An Outbreak of Cryptosporidiosis Linked to a Foodhandler
Eva S. QuirozCaryn BernJohn R. MacArthurLihua XiaoMadeleine M. FletcherMichael J. ArrowoodDavid K. ShayMartin E. LevyRoger I. GlassAltaf A. Lal
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In September and October 1998, a cryptosporidiosis outbreak occurred on a Washington, DC, university campus. In a case-control study of 88 case patients and 67 control subjects, eating in 1 of 2 cafeterias was associated with diarrheal illness (P < .001). Morbidity was associated with eating dinner on 22 September (odds ratio, 8.1; 95% confidence interval, 3.4–19.5); weaker associations were found for 6 other meals. Cryptosporidium parvum was detected in stool specimens of 16 (70%) of 23 ill students and 2 of 4 ill employees. One ill foodhandler with laboratory-confirmed C. parvum prepared raw produce on 20–22 September. All 25 Cryptosporidium isolates submitted for DNA analysis, including 3 from the ill food-handler, were genotype 1. This outbreak illustrates the potential for cryptosporidiosis to cause foodborne illness. Epidemiologic and molecular evidence indicate that an ill foodhandler was the likely outbreak source.Keywords:
Cryptosporidium parvum
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A retrospective, hospital-based case-control study was used to investigate whether there were any clinical characteristics that could distinguish Cryptosporidium parvum-infected children with diarrhea from other non-C. parvum-infected children with diarrhea. Ten percent (24 of 248) of children admitted to a rehydration ward at Cayetano Heredia University Hospital, Lima, Peru, were infected with C. parvum. The 24 patients infected with C. parvum (cases) were matched to an equal number of noninfected patients (controls). C. parvum-infected patients were more likely to be malnourished than were children without this infection (P less than 0.05). Also nosocomial infection caused by C. parvum occurred in three severely malnourished patients, two of whom died. No other clinical or laboratory characteristics were found that would distinguish children with diarrhea caused by C. parvum from other children with diarrhea. In children hospitalized for diarrhea C. parvum infection occurs most frequently in malnourished children.
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The emergence of Cryptosporidium parvum-associated cryptosporidiosis as a worldwide zoonosis has stimulated interest in the modes of pathogen transmission. Here, Thaddeus Graczyk, Ronald Fayer and Michael Cranfield discuss the complex epidemiology of C. parvum, emphasizing the crosstransmission potential of the pathogen, mechanical vectors involved in water-borne transmission of the oocysts, and factors contributing to contamination of pristine waters with Cryptosporidium. They also outline the public health importance of proper interpretation of positive detection of Cryptosporidium oocysts at water-treatment facilities and identify means by which watersheds can be protected from Cryptosporidium contamination.
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A prospective study was done to identify Cryptosporidium in the stools of young children, aged 2 months to 3 years, admitted to hospital. Of a total of 387 stool samples from 387 individuals, 131 stool specimens forming the control group were from children with non-diarrheal, respiratory tract infections, 200 and 56 stool samples were from children with acute diarrhea and prolonged diarrhea, respectively. No Cryptosporidium was discovered in the control group. Only 1 sample positive for Cryptosporidium was found in the group with acute diarrhea, whereas 4 samples of Cryptosporidium were found in the group with prolonged diarrhea. The prevalence of Cryptosporidium in the group with prolonged diarrhea was significantly higher than the other two groups (p < 0.05). In those children with prolonged diarrhea, Cryptosporidium should always be included in the differential diagnosis.
