Cryptosporidiosis
Cryptosporidiosis is a diarrheal disease caused by the parasite Cryptosporidium parvum, which until 1976 was not known to cause disease in humans. Cryptosporidiosis was responsible for a large outbreak of diarrheal disease in Milwaukee, Wisconsin in 1993, due to contamination of the public drinking water supply. In 2001, there were 123 cases reported among Berkeley County residents (rate of 1.5 cases per 100,000 persons).
Who gets cryptosporidiosis?
Anyone, but it causes more severe illness in persons with HIV/AIDS and others with impaired immune systems.
How is cryptosporidiosis spread?
Infected animals and humans have Cryptosporidium in their digestive systems. Calves are often infected, although any cat or dog, farm animal, or wild mammal can become infected. When infected,Cryptosporidium oocysts (egg-like forms of the organism)are passed in their stool (feces). People can become infected by touching stool (feces) or objects contaminated by stool (feces) and then touching their mouth with unwashed hands. Persons and animals can also become infected by drinking water or eating raw or undercooked food that is contaminated with stool (feces) from infected animals or persons. Some people have become sick after swimming in public pools contaminated with stools (feces) from infected persons. Sexual activity presents a risk whenever there is fecal contamination. It may take very few oocysts to cause infection.
What are the symptoms of cryptosporidiosis?
The major symptoms are watery diarrhea and abdominal cramping. Headache, vomiting, low-grade fever, loss of appetite, weight loss, and dehydration may occur. In persons with healthy immune systems, symptoms may last about 1 to 2 weeks. In persons with weakened immune systems, especially persons with HIV/AIDS, the infection may lead to prolonged illness.
How soon after infection do symptoms appear?
In healthy individuals, symptoms usually appear within 1 to 12 days after exposure, with an average of 7 days. The incubation period may be longer in persons with impaired immune systems.
How is cryptosporidiosis diagnosed?
If your doctor suspects cryptosporidiosis, you will be asked to submit one or more stool samples. Diagnosis is made by examining the stool under a microscope or by using special detection tests for Cryptosporidium. The test for Cryptosporidium must be specifically requested by your doctor.
What is the treatment for cryptosporidiosis?
People with healthy immune systems usually get well on their own. People with diarrhea should drink plenty of fluids. Currently, there are no medicines proven to be effective against cryptosporidiosis. Persons infected with HIV and Cryptosporidium may be eligible to participate in clinical trails of new medications. Consult with your physician.
Can people who get cryptosporidiosis get it again?
It is unknown whether past infection means people are protected from getting it again.
How can cryptosporidiosis be prevented?
The following measures for preventing cryptosporidiosis are recommended:
Always thoroughly your wash hands with soap and warm running water before handling food,after using the toilet or changing diapers, after handling animal stools (feces), and after gardening or other direct contact with soil.
Do not drink water directly from streams, lakes, springs or swimming pools. Boil water for 1 minute whenever you are unsure of the safety of the water supply.
If you work in a child-care center where you change children's diapers, wash your hands carefully between changing each child's diapers. If you use gloves, wash your hands and change gloves between each child.
If you take care of persons with cryptosporidiosis infection, or persons who have diarrhea, wash your hands after bathing patients, emptying bedpans, changing soiled linen, or otherwise coming in contact with stool (feces). If your have cryptosporidiosis, wash your hands often to prevent spreading the disease to other people.
Avoid eating unwashed fruits and vegetables, and drinking unpasteurized milk or other milk products that are not pasteurized. Unpasteurized apple cider has also caused infection.
Avoid sexual practices that may result in hand or mouth contact with stool (feces), including anal sex or touching the anus. Oral-anal sex ("rimming") without barrier protection should be avoided at all times. Follow "safer sex" guidelines: always use a condom. Persons with diarrhea should not use public swimming facilities.
Comply fully with water advisories whenever issued by public health or government authorities.
Is Berkeley County drinking water safe to drink?
Very low levels of Cryptosporidium are sometimes found in Berkeley County drinking water. No one knows if these very low levels can cause infection among persons with healthy immune systems or immunocompromised persons. At this time there is no evidence to suggest that there is a significant risk of cryptosporidiosis from Berkeley County drinking water. However, if you want complete assurance, see recommendations below.
