually recommends treatments based on alleviating symptoms and improving the body's immunological response. Treatment options for individuals with a compromised immune system involve:
- Anti-Parasitic Medications including Alinia (nitazoxanide) are prescribed to alleviate diarrheal symptoms. The drugs attack the metabolic processes of the parasitic organism. The doctor might also prescribe Zithromax (azithromycin) to help support a compromise immune system.
- Fluid Replacement – Persistent diarrhea can cause severe dehydration that requires intravenous or oral fluid replacement to ensure the patient receives necessary electrolytes including calcium, potassium, sodium and other minerals to help maintain fluid balance. Continuously replacing lost fluids helps a body remain hydrated to ensure it properly functions.
- Anti-Motility Agents – These drugs are highly effective at slowing down intestinal movement while increasing the absorption of fluids caused by abnormal stools and persistent diarrhea. The anti-motility medications are usually formulated with loperamide or some derivative including Imodium AD. However, it is essential to talk with your physician before taking any of these over-the-counter drugs.
- Antiretroviral Therapies – Individuals who suffered extremely compromised immune systems including those with AIDS and HIV should consider antiretroviral therapies (HAART) that are highly effective at reducing viral damage while boosting the body's immune system response. Bolstering the body's immune system can help completely resolve many of the signs and symptoms associated with cryptosporidiosis.
Generally, healthy individual suffering the signs and symptoms of cryptosporidiosis experienced mild to moderate levels of diarrhea that often prolong for a week or two. Their prognosis is usually extremely positive where many of the symptoms are no longer detected after 14 days.
However, those with highly compromised immune systems often suffer cryptosporidiosis at a level considered to be severe, chronic and, at times, fatal. Additionally, these individuals often suffer extra-intestinal manifestations that involve persistent abdominal pain, eye pain, joint pain, dizziness, headaches, fatigue, and loose stools.
Those who are diagnosed with the condition should avoid recreational water and any sexual practice that might involve oral exposure to another individual's stool. In addition, infected children with diarrheal symptoms should avoid child care settings until they are no longer infectious. People with close contact with another human or animal with the weakened immune system could transmit the disease to others who might be highly challenged in overcoming the effect caused by the harmful parasite.