Cryptosporidiosis (krip-toe-spor-id-ee-o-sis), is a diarrheal disease caused by a microscopic parasite, Cryptosporidium parvum, that can live in the intestine of humans and animals and is passed in the stool of an infected person or animal. Both the disease and the parasite are also known as "Crypto." The parasite is protected by an outer shell that allows it to survive outside the body for long periods of time and makes it very resistant to chlorine disinfection. During the past 2 decades, Crypto has become recognized as one of the most common causes of waterborne disease (drinking water and recreational water) in humans in the United States. The parasite is found in every region of the United States and throughout the world.
Symptoms include diarrhea, loose or watery stool, stomach cramps, upset stomach, and a slight fever. Some people have no symptoms.
Symptoms generally begin 2-10 days after being infected.
In persons with average immune systems, symptoms usually last about 2 weeks; the symptoms may go in cycles in which you may seem to get better for a few day, then feel worse before the illness ends.
Examples of persons with weakened immune systems include those with AIDS; cancer and transplant patients who are taking certain immunosuppressive drugs; and those with inherited diseases that affect the immune system. The risk of developing severe disease may differ depending on each person's degree of immune suppression. Following all the recommendations in this fact sheet can be a great personal burden, so consult with your health care provider to determine whether your medical condition makes it advisable to follow all of these recommendations.
In persons with AIDS and in others whose immune system is weakened, Crypto can be serious, long-lasting, and sometimes fatal. If your CD4+ cell count is below 200, Crypto is more likely to cause diarrhea and other symptoms for a long time. If your CD4+ count is above 200, your illness may not last more than 1 to 3 weeks or slightly longer. However, you could still carry the infection, which means that the Crypto parasites are living in your intestine, but are not causing illness. As a carrier of Crypto, you could infect other people. If your CD4+ count later drops below 200, your symptoms may reappear.
Crypto lives in the intestine of infected humans or animals. Millions of Crypto can be released in a bowel movement from an infected human or animal. You can become infected after accidentally swallowing the parasite. Crypto may be found in soil, food, water, or surfaces that have been contaminated with the feces from infected humans or animals. Crypto is not spread by contact with blood. Crypto can be spread:
Yes, Crypto can be very contagious. Follow these guidelines to avoid spreading Crypto to others.
Note: you are not protected in a chlorinated pool because Crypto is chlorine resistant and can live for days in pools.
See your health care provider.
Your health care provider will ask you to submit stool samples to see if you are infected. Because testing for Crypto can be difficult, you may be asked to submit several stool specimens over several days. Because tests for Crypto are not routinely done in most laboratories, your health care provider should specifically request testing for the parasite.
There is no effective treatment. If you have diarrhea, drink plenty of fluids to prevent dehydration. Rapid loss of fluids because of diarrhea can be life-threatening in babies; parents should consult their health care provider about fluid replacement therapy options for babies. Anti-diarrhea medicine may help slow down diarrhea, but consult with your health care provider before taking it.
People who are in poor health or who have a weakened immune system are at higher risk for more severe and more prolonged illness. For persons with AIDS, anti-retroviral therapy that improves immune status will also decrease or eliminate symptoms of Crypto infection. Some drugs, such as paromomycin, may reduce the symptoms of Crypto and new drugs are being tested. However, Crypto is usually not cured and may come back if the immune status worsens. See your health care provider to discuss anti-retroviral therapy used to improve immune status.
You can reduce your risk of getting Crypto. The more steps you take, the less likely you are to get infected. These actions will also help protect you against other diseases. Following all the recommendations in this fact sheet can be a great personal burden. Consult with your health care provider to determine whether your medical condition makes it advisable to follow all of these recommendations.
Washing your hands often with soap and water is probably the single most important step you can take to prevent Crypto and other illnesses. Always wash your hands before eating and preparing food. Wash your hands well after touching children in diapers; after touching clothing, bedding, toilets, or bed pans soiled by someone who has diarrhea; after gardening; any time you touch pets or other animals; and after touching anything that might have had contact with even the smallest amounts of human or animal stool, including dirt in your garden and other places. Even if you wear gloves when you do these activities you should still wash well when you finish. Children should be supervised by adults to make sure they wash their hands well.
Infected people may have Crypto on their skin in the anal and genital areas, including the thighs and buttocks. However, since you cannot tell if someone has Crypto, you may want to take these precautions with any sex partner: "Rimming" (kissing or licking the anus) is so likely to spread infection that you should avoid it, even if you and your partner wash well before. Always wash your hands well after touching your partner's anus or rectal area.
If you touch a farm animal, particularly a calf, lamb, or other young animal, or visit a farm where animals are raised, wash your hands well with soap and water before preparing food or putting anything in your mouth. Do not touch the stool of any animal. After you visit a farm or other area with animals, have someone who is not immuno-compromised clean your shoes, or wear disposable gloves if you clean them yourself. Wash your hands after taking off the gloves.
