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CryptosporidiosisA07.2
HistoryThis section has been translated automatically.
Meisel, 1976
DefinitionThis section has been translated automatically.
Parasitic, fecal-orally transmitted intestinal disease caused by cryptosporidia, especially Cryptosporidium parvum.
PathogenThis section has been translated automatically.
protozoon (genotypes: C. parvum and C. hominis). More than 10 species are known to infest humans, mammals, reptiles and fish. C. parvum infects humans and animals, C. hominis only infects humans. Faecal-oral transmission.
Occurrence/EpidemiologyThis section has been translated automatically.
- Besides giardiasis one of the most common intestinal parasitic diseases in humans.
- Since the 1980s, there has been a significant increase in the number of cases, especially among HIV-infected persons, but the number of cases is currently declining due to HAART.
- Mainly occurring in countries with poor hygienic conditions and among farmers with animal husbandry. 1-3% among immunocompetent people in industrialised countries, 7-10% in developing countries; seroprevalence rates seem to be significantly higher: in the USA: 25-60%, in developing countries: 65-95%.
ManifestationThis section has been translated automatically.
Especially in immunocompromised and immunocompetent children. No gender preference. Occurrence in Germany mainly in the summer months, not infrequently after swimming in rivers or lakes.
Clinical featuresThis section has been translated automatically.
- Incubation period: about 10 days.
- Asymptomatic infection, mild diarrhea and severe enteritis are possible, as well as acute and chronic courses.
- In immunocompetent patients, self-limiting gastroenteritis with diarrhea is usually observed (3-10 days).
- Accompanying symptoms: weight loss, inappetence, nausea and vomiting as well as abdominal cramp-like pain (tenesmus).
- Extraintestinal symptoms: arthragalas, eye pain, headache, fatigue.
- The bile duct system may be affected. Cholecystitis, sclerosing cholangitis, stricture, jaundice.
- Pulmonary involvement: non-specific respiratory symptoms such as coughing.
DiagnosisThis section has been translated automatically.
- Microscopy (oocyst detection in stool, tissue, duodenal, bronchial and bile fluid): fresh stool sample or formalin-fixed; stool concentration by flotation; light or phase contrast microscopy. Staining: Kinyoun (acid-proof staining), HE, Giemsa, Auramin, Malachite green.
- Antigen and antibody tests (ELISA)
- PCR.
Differential diagnosisThis section has been translated automatically.
Enteritides by other parasites, bacteria or viruses.
TherapyThis section has been translated automatically.
- Spontaneous healing possible after 10-14 days in immunocompetent patients.
- In children and immunocompromised persons long and severe courses are more frequent.
- Immunocompetent patients (including children): Nitazoxanide (Alinia or Cryptaz): 2 times/day 500 mg p.o. for 3 days. Both preparations are not listed in Germany and are available from international pharmacies.
- Immunocompromised patients: Nitazoxanide 2 times/day 500 mg p.o. for 3 days. Alternatively: Paromomycin (Humatin) 25-35 mg/kg bw/day p.o. for 2-8 weeks, if necessary in combination with Azithromycin (Zithromax) once/day 500 mg/day p.o. for 3 days.
- According to studies, Rifaximin (Xifaxan) is very effective: 2 times/day 200 mg p.o. The preparation is not listed in Germany and is available from international pharmacies.
- Volume and electolyte substitution.
- In HIV-infected persons: if necessary, initiate, continue or optimize HAART.
Progression/forecastThis section has been translated automatically.
- Severe and prolonged courses in patients with disorders in the cellular and humoral immune response.
- In immunocompetent patients more than half develop a chronic disease. Approximately 10% of cases take a fulminant course.
ProphylaxisThis section has been translated automatically.
- Food and drinking water hygiene.
- Toilet hygiene.
- Spores can be eliminated by freezing, heating, ammonia and formalin.
- Questionable prophylaxis by clarithromycin and rifabutin.
Note(s)This section has been translated automatically.
Remember! When sending stool samples, explicitly indicate the suspicion of cryptosporidiosis. Otherwise cryptosporidia are often overlooked.
Notice! According to § 7 Abs. 1 Nr. 10 IfSG the direct or indirect detection of Cryptosporidium parvum, as far as it indicates an acute infection, is reported to the public health department by name.
LiteratureThis section has been translated automatically.
- Caccio SM (2005) Molecular epidemiology of human cryptosporidiosis. Parassitologia 47: 185
- Fox LM, Saravolatz LD (2005) Nitazoxanide: a new thiazolide antiparasitic agent. Clin Infect Dis 40: 1173
- Smith HV, Corcoran GD (2004) New drugs and treatment for cryptosporidiosis. Curr Opin Infect Dis 17: 557
- Blanshard C, Shanson DC, Gazzard BG (1997) Pilot studies of azithromycin, letrazuril and paromomycin in the treatment of cryptosporidiosis. Int J STD AIDS 8: 124