CRYTOSPORIDIM PARVUM

1. CRYTOSPORIDIM PARVUM OLU-LAWAL TOLULOPE MD 3 - 1299

2. INTRODUCTION • Cryptosporidiosis is a diarrheal disease caused by a microscopic parasite, Cryptosporidiumparvumthat can live in the intestine of humans and animals and is passed in the stool of an infected person or animal. • Cryptosporidium a coccidian protozoan parasite which is about 3 micrometer in diameter was in 1912 first discovered by Earnest Edward TyzzerAmerican parasitologist • Both the disease and the parasite are also known as "Crypto." The parasite is protected by an outer shell that allows it to survive outside the body for long periods of time and makes it very resistant to chlorine-based disinfectants.

3. Introduction (cont’d) • During the past 2 decades, Crypto has become recognized as one of the most common causes of waterborne disease (recreational water and drinking water) in humans in the United States. The parasite is found in every region of the United States and throughout the world.

4. REPLICATIVE CYCLE

5. REPLICATIVE CYCLE (cont’d) • Oocysts release sporozoites; they form trophozoites. After schizonts and merozoites form, microgametes and macrogametes are produced; they unite to form a zygote and then an oocyst.

6. http://www.dpd.cdc.gov/dpdx/HTML/Cryptosporidiosis.htm

7. TRANSMISSION AND EPIDEMIOLOGY • Basically transmitted Fecal-orally. •  The protozoa also caused the largest waterborne-disease outbreak ever documented in the United States, making 403,000 people ill in Milwaukee, Wisconsin in 1993. • North America • 2% of population infected • 80% previously exposed • Worldwide • Prevalence lower in developed countries, higher in developing countries

9. Geographical Distribution:

10. Cryptosporidiosis. Incidence — United States, 2000–2011 * Per 100,000 population.

11. OUTBREAKS:

13. PATHOGENESIS AND IMMUNITY • Cryptosporidumparvuminhabits the brush boder of mucosal epithelial cells of the GIT (villi). • Could be found upon infection in the small intestine but its infections have been found in other organs (other digestive organs, the lungs and conjunctiva of the eye). • Causes mild watery diarrhea which is self-limiting (1-2 weeks) in normal persons but maybe severe and prolonged in immunocompromised individuals where diarrhea can reach 10–15L per day.

14. PATHOGENESIS AND IMMUNITY • Infectious dose: < 10 organisms (only 1 needed to initiate) • Cell death is a direct result of parasite invasion, multiplication, and extrusion or • Cell damage could occur through T cell-mediated inflammation, producing microvilli death and Cryptosporidium excess growth

15. CLINICAL FINDINGS • Some individuals can be asymptomatic • Incubation period: 2-10 days • Symptoms include: • Stomach cramps, pain, watery diarrhea, dehydration, weight loss, vomiting, fever. • Immuno-competent individuals: 1-2 weeks • Immuno-compromised individuals: longer (months, even years!)

16. LAB DIAGNOSIS • Round oocysts visible in stool with acid-fast stain. • Enzyme immunoassay for greatest sensitivity and specificity • Molecular methods using PCR

17. TREATMENT • No effective therapy, currently researching for a suitable prophylactic drug. • Immuno-competent individuals will recover with fluid and electrolyte replacement. • Paromomycin and Nitazoxanide may alleviate some diarrheal symptoms. • For individuals with AIDS, anti-retroviral therapy will reduce oocyst excretion and decreases diarrhea. Although Spiramycinhas been said to be used immunocompromised patients.

18. PREVENTION • Water purification and filtration • Routine testing • Use of 1 micron filter to remove cysts • Boil water • Drink bottled water when traveling abroad • Awareness and Education • Wash hands frequently • Avoid fecal matter during sexual activity

19. INTERESTING FACTS • Cryptosporidium is resistant to chlorine. • Not protected in chlorinated pool. • Cannot be infected by blood exposure • The sporocysts are resistant to most chemical disinfectants, but are susceptible to drying and the ultraviolet portion of sunlight

20. REFERENCES • ”Cryptosporidiosis.” Laboratory Identification of Parasites of Public Health Concern. CDC. 5 Sept 2007. <http://www.dpd.cdc.gov/dpdx/HTML/Cryptosporidiosis.htm> •  DuPont HL, Chappell CL, Sterling CR, Okhuysen PC, Rose JB, Jakubowski W (March 1995). "The infectivity of Cryptosporidium parvum in healthy volunteers". N. Engl. J. Med.332 (13): 855–9. doi:10.1056/NEJM199503303321304. PMID7870140. •  DuPont et al "The Infectivivty of Cryptosporidium parvum in healthy Volunteers"http://www.nejm.org/doi/pdf/10.1056/NEJM199503303321304 •  ”Surveillance for Waterborne-Disease Outbreaks -- United States, 1993-1994” CDC. 1996. <http://www.cdc.gov/mmwr/preview/mmwrhtml/00040818.htm> •  Deng, M.; Lancto, C. A.; Abrahamsen, M. S. (2004). "Cryptosporidium parvum regulation of human epithelial cell gene expression". International Journal for Parasitology34 (1): 73–82. doi:10.1016/j.ijpara.2003.10.001. PMID14711592. edit •  Robertson et al "Survival of Cryposporidiumparvumoocysts under various environmental pressures" http://aem.asm.org/content/58/11/3494.full.pdf+html •  Robertson et al "Survival of Cryposporidiumparvumoocysts under various environmental pressures" http://aem.asm.org/content/58/11/3494.full.pdf+html