Extra Precautions to Avoid Cryptosporidiosis for Persons with HIV/AIDS or Other Causes of Immunosuppression
If you are HIV positive or otherwise immunocompromised, be extra careful about handwashing, carefully wash food before eating, and thoroughly cook foods which are heated before eating. Do not let raw foods contaminate other foods. Avoid drinking or accidentally swallowing water from lakes, rivers, or swimming pools. Follow "safer sex" guidelines. Any sex act that involves contact with the anus or feces increases the risk for cryptosporidiosis. You may want to discuss the need for taking further protective measures withyour medical provider. Drinking water that is considered safe for persons with healthy immune systems may contain some Cryptosporidium oocysts. No one knows whether a small number of oocysts could create a risk for someone who is immunocompromised. Some researchers think that oocysts ingested while you are still relatively healthy can remain in your digestive system until your immune system is severely depressed and then cause serious illness.
If you want greater assurance that your drinking water is safe to drink, here are some options for safer beverages:
Boil tap water for one minute before using. This will kill all organisms including Cryptosporidium. To avoid burning yourself, allow water to cool before pouring into clean, dry containers. Taste can be improved by adding lemon, herbal tea bags, or other flavorings.
Use boiled water for ice cubes, toothbrushing, washing vegetables that will be eaten raw, and mixing with concentrates. You do not need to use boiled water for food that will be cooked before eating. Dishes, silverware, pots, and pans may be washed with tap water as long as they are dry before being used.
Use a submicron, personal-use water filter (home or office type water filter) that will remove particles as small as one micron in diameter. Use filters that are certified by the National Sanitation Foundation (NSF) for "cyst reduction" Be sure to follow directions accurately and to maintain and replace standard #53 filters according to schedule.
Use bottled water. While bottled water is not regulated for levels of Cryptosporidium, bottlers provide information on their labels that is useful to the consumer. Bottled water can be considered free of Cryptosporidium if it has been treated by submicron filtration, reverse osmosis or distillation. Bottled water that comes from deep underground sources (spring or well water) is generally thought to be safe from contamination by Cryptosporidium.
Cryptosporidiosis and Drinking Water:
In the past ten years, at least five outbreaks of cryptosporidiosis have been associated with contaminated drinking water, including the well-publicized outbreak in Milwaukee, Wisconsin in 1993.
How do Cryptosporidium oocysts get into drinking water?
Cryptosporidium gets into surface water sources, such as rivers and lakes, from the stools of infected animals. Many municipal water systems get their water from surface water sources that can contain Cryptosporidium oocysts.
Does the treatment process remove the oocysts?
Chlorination of drinking water by itself is not effective.
What does it mean if Cryptosporidium oocysts are found in drinking water?
Authorities believe that the detection of a few oocysts in drinking water does not pose a threat to people with healthy immune systems. The public health significance of finding low levels of Cryptosporidium oocysts in drinking water is not known.
How will officials decide that water is not safe to drink?
Officials look at all indicators of water quality including such things as changes in the source water, number of Cryptosporidium oocysts, turbidity (cloudiness of the water), particle counts, and presence of other organisms. The presence of oocysts alone does not necessarily indicate an increased risk for disease.
What will they recommend if water isn't safe?
Boiling water for one minute will kill all organisms, including Cryptosporidium.
What laws regulate Cryptosporidium in drinking water?
There are no federal or state regulatory standards for Cryptosporidium in drinking water because there is not enough information on which to base standards.
Are there any problems with the laboratory tests for Cryptosporidium in water?
There are several things to be aware of regarding Cryptosporidium test results:
The laboratory test used to detect Cryptosporidium in water cannot tell the difference between viable (able to cause illness) and nonviable oocysts, nor do the test results distinguish between various species of Cryptosporidium(many of which do not infect humans). In most cases, the results of the tests on drinking water will not be available until several weeks after the sample was taken and so will not be an accurate measure of present conditions.
The number or concentration of oocysts is not necessarily a predictor of when illness will occur. Other factors, such as clumping of oocysts and water temperature may play a role.
Has any water been tested in our area?
Yes. Berkeley County has been testing drinking water since 1992; levels of Cryptosporidium have been extremely low in water samples tested to date. Berkeley County regularly tests its source water.
** Note **
Please remember that the information presented in this forum is for your education only, and is not intended to extend medical advice or diagnosis. If you have questions or feel that you may be experiencing symptoms similar to those presented, please call the Berkeley County Health Department at (304) 263-5131 or your primary care provider for formal medical attention.
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Berkeley County Health Department