Pediatric Cryptosporidiosis Treatment & Management

  • Author: Jaya Sureshbabu, MBBS, DCh, MRCPCH(UK), MRCPI(Paeds), MRCPS(Glasg), DCH(Glasg); Chief Editor: Russell W Steele, MD   more...
 
Updated: Jun 15, 2011
 

Approach Considerations

No reliable curative treatment for cryptosporidiosis is available,[16] and most people who have healthy immune systems will recover without treatment.

Supportive therapy is the key component in the management of cryptosporidiosis.[17] Replacement of fluids and electrolytes is the critically important first step in the management of this diarrheal illness. Oral rehydration is the preferred mode, but severely ill patients may require parenteral fluids.

Mature epithelial cells at the tips of the villi are preferentially lost; hence, enzymes expressed on these cells (including lactase) are lost. These losses lead to secondary lactose intolerance. Therefore, supportive care should include a lactose-free diet.

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

Go to Cryptosporidiosis for complete information on this topic.

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Fluid and Electrolyte Management

Fluid and electrolyte management is critical, particularly in cases with large diarrheal losses.

Nonspecific antidiarrheal agents may provide relief.

Octreotide, a somatostatin analogue and substance P antagonist, suppresses diarrhea in chronic cryptosporidiosis.

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Biliary Involvement

Biliary involvement in cryptosporidiosis requires specific interventions.

Acalculous cholecystitis should be treated with cholecystectomy.

Patients with sclerosing cholangitis can usually be treated by endoscopic retrograde cholangiopancreatography (ERCP), although sphincterotomy may result in temporary relief.

In selected cases, recurrence may be prevented by placing a stent.

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Dietary Considerations

Supportive care should include a lactose-free diet.

Although nutrition remains important, feeding is as effective as parenteral nutrition.

Fluids should include sodium, potassium, bicarbonate, and glucose.

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Prevention of Cryptosporidiosis

Water purification is the most important public health measure.[7, 9, 18]

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 μm.

Prompt, aggressive measures, including temporary closure of pools, must be carried out 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.

Individuals with AIDS and other conditions that cause immunosuppression may wish to avoid swimming in communal pools.

In hospitalized patients, contact precautions are strictly recommended in addition to standard precautions for patients who are incontinent or who use diapers.

Handwashing and wearing gloves can prevent spread in daycare centers.

Travelers visiting developing countries can bring drinking water to a boil before consuming it.

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Consultations

The following consultations may be necessary in cases of cryptosporidiosis:

  • Infectious diseases specialist (for evaluation and specific treatment options)
  • Gastroenterologist (particularly for hepatobiliary involvement)
  • Surgeon (for cholecystectomy and T-tube drainage)
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Contributor Information and Disclosures
Author

Jaya Sureshbabu, MBBS, DCh, MRCPCH(UK), MRCPI(Paeds), MRCPS(Glasg), DCH(Glasg),  Consultant, Department of Pediatrics and Neonatology, Credence Institute for Womens Health and Fertility Research, Thiruvananthapuram

Jaya Sureshbabu, MBBS, DCh, MRCPCH(UK), MRCPI(Paeds), MRCPS(Glasg), DCH(Glasg), is a member of the following medical societies: Indian Academy of Pediatrics, Indian Medical Association, 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 North Tees and Hartlepool, UK

Poothirikovil Venugopalan, MBBS, MD, FRCP(Glasg), FRCPCH, is a member of the following medical societies: British Cardiac Society, Paediatrician with Cardiology Expertise Special Interest Group, 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  Associate Professor, Department of Pediatrics, Divisions of Infectious Diseases and Epidemiology, Emory University School of Medicine; Senior Fellow, Centers for Disease Control and Prevention

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.

Specialty Editor Board

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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: Nothing to disclose.

References

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

  2. 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.

  3. Huang DB, Chappell C, Okhuysen PC. Cryptosporidiosis in children. Semin Pediatr Infect Dis. Oct 2004;15(4):253-9. [Medline].

  4. 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.

  5. 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].

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

  7. Cryptosporidiosis surveillance--United States, 2003-2005.Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, CDC [database online]. Atlanta, GA 30333: Centers for Disease Control and Prevention (CDC); Updated 2007 Sep 7.

  8. MacKenzie WR, Schell WL, Blair KA, Addiss DG, Peterson DE, Hoxie NJ, et al. Massive outbreak of waterborne cryptosporidium infection in Milwaukee, Wisconsin: recurrence of illness and risk of secondary transmission. Clin Infect Dis. Jul 1995;21(1):57-62. [Medline].

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

  10. Cooper DL, Verlander NQ, Smith GE, Charlett A, Gerard E, Willocks L, 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]. [Full Text].

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

  12. 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].

  13. 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].

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

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

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

  17. Ayuo PO. Human cryptosporidiosis: a review. East Afr Med J. Feb 2009;86(2):89-93. [Medline].

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

  19. Fox LM, Saravolatz LD. Nitazoxanide: a new thiazolide antiparasitic agent. Clin Infect Dis. Apr 15 2005;40(8):1173-80. [Medline].

  20. Smith NH, Cron S, Valdez LM, Chappell CL, White AC Jr. Combination drug therapy for cryptosporidiosis in AIDS. J Infect Dis. Sep 1998;178(3):900-3. [Medline].

  21. Mofenson LM, Brady MT, Danner SP, Dominguez KL, Hazra R, Handelsman E, et al. Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected children: recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. MMWR Recomm Rep. Sep 4 2009;58:1-166. [Medline]. [Full Text].

  22. Hicks P, Zwiener RJ, Squires J, Savell V. Azithromycin therapy for Cryptosporidium parvum infection in four children infected with human immunodeficiency virus. J Pediatr. Aug 1996;129(2):297-300. [Medline].

  23. Abubakar I, Aliyu SH, Arumugam C, Hunter PR, Usman NK. Prevention and treatment of cryptosporidiosis in immunocompromised patients. Cochrane Database Syst Rev. Jan 24 2007;CD004932. [Medline].

 
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Hematoxylin and eosin stain of intestinal epithelium. The blue dots (arrows) represent Cryptosporidium on the surface of the epithelial cells. Image courtesy of Carlos Abramowsky, MD, Professor of Pediatrics and Pathology, Emory University School of Medicine.
Cryptosporidium species oocysts are rounded and measure 4.2-5.4 µm in diameter. Sporozoites are sometimes visible inside the oocysts, indicating that sporulation has occurred on wet mount.
Cryptosporidium parvum oocysts stained with modified acid-fast. Against a blue-green background, the oocysts stand out in a bright red stain. Image courtesy of CDC DPDx parasite image library.
Cryptosporidium species oocysts stained with modified acid-fast.
 
 
 
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