Frank Bures: Cryptosporidiosis is really quite atrocious

February 10, 2019
Dr. Frank Bures

Cryptosporidiosis (KRIP-toe-spor-id-ee-osis) is a rather common small bowel infection caused by a rather widespread microscopic protozoan parasite named cryptosporidium (kryptos, Greek for concealed and sporos for seed). According to the Centers for Disease Control, during the past two decades, Crypto, as it is commonly referred to, has become recognized as one of the most common causes of waterborne (recreational and drinking water) disease in people. Different species of crypto also cause diarrheal disease in other vertebrate animals. We can share theirs, too. (Consider what follows as cryptic information from the crypts?)

Crypto is found in every region of the U.S. and throughout the world. The organism is detected in 65 to 97 percent of the U.S. surface water supply. It is spread by a person swallowing some of the crypto cysts from the stool of an infected human or other animal. One bowel motion from an infected person can discharge millions of cysts. They can by found in recreational water like swimming pools, lakes, streams, hot tubs, Jacuzzis without knowing how they got there. To acquire the infection you need only consume a few cysts, which lodge and infect your small intestine primarily. On occasion it may spread to liver, pancreas, bile ducts, or even be inhaled into respiratory airways and lungs. You may not be able to detect by looking or smelling if something has been contaminated with stool.

Consuming recreational water while swimming is one of the main ways cysts invade folks. But swallowing water or beverages contaminated with stool from infected individuals, eating uncooked or unwashed contaminated food, changing diapers of infected wee ones or touching materials or objects contaminated by infected patients in a health care setting are documented options. Sort like the Dr. Seuss book, “Oh, The Places You’ll Go?” The CDC and other sites also include fecal matter contact during sexual activities. Crypto is not transmitted via blood in any way.

The primary symptom is a moderate to severe watery diarrhea rather sudden in onset. It starts about a week after being infected, range 2 to 28 days. There’s a big distinction in reaction between hosts whose immune systems are intact or competent and those with defects, called immunocompromised, from HIV infection or organ transplanting, etc. It is commonly found in HIV patients with diarrhea. Accompanying symptoms may include crampy belly pain, low-grade fever, nausea and vomiting, weight loss, even dehydration, especially bad in tykes. Around 20 percent of those infected have no symptoms. With a healthy immune system, symptoms last one to two weeks, sometime even a month, or they remit and recur a couple times. Immunocompromised folks are very difficult to cure.

The cysts are shed for several weeks after symptoms are over. The cysts actually can survive in soil for long periods of time. People with elevated risk of exposure include childcare workers, parents of sick kids, those caring for infected people, international travelers, backpacker or hikers, or campers who drink unfiltered, untreated water, and people handling infected animals like cattle.

Crypto is notoriously hard to kill except by boiling the water or using extra small pore filters in a public water supply. It resists the chlorine added to swimming pools, water supplies, or used as an antiseptic in facilities, because its cysts have a kind of unique shell that protects and enables them to survive for long periods of time outside bodies and still remain infective. Several epidemics in cities have been documented over time. In 1993 an outbreak occurred in Milwaukee where storm sewer and sanitary water sources became accidentally mixed. An estimated 403,000 people became ill, with 4,400 going to hospital, and 60 dying. Another example occurred in 1987 when 13,000 citizens in Carrollton, Ga., became ill from a municipal water system that had met all state and federal drinking standards. It somehow escaped detection. A host of others have occurred worldwide.

Diagnosis is made via analysis with different methods of multiple stool samples or even small bowel biopsy in severe cases. Blood tests only show if you have been infected in the past, which is 30 percent of U.S. adults. Treatment is one broad-spectrum antiparasitic medicine called nitazoxanide, approved only since 2015. It may not be needed in immunocompetent patients because the disease eventually runs itself out. In immunocompromised ones it doesn’t work well, and immune system therapies have to be used simultaneously to boost host response. The trick is to establish a diagnosis since other waterborne organisms like E. coli, Giardia, Campylobacter, cholera, leptospirosis, etc. can produce the same compelling intestinal reaction.

Treatment used to be only supportive, with fluids, abdominal pain medicines, etc., until the approval of nitazoxanide. Immunocompromised patients are in the deep doo-doo in two ways because their systems can’t help eliminate the bug. It can and does become chronic and even desperate.

Why consider the topic of Crypto? Because it is part of the world we live in, and that lives in us. We can avoid it with that incredibly rare commodity, common sense, by good hand washing, boiling untreated water if you’re partaking of the great out-of-doors, or trying to be a survivalist (to escape the current political storms?). Curiously, many public health departments recommend soaking contaminated surface for 20 minutes with plain ol’ 3 percent hydrogen peroxide then rinsing them off for a 99 percent kill rate.

Please don’t take these cryptic comments as just a load of ... well, you know. And still enjoy the beautiful world we live in and should care for.

Why consider the topic of Crypto? Because it is part of the world we live in, and that lives in us. We can avoid it with that incredibly rare commodity, common sense, by good hand washing, boiling untreated water if you’re partaking of the great out-of-doors.