Contents
Cryptosporidiosis is an invasive parasitic disease caused by coccidia of the genus Cryptosporidium. Diarrheal syndromes most often occur in people with congenital or acquired immunodeficiencies, receiving immunosuppressive drugs, and in children up to 2 years of age. Personal hygiene is important in preventing disease.
- Cryptosporidiosis is the most talked about disease in the summer
- It is most dangerous to young children, and one of the ways of infection is drinking contaminated water – for example from a swimming pool
- The main symptom is acute, prolonged diarrhea – it should not be underestimated in toddlers
- You can find more such stories on the TvoiLokony home page
Cryptosporidiosis — epidemiology
Cryptosporidiosis is a cosmopolitan parasitosis. Infections occur in humans and many animal species, and the invasive form of the protozoan is the oocyst and is excreted in the faeces. The source of infection is contaminated with human or animal faeces:
- water,
- vegetables,
- fruit,
- other food products,
- hands.
Young cattle may be the carrier of the parasite on farms.
Direct transmissions of oocysts may occur in nurseries, kindergartens, hospitals (patient-patient, patient-medical staff), between household members, sexual partners (especially homosexuals).
Cryptosporidium parvum is an opportunistic pathogen for people with congenital or acquired immune disorders and treated with immunosuppressants. The implementation of an effective combined antiretroviral therapy (cART) contributed to a decrease in the incidence of symptomatic cryptosporidiosis in HIV-infected patients.
The causes of cryptosporidiosis
The causative agent of human cryptosporidiosis is several species of Cryptosporidium, but the most important is Cryptosporidium minor.
The pathophysiology of cryptosporidiosis
The protozoan parasitizes the enterocytes of the end part of the small intestine, causing inflammation. Additional locations (cells of the mucosa of the large intestine, stomach, respiratory tract) are diagnosed in people with impaired immunity. Invasion of the bile duct epithelial cells results in the appearance of cholangitis symptoms.
Cryptosporidiosis – clinical symptoms
Cryptosporidiosis is characterized by watery diarrhea of varying intensity and paroxysmal cramping abdominal pain. Other symptoms of infection include:
- headaches,
- weakness,
- muscle aches,
- nausea,
- loss of appetite
- vomiting,
- weariness.
The parasitic disease in the form of cryptosporidiosis is usually fever-free. On the other hand, mucus is found in the stool, while erythrocytes and leukocytes are absent. In people with immunodeficiency, malabsorption disorders caused by chronic diarrhea lead to malnutrition, weight loss and cachexia.
Diagnostics of cryptosporidiosis
In the diagnosis of cryptosporidiosis, microscopic examination of fresh or 10% formalin-fixed feces is performed. The diagnosis of the disease is also facilitated by staining the preparations according to Ziehl-Neelsen or Kinyoun. Finding small (4-5 mikrom) Cryptosporidium spp oocysts confirm invasion.
Multiple microscopic examination of the stool is of great importance. In addition, enzyme immuno-methods for the detection of Cryptosporidium spp. Coproantigens and immunofluorescence methods for revealing oocysts (direct immunofluorescence with monoclonal antibodies) can be used. The polymerase chain reaction (PCR) technique is used to detect protozoan DNA in the stool.
Differentiation
Cryptosporidiosis should be differentiated, inter alia, from diarrhea of infectious origin, especially other protozoal invasions and functional disorders of the intestines.
Cryptosporidiosis – treatment
The drug of choice for the treatment of cryptosporidiosis is we stopped in the form of tablets or a suspension (nitazoxanide, trade names of the drug: Alinia, Annita). The standard dosage in immunocompetent adults is 2 times 500 mg orally for 3 days (treatment is 2 weeks in HIV-infected adults).
Alternatively, you can apply paromomycin at a dose of 500 mg 4 times a day for 3-4 weeks. The application also brings effects azithromycin at a dose of 1200 mg twice daily on the first day and then 2 mg twice daily for one month.
It also applies to the causal procedure spiramycin, clarithromycin, atovaquone. In the treatment of cryptosporidiosis, it is also important to correct fluid and electrolyte disturbances. Treatment of people with immunodeficiency may not be effective. In HIV-infected patients, effective cART relieves the symptoms of cryptosporidiosis and reduces the risk of relapse.
How to prevent cryptosporidiosis?
In the prevention of cryptosporidiosis, an important role is played by:
- consuming water that is not biologically contaminated (chlorination is not effective because it does not kill oocysts). You can use other methods of water treatment, e.g. ozonation or filtering,
- avoiding bathing in places where the water is not ozonated,
- avoiding eating raw or semi-raw foods (e.g. seafood) as they may be contaminated with protozoan oocysts by water or soil,
- avoiding eating food left out long before eating (it can be contaminated by e.g. flies),
- taking care of personal hygiene,
- providing a patient hospitalized due to cryptosporidiosis – contact isolation.
What’s the prognosis?
The prognosis for cryptosporidiosis in patients with an efficient immune system is favorable. However, in patients with HIV / AIDS, it depends on the treatment of the underlying disease.