Skip to main content
PMC home page
Emerging Infectious Diseases logoLink to Emerging Infectious Diseases
. 1997 Jan-Mar;3(1):51–57. doi: 10.3201/eid0301.970106

Cryptosporidiosis: an emerging, highly infectious threat.

R L Guerrant 1
PMCID: PMC2627589  PMID: 9126444

Abstract

Cryptosporidium parvum, a leading cause of persistent diarrhea in developing countries, is a major threat to the U.S. water supply. Able to infect with as few as 30 microscopic oocysts, Cryptosporidium is found in untreated surface water, as well as in swimming and wade pools, day-care centers, and hospitals. The organism can cause illnesses lasting longer than 1 to 2 weeks in previously healthy persons or indefinitely in immunocompromised patients; furthermore, in young children in developing countries, cryptosporidiosis predisposes to substantially increased diarrheal illnesses. Recent increased awareness of the threat of cryptosporidiosis should improve detection in patients with diarrhea. New methods such as those using polymerase chain reaction may help with detection of Cryptosporidium in water supplies or in asymptomatic carriers. Although treatment is very limited, new approaches that may reduce secretion or enhance repair of the damaged intestinal mucosa are under study.

Full Text

The Full Text of this article is available as a PDF (48.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Argenzio R. A., Lecce J., Powell D. W. Prostanoids inhibit intestinal NaCl absorption in experimental porcine cryptosporidiosis. Gastroenterology. 1993 Feb;104(2):440–447. doi: 10.1016/0016-5085(93)90412-6. [DOI] [PubMed] [Google Scholar]
  2. Argenzio R. A., Rhoads J. M., Armstrong M., Gomez G. Glutamine stimulates prostaglandin-sensitive Na(+)-H+ exchange in experimental porcine cryptosporidiosis. Gastroenterology. 1994 Jun;106(6):1418–1428. doi: 10.1016/0016-5085(94)90393-x. [DOI] [PubMed] [Google Scholar]
  3. Awad-el-Kariem F. M., Warhurst D. C., McDonald V. Detection and species identification of Cryptosporidium oocysts using a system based on PCR and endonuclease restriction. Parasitology. 1994 Jul;109(Pt 1):19–22. doi: 10.1017/s0031182000077714. [DOI] [PubMed] [Google Scholar]
  4. Baxby D., Hart C. A., Taylor C. Human cryptosporidiosis: a possible case of hospital cross infection. Br Med J (Clin Res Ed) 1983 Dec 10;287(6407):1760–1761. doi: 10.1136/bmj.287.6407.1760-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Collier A. C., Miller R. A., Meyers J. D. Cryptosporidiosis after marrow transplantation: person-to-person transmission and treatment with spiramycin. Ann Intern Med. 1984 Aug;101(2):205–206. doi: 10.7326/0003-4819-101-2-205. [DOI] [PubMed] [Google Scholar]
  6. D'Antonio R. G., Winn R. E., Taylor J. P., Gustafson T. L., Current W. L., Rhodes M. M., Gary G. W., Jr, Zajac R. A. A waterborne outbreak of cryptosporidiosis in normal hosts. Ann Intern Med. 1985 Dec;103(6 ):886–888. doi: 10.7326/0003-4819-103-6-886. [DOI] [PubMed] [Google Scholar]
  7. Diers J., McCallister G. L. Occurrence of Cryptosporidium in home daycare centers in west-central Colorado. J Parasitol. 1989 Aug;75(4):637–638. [PubMed] [Google Scholar]
  8. Dryjanski J., Gold J. W., Ritchie M. T., Kurtz R. C., Lim S. L., Armstrong D. Cryptosporidiosis. Case report in a health team worker. Am J Med. 1986 Apr;80(4):751–752. doi: 10.1016/0002-9343(86)90839-9. [DOI] [PubMed] [Google Scholar]
  9. DuPont H. L., Chappell C. L., Sterling C. R., Okhuysen P. C., Rose J. B., Jakubowski W. The infectivity of Cryptosporidium parvum in healthy volunteers. N Engl J Med. 1995 Mar 30;332(13):855–859. doi: 10.1056/NEJM199503303321304. [DOI] [PubMed] [Google Scholar]
  10. Fang G. D., Lima A. A., Martins C. V., Nataro J. P., Guerrant R. L. Etiology and epidemiology of persistent diarrhea in northeastern Brazil: a hospital-based, prospective, case-control study. J Pediatr Gastroenterol Nutr. 1995 Aug;21(2):137–144. doi: 10.1097/00005176-199508000-00003. [DOI] [PubMed] [Google Scholar]
  11. Fayer R. Effect of sodium hypochlorite exposure on infectivity of Cryptosporidium parvum oocysts for neonatal BALB/c mice. Appl Environ Microbiol. 1995 Feb;61(2):844–846. doi: 10.1128/aem.61.2.844-846.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Gardner A. L., Roche J. K., Weikel C. S., Guerrant R. L. Intestinal cryptosporidiosis: pathophysiologic alterations and specific cellular and humoral immune responses in rnu/+ and rnu/rnu (athymic) rats. Am J Trop Med Hyg. 1991 Jan;44(1):49–62. doi: 10.4269/ajtmh.1991.44.49. [DOI] [PubMed] [Google Scholar]
  13. Gentile G., Venditti M., Micozzi A., Caprioli A., Donelli G., Tirindelli C., Meloni G., Arcese W., Martino P. Cryptosporidiosis in patients with hematologic malignancies. Rev Infect Dis. 1991