Most pets are safe to own. However, someone who is not immuno-compromised should clean their litter boxes or cages, and dispose of the stool. If you must clean up after a pet, use disposable gloves. Wash your hands afterwards. The risk of getting Crypto is greatest from pets that are less than 6 months old, animals that have diarrhea, and stray animals. Older animals can also have Crypto, but they are less likely to have it than younger animals. If you get a puppy or kitten that is less than 6 months old, have the animal tested for Crypto before bringing it home. If any pet gets diarrhea, have it tested for Crypto.
When swimming in lakes, rivers, or pools, and when using hot tubs, avoid swallowing water. Several outbreaks of Crypto have been traced to swallowing contaminated water while swimming. Crypto can live in chlorinated swimming pools and water parks for days. Crypto also can remain alive in salt water for several days, so swimming in polluted ocean water may also be unsafe.
Fresh vegetables and fruits may be contaminated with Crypto. Therefore, wash well all vegetables or fruit you will eat uncooked. If you take extra steps to make your water safe (see below for ways to do so), use this safe water to wash your fruits and vegetables. When you can, peel fruit that you will eat raw, after washing it. Do not eat or drink unpasteurized milk or dairy products. Cooking kills Crypto. Therefore, cooked food and heat-processed foods are probably safe if, after cooking or processing, they are not handled by someone infected with Crypto, or exposed to possibly contaminated water.
If you travel to developing nations, you may be at a greater risk for Crypto because of poorer water treatment and food sanitation. Warnings about food, drinks, and swimming are even more important when visiting developing countries. Avoid foods and drinks, in particular raw fruits and vegetables, tap water, or ice made from tap water, unpasteurized milk or dairy products, and items purchased from street vendors. These items may be contaminated with Crypto. Steaming-hot foods, fruits you peel yourself, bottled and canned processed drinks, and hot coffee or tea are probably safe. Talk with your health care provider about other guidelines for travel abroad.
Do not drink water directly from lakes, rivers, streams, or springs. Because you cannot be sure if your tap water contains Crypto, you may wish to avoid drinking tap water, including water or ice from a refrigerator, which is usually made with tap water. Because public water quality and treatment vary throughout the U.S., always check with the local health department and water utility to see if they have issued any special notices about the use of tap water by immuno-compromised persons. You may also wish to take some additional measures: boiling your water, filtering your water with certain home filters, or drinking certain types of bottled water. Processed carbonated (bubbly) drinks in cans or bottles are probably safe, but drinks made at a fountain might not be because they are made with tap water. If you choose to take these extra measures, use them all the time, not just at home. If the public health department advises boiling the water, do not drink tap water unless you boil it. You could also use one of the bottled waters described below.
To find out if a particular filter removes Crypto, contact:
3475 Plymouth Road
P.O. Box 130140
Ann Arbor, MI 48113-0140
fax: 1-313-769- 0109
NSF International is an independent testing group. Ask NSF for a list of "Standard 53 Cyst Filters." Check the model number on the filter you intend to buy to make sure it is exactly the same as the number on the NSF list. Look for the NSF trademark on filters, but be aware that NSF tests filters for many different things. Because NSF testing is expensive, many filters that may work against Crypto have not been tested. Reverse-osmosis filters work against Crypto whether they have been tested by NSF or not. Many other filters not tested by NSF also work if they have an absolute pore size of 1 micron or smaller.
Filters designed to remove Crypto (any of the four messages below on a package label indicate that the filter should be able to remove Crypto):
Filters labeled only with these words may not be designed to remove Crypto
Filters collect germs from your water, so someone who is not immuno-compromised should change the filter cartridges for you; if you do it yourself, wear gloves and wash your hands afterwards. Filters may not remove Crypto as well as boiling does because even good brands of filters may sometimes have manufacturing flaws that allow small numbers of Crypto to get past the filter. Also, poor filter maintenance or failure to replace filter cartridges as recommended by the manufacturer can cause your filter to fail.
Water so labeled has been processed by a method effective against Crypto:
Water so labeled may not have been processed by a method effective against Crypto:
Bottled water labels reading "well water," "artesian well water," "spring water," or "mineral water" do not guarantee that the water does not contain Crypto. However, water that comes from protected well or protected spring water sources is less likely to contain Crypto than bottled water or tap water from less protected sources, such as rivers and lakes. Any bottled water (no matter what the source) that has been treated by one or more of the methods listed in the top part of the water filters table is considered safe.
Soft drinks and other beverages may or may not contain Crypto. You need to know how they were prepared to know if they might contain Crypto. If you drink prepared drinks, look for drinks prepared to remove Crypto:
Crypto killed or removed in preparation
Crypto may not be killed or removed in preparation of:
|For more information on Crypto, call the CDC National HIV/AIDS Hotline at 1-800-342-AIDS. This publication was prepared by the inter-agency Working Group on Waterborne Cryptosporidiosis, which includes representatives from the Centers for Disease Control and Prevention, Environmental Protection Agency, Food and Drug Administration, U.S. Department of Agriculture, National Association of People With AIDS, AIDS Coalition to Unleash Power, and representatives of state and local health departments and water utilities.|
* CDC Centers for Disease Control and Prevention
** EPA Environmental Protection Agency
This article was reprinted from the Centers for Disease Control (CDC).