eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Cryptosporidiosis: Follow-up

Author: Jaya Sureshbabu, MBBS, DCh, MRCPCH (UK), MRCPI (Paeds), DCH (GLAS), Registrar, Department of Pediatrics/Neonatology, Mid-western Regional Hospital, Limerick, Ireland
Coauthor(s): Poothirikovil Venugopalan, MBBS, MD, FRCP (Glasg), FRCPCH, Consulting Staff, Department of Child Health, University Hospital of Hartlepool, UK; Athena P Kourtis, MD, PhD, Assistant Professor, Department of Pediatrics, Divisions of Infectious Diseases and Epidemiology, Emory University School of Medicine
Contributor Information and Disclosures

Updated: Apr 29, 2008

Follow-up

No follow-up care is necessary after resolution of infection.

Deterrence/Prevention

  • See Activity.
  • Water purification is the most important public health measure.20,9,10
  • Because chlorination has little effect on the oocysts, water purification should involve flocculation and filtration.
  • Ultraviolet radiation or ozonization can also disinfect contaminated water.
  • Water can also be decontaminated by bringing it to a boil or by using a filter with pore size of 1-4 μ m.
  • Prompt aggressive measures including temporary closure of pools must be done in case of suspected fecal contamination of recreational water. People with diarrhea should not use recreational water, and those with cryptosporidiosis should not use recreational waters for 2 weeks after symptoms resolve.
  • Wearing gloves and handwashing after handling diapers can prevent person-to-person spread in daycare or centers.
  • Endoscopes and similar instruments should be disinfected between uses.

Complications

Prognosis

  • In most healthy individuals, Cryptosporidium -induced diarrhea is usually self-limited.
  • In patients who are severely immunocompromised, cryptosporidiosis may be more prolonged and severe with extraintestinal manifestations.
  • According to the Centers for Disease Control and Prevention (CDC), part of the case definition of AIDS is that cryptosporidiosis lasts more than 30 days in individuals who are infected with HIV. Some patients have clinical resolution but parasitic elimination rate is unclear. This may correlate with CD4 lymphocyte counts higher than 150. In late-stage HIV infection, infection rarely remits and often contributes to death.

Patient Education

  • Enteric precautions and good hygiene are important.
  • Consider boiled or bottled drinking water for patients who are immunocompromised, particularly those infected with HIV with fewer than 200 CD4 cells/µL.
  • Persons at risk should avoid contact with known sources such as infected humans, farm animals, and pets. They should also consider avoiding communal swimming pools.

Miscellaneous

Medicolegal Pitfalls

  • Failing to consider Cryptosporidium as the cause of diarrhea, particularly in cases with prolonged symptoms, may cause expensive diagnostic tests and consultations to be undertaken.
  • Failing to warn patients who are immunocompromised about the risks associated with swimming in communal pools or drinking unfiltered water may lead to medicolegal problems.

Special Concerns

  • Pregnancy may predispose women to infection.
  • Transmission of cryptosporidiosis to children and their caregivers at daycare facilities is believed to be a major mode of person-to-person transmission. Daycare center–related outbreaks have a high infection rate of 30-60%.
  • Hospital-associated infection in patients and health care providers has been reported.
 


More on Cryptosporidiosis

Overview: Cryptosporidiosis
Differential Diagnoses & Workup: Cryptosporidiosis
Treatment & Medication: Cryptosporidiosis
Follow-up: Cryptosporidiosis
Multimedia: Cryptosporidiosis
References
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References

  1. Meinhardt PL, Casemore DP, Miller KB. Epidemiologic aspects of human cryptosporidiosis and the role of waterborne transmission. Epidemiol Rev. 1996;18(2):118-36. [Medline].

  2. Fayer R, Morgan U, Upton SJ. Epidemiology of Cryptosporidium: Transmission,detection and identification. Int J Parasitol. 2000;30:1305-1322.

  3. Flynn PM. Cryptosporidium parvum. In: Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatrics. New York, NY: Churchill Livingstone; 1997.

  4. White C Jr. Cryptosporidiosis. In: Mandell GL, Bennett JE, Doilin R. Principles and practice of Infectious Diseases. Vol 2. 6th. Philadelphia, Pennsylvania: Elsivier Churchill Livingstone; 2005:280.

  5. Huang DB, Chappell C, Okhuysen PC. Cryptosporidiosis in children. Semin pediatr Infect Dis. Oct, 2004;15 (4):253-259. [Medline].

  6. CDC. Classification system for human T-lymphotropic virus type III/lymphadenopathy-associated virus infections. MMWR Morb Mortal Wkly Rep. May 23 1986;35(20):334-9. [Medline].

  7. Committee on Infectious Diseases, American Academy of Pediatrics. Cryptosporidiosis. In: Pickering LK, Baker CJ, Long S, McMillan JA. Red book. 27th. Elk Grove Village, IL: AAP; 2006:270-272.