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During the period February 1987-June 1988, we examined 542 stool samples of 271 HIV positive patients both with and without full-blown AIDS. One hundred patients with either acute or chronic diarrhea and 180 patients without diarrhea were studied. The stool samples were examined for the presence of Cryptosporidium sp., other protozoa, helmints, and pathogenic enterobacteria. We found a prevalence of 14.3% of Cryptosporidium sp. in patients with full-blown disease and diarrhea. We encountered no Cryptosporidium sp. among asymptomatic patients. The occurrence of diarrhea was significantly associated with a CD4/CD8 ratio lower than 0.4, with the finding of Cryptosporidium sp. in the stools, being a CDC group IV, and with a positive stool culture for pathogenic enterobacteria. The diarrhea caused by Cryptosporidium sp. could not be distinguished, on clinical grounds, from diarrhea caused by other etiologic agents.During the period February 1987-June 1988, the authors examined 542 stool samples of 271 HIV-positive patients both with and without fullblown AIDS. 100 patients with either acute or chronic diarrhea and 180 without diarrhea were studied. The stool samples were examined for the presence of Cryptosporidium sp., other protozoa, helminths, and pathogenic enterobacteria. A prevalence of 14.3% of Cryptosporidium sp. in patients with fullblown AIDS and diarrhea was found. No Cryptosporidium sp. was seen among asymptomatic patients. The occurrence of diarrhea was significantly associated with a CD4/CD8 ratio lower than 0.4, with the finding of Cryptosporidium sp. in the stools, being a CDC group IV, and with a positive stool culture for pathogenic enterobacteria. The diarrhea caused by Cryptosporidium sp. could not be distinguished on clinical grounds from diarrhea caused by other etiologic agents. (author's modified) (summaries in ENG, POR
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Cryptosporidium sp was searched prospectively by means of the Ziehl-Nielsen acid fast staining of stools in 403 samples obtained from patients with diarrhea (n =/152) or other non-gastrointestinal diseases (n =/152) in a six month period. Cryptosporidium was present in 11/304 samples (3.6%), 9 (81%) were taken from patients with diarrhea. Oocysts were detected in 5% of stools form malnourished (II or III) children with diarrhea; 10/11 (91%) with positive-cryptosporidium stools occurred in children less than one year of age. Cryptosporidium was present with increased frequency in malnourished children with diarrhea (p < 0.05).
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类 Cryptosporidium 的 Apicomplexan 原生动物门寄生虫感染许多动物的胃肠的道和肺，包括人。人的感染的多数由于任何一个 Cryptosporidium hominis (C。hominis ) 或 Cryptosporidium parvum (C。parvum ) 。寄生虫有包括无性、性的阶段的一个复杂生命周期。当有侵略免费生活阶段时，增长和区别在主人房间刷子边阶下面，但是在主人房间细胞质外面发生在一个唯一的 parasitrophorous 液泡以内。感染被首先污染喝的水的环境地抵抗的孢子散布，偶尔，食物采购原料，它可以引起通常在免疫能力的个人持续不到 2 w 的腹泻的重要爆发。在 immunodeficient 或 immunosuppressed 个人，腹泻可能是丰富的并且能导致重要病态和死亡，特别地在爱滋病病人。尽管诊断相对简单，有效的药治疗，为在 immunodeficient 病人的感染的 particulary，一直不是一致地成功的。这概述总结知道在中国感染人，寄生虫生命周期的方面，感染的来源， cryptosporidiosis 的 pathophysiology，对感染的有免疫力的反应，诊断，治疗和 cryptosporidiosis 的一些方面的种类。
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Two studies were done on cryptosporidiosis in children. A retrospective survey showed that from 2005 to 2015, Cryptosporidium species was detected by microscopy of stool from 0.25% of children with diarrhea. In a subsequent prospective study, polymerase chain reaction detected Cryptosporidium species in 4 (1.3%) of 304 children. Cryptosporidium species is as frequent as other intestinal pathogens in childhood diarrhea. Testing is relevant.
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Cryptosporidium was found in the stools of 13.5% of 221 children hospitalized with diarrhea. It was the single most prevalent pathogen isolated. Children with Cryptosporidium-positive stools were significantly more malnourished than children in whom Cryptosporidium was not detected. Children with more severe malnutrition (ie, less than 50% of their expected weight) and with Cryptosporidium in their stools had a significantly longer duration of diarrhea than similarly malnourished children without Cryptosporidium (63 vs 32 days, respectively). In 77 better-nourished outpatients with diarrhea, Cryptosporidium was found in only 5.2% of cases and was associated with less-severe illness. Our findings are consistent with the hypothesis that in less-developed areas, Cryptosporidium is a major pathogen, not only in acute but also in chronic childhood diarrhea, and may play an important role in the interaction between diarrhea and malnutrition.
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