1 / 35

Cryptosporidiosis

Cryptosporidiosis. What is Cryptosporidiosis?. Caused by a parasite, Cryptosporidium parvum Healthy people recover on their own In those with AIDS or with weak immune systems, it can cause serious illness and may even cause death. Etiologic Agent.

juanitas
Download Presentation

Cryptosporidiosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Cryptosporidiosis

  2. What is Cryptosporidiosis? • Caused by a parasite, Cryptosporidium parvum • Healthy people recover on their own • In those with AIDS or with weak immune systems, it can cause serious illness and may even cause death

  3. Etiologic Agent • Infected animals and people excrete large numbers of oocysts (infectious form) in stool • Oocysts relatively hardy • May be excreted for up to 5 weeks after diarrheal illness ends • Can survive in the environment for weeks/months • Resistant to chlorine & other disinfectants used to treat water • They can be killed by heat (bringing water to a rolling boil) or removed by adequate filtration

  4. Transmission • It may also be spread by touching others with unwashed hands • Outbreaks have occurred when people swallow water • An outbreak has also occurred from consumption of unpasteurized cider

  5. Symptoms • Watery diarrhea (can be several times a day) • Stomach cramps • Upset stomach • Slight fever • Weight loss

  6. Incubation Period & Duration • Incubation Period • 1-12 days • Duration • In healthy people, symptoms usually last about two weeks or less • Some people may not get sick but can still pass the disease to others. • After infection, people can pass cryptosporidiosis in their stool for months. • People with weak immune systems may have the disease for a longer time.

  7. Treatment • There is no drug to cure cryptosporidiosis • Since diarrhea can cause dehydration, drink plenty of fluids.

  8. Prevention • Always wash hands with soap and water: • after using the bathroom • after touching children in diapers • after touching anything soiled with stool • after touching pets or other animals • after gardening • and before eating and preparing food • Supervise young children when they are washing their hands • Wash or peel all uncooked vegetables and fruits • Do not eat or drink unpasteurized milk, dairy products, juice or cider

  9. Prevention • Persons with diarrhea should not: • swim or bathe with others • prepare food that will be eaten by others • attend daycare • Practice safe sex • People with AIDS or weak immune systems should consider using bottled or filtered water

  10. A Massive Outbreak in Milwaukee of Cryptosporidium Infection Transmitted Through The Public Water SupplyNEJM, Volume 331:161-167, July 21,1994 • April 5,1993 Wisconsin Division of Health was contacted by Milwaukee Department of Health • Numerous cases of GI illness • Hospital employees • Students • School teachers • April 7th • 2 labs identified Cryptosporidium oocysts in stool samples of 7 adults

  11. Milwaukee Outbreak NEJM, Volume 331:161-167, July 21,1994 • Milwaukee Water Works (MWW) • Obtained water from Lake Michigan • Examination of Untreated and Treated Water • Revealed an increase in the turbidity of treated water beginning on March 21 • Unprecedented levels of turbidity from 3/23/-4/5 • April 7th advisory to all MWW customers to boil water. • Plant closed on 4/9

  12. Figure 1. Maximal turbidity of treated water in the northern and southern

  13. Milwaukee OutbreakNEJM, Volume 331:161-167, July 21,1994 • 14 Clinical Laboratories • Surveillance • Retrospectively (3/1-4/6) • Prospectively (4/7-4/16) • Before April 7th 12 of 14 laboratories tested for Crypto, only at the request of a physician • 739 lab confirmed cases from 3/1-5/30 • 567 had telephone numbers • 312 interviewed • 285 (91%) onset 3/1-5/15

  14. Milwaukee OutbreakNEJM, Volume 331:161-167, July 21,1994 • Laboratory Surveillance • 3/1-4/6 • 12 of 42 (29%) specimens positive for Cryptosporidium • 4/8-4/16 • 331 of 1009 (33%)specimens positive for Cryptosporidium

  15. Milwaukee OutbreakNEJM, Volume 331:161-167, July 21,1994 • Lab confirmed cases • 285 confirmed cases • 170 (60%) female • 130 (46%) hospitalized • 48 (17%) immunocompromised • Mean age 41 years (2 months- 93 years) • All had diarrhea • 265 (93%) watery • Median duration of diarrhea 9 days (1-55) • Onset of illness 3/1-5/15

  16. Figure 2. Reported Date of Onset of Illness In cases of laboratory confirmed or clinically defined cryptosporidium infection during the period from March 1 through April 15, 1993 Clinically defined cases were identified during a telephone survey begun on April 9 of residents in the area served by the Milwaukee Water Works

  17. Figure 3. Reported date of onset of watery diarrhea during the period of March 1 through April 28, 1993, in 436 cases of infection identified by a random digit telephone survey of the greater Milwaukee area

  18. Milwaukee OutbreakNEJM, Volume 331:161-167, July 21,1994 • Rate of Watery Diarrhea • MWW Southern region (52%) • MWW Middle zone (33%) • MWW Northern region (26%) • Outside of MWW service area (15%)