  8. MacKenzie WR, Schell WL, Blair KA. Massive outbreak of waterborne Cryptosporidium infection in Milwaukee, Wisconsin. Clin Infect Dis. Jul, 1995;21 (1):57-62. [Medline].

  9. Cryptosporidiosis surveillance--United States, 2003-2005 [database online]. Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, CDC, Atlanta, GA 30333, USA. jey9@cdc.gov: Yoder JS, Beach MJ; Centers for Disease Control and Prevention (CDC).; 2007 Sep 7.

  10. Semenza JC, Nichols G. Cryptosporidiosis surveillance and water-borne outbreaks in Europe. Euro Surveill. May 2007;1;12(5):E13-4. [Medline].

  11. Cooper DL, Verlander NQ, Smith GE, et al. Can syndromic surveillance data detect local outbreaks of communicable disease? A model using a historical cryptosporidiosis outbreak. Epidemiol Infect. Feb 2006;134(1):13-20. [Medline].

  12. Navin TR, Hardy AM. Cryptosporidiosis in patients with AIDS. J Infect Dis. Jan 1987;155(1):150. [Medline].

  13. Abubakar I, Aliyu SH, Arumugam C, Usman NK, Hunter PR. Treatment of cryptosporidiosis in immunocompromised individuals: systematic review and meta-analysis. Br J Clin Pharmacol. Apr 2007;63(4):387-93. [Medline]. [Full Text].

  14. Wolska-Kusnierz B, Bajer A, Caccio S, Heropolitanska-Pliszka E, Bernatowska E, Socha P, et al. Cryptosporidium infection in patients with primary immunodeficiencies. J Pediatr Gastroenterol Nutr. Oct 2007;45(4):458-64. [Medline].

  15. Cello JP. Acquired immunodeficiency syndrome cholangiopathy: spectrum of disease. Am J Med. May 1989;86(5):539-46. [Medline].

  16. Weintraub JM. Improving cryptosporidium testing methods: a public health perspective. J Water Health. 2006;4 Suppl 1:23-6. [Medline].

  17. Soave R. Treatment strategies for cryptosporidiosis. Ann N Y Acad Sci. 1990;616:442-51. [Medline].

  18. Fox LM, Saravolatz LD. Nitazoxanide: a new thiazolide antiparasitic agent. Clin Infect Dis. 2005;40 (8)::1173-80. [Medline].

  19. Smith NH, Cron S, Valdez LM, et al. Combination drug therapy for cryptosporidiosis in AIDS. J Infect Dis. Sep 1998;178(3):900-3. [Medline].

  20. Juranek DD. Cryptosporidiosis: sources of infection and guidelines for prevention. Clin Infect Dis. Aug 1995;21 Suppl 1:S57-61. [Medline].

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Further Reading

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Keywords

cryptosporidiosis, Cryptosporidium, Cryptosporidium parvum, C parvum, Cryptosporidium hominis, C hominis, diarrhea, oocysts, acquired immunodeficiency syndrome, AIDS, Plasmodium, Cryptosporidium canis, waterborne infection, traveler's diarrhea, diarrhea, villous atrophy, malabsorption, steatorrhea, foodborne diarrhea, hepatobiliary disease, respiratory disease, jaundice, nausea, vomiting, croup, respiratory infection, human immunodeficiency virus, HIV, acalculous cholecystitis, sclerosing cholangitis, pancreatitis, ascites, icterus, reactive arthritis, diabetes mellitus, cytomegalovirus, CMV, Enterobacter cloacae, microsporidia, Pneumocystis carinii

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Contributor Information and Disclosures

Author

Jaya Sureshbabu, MBBS, DCh, MRCPCH (UK), MRCPI (Paeds), DCH (GLAS), Registrar, Department of Pediatrics/Neonatology, Mid-western Regional Hospital, Limerick, Ireland
Jaya Sureshbabu, MBBS, DCh, MRCPCH (UK), MRCPI (Paeds), DCH (GLAS) is a member of the following medical societies: Royal College of Paediatrics and Child Health, Royal College of Physicians and Surgeons of Glasgow, and Royal College of Physicians of Ireland
Disclosure: Nothing to disclose.

Coauthor(s)

Poothirikovil Venugopalan, MBBS, MD, FRCP (Glasg), FRCPCH, Consulting Staff, Department of Child Health, University Hospital of Hartlepool, UK
Poothirikovil Venugopalan, MBBS, MD, FRCP (Glasg), FRCPCH is a member of the following medical societies: British Cardiac Society, Royal College of Paediatrics and Child Health, and Royal College of Physicians and Surgeons of Glasgow
Disclosure: Nothing to disclose.

Athena P Kourtis, MD, PhD, Assistant Professor, Department of Pediatrics, Divisions of Infectious Diseases and Epidemiology, Emory University School of Medicine
Athena P Kourtis, MD, PhD is a member of the following medical societies: American Academy of Pediatrics and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Medical Editor

Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital
Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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