  19. Milwaukee OutbreakNEJM, Volume 331:161-167, July 21,1994 • Estimate of the Magnitude of the Outbreak • Rate of watery diarrhea among survey participants to the total of greater Milwaukee area (1,610,000) • Estimate of 419,000 people had watery diarrhea

  20. Milwaukee OutbreakNEJM, Volume 331:161-167, July 21,1994 • Recognition of outbreak was delayed • GI symptoms • Constitutional signs (fatigue, low grade fever, muscle aches, and headaches) • Diagnosed as “intestinal flu” • Infrequent testing

  21. An Outbreak of Cryptosporidiosis From Fresh Apple Cider (JAMA , 11/23/1994, 272 (20) 1592-1596) • October 1993 • Elementary school principal • Outbreak of enteric illness • Maine BPH • 2 Elementary schools • 1 High school – rural farming community • Elementary schools • High absenteeism in classes that attended 1 day agricultural fair 8 days ago

  22. Apple Cider Outbreak(JAMA , 11/23/1994, 272 (20) 1592-1596) • Fair • Organized & Staffed by High School Students • Elementary students attended either morning or afternoon session- but not both • Consisted of: • Agricultural demonstrations • Petting zoo of farm animals • Hayride • Cider-pressing demonstration • Light refreshments

  23. Apple Cider Outbreak(JAMA , 11/23/1994, 272 (20) 1592-1596) • Cryptosporidium • Found in 3 ill students attending the fair • Cohort & Environmental/Lab Study • Identify Source • Characterize natural history of Cryptosporidium • Determine risk of secondary household transmission

  24. Apple Cider Outbreak(JAMA , 11/23/1994, 272 (20) 1592-1596) • Study Population • Students and staff attending the fair • Household members of primary case patients • Clinical Cryptosporidiosis • 3 days of diarrhea or vomiting with abdominal cramps • Laboratory Cryptosporidiosis • GI Illness with lab confirmed Cryptosporidium oocysts • Primary cases • Lab or Clinical Cryptosporidiosis following fair attendance • Secondary • household members of primary case patients who did attend the fair but who became ill within 1 month of onset of illness in the primary case patient

  25. Apple Cider Outbreak(JAMA , 11/23/1994, 272 (20) 1592-1596) • Epidemiological Investigation • Questionnaire • Possible exposures • All 6 food & drink items • Petting of farm animals • Participation in the hayride • Dates of Onset • Date of Recovery • Symptoms • Underlying medical conditions

  26. Apple Cider Outbreak(JAMA , 11/23/1994, 272 (20) 1592-1596) • Environmental Investigation • High school student had taken a gallon of leftover cider • Interviewed 3 high school students & supervisor who pressed the cider • Pre-existing illness • Source of apples • Details of cider making process • Possible sources of contamination during pressing operation • Obtained stool: • 2 calves that had been at the petting zoo • 6 of 14 cows & 2 of 8 calves from farm that supplied the apples

  27. Apple Cider Outbreak(JAMA , 11/23/1994, 272 (20) 1592-1596) • Results • 611 of 759 (81%) completed survey • 230 (38%) GI symptoms • 160 primary cases identified • 33 Laboratory confirmed • Primary cases patients • 5 to 66 years • 54% males • 56% younger than 10 years

  28. Apple Cider Outbreak(JAMA , 11/23/1994, 272 (20) 1592-1596) • Clinical Illness – 160 primary case patients • 106 (66%) both vomiting & diarrhea • 19 (12%) diarrhea w/o vomiting • 26 (16%) vomiting w/o diarrhea • Median incubation period • 6 days (Range 10 hours-13 days) • Median duration of illness • 6 days (Range 1 to 16 days)

  29. Apple Cider Outbreak(JAMA , 11/23/1994, 272 (20) 1592-1596) • Exposures • 576 answered if they had drank cider at the fair • 284 drank in the afternoon • 154 (54%) met case definition • 6 (2%) who did not drink in the afternoon met case definition • All laboratory confirmed primary case patients & 121 (95%) of 127 clinically defined primary case patients • Reported drinking cider in the afternoon

  30. Apple Cider Outbreak(JAMA , 11/23/1994, 272 (20) 1592-1596) • Household transmission • 53 secondary cases • 17 lab confirmed • 37 (33%) of 112 households with one primary case and four (36%) of 11 households with 2 primary cases reported one or more secondary cases • Impact of outbreak • 14 (31%) of 45 missed work • 13 (29%) visited private medical office

  31. Apple Cider Outbreak(JAMA , 11/23/1994, 272 (20) 1592-1596) • Environmental Investigation • 5 bushels of apples used for morning pressing • Purchased from commercial producer • 5 bushels of apples used in afternoon pressing • Collected from uncultivated trees of edge of pasture • Students harvested apples- shaking trees • Apples were sprayed with municipal water from a hose in the morning of the fair • Municipal water supplied by surface water source that was chlorinated but not filtered

  32. Apple Cider Outbreak(JAMA , 11/23/1994, 272 (20) 1592-1596) • Environmental & Laboratory Investigation • Cryptosporidium detected • Leftover apple cider • Swabs from surface of the portable cider press • 2 calves from farm that supplied implicated apples • Not detected in calves at the petting zoo

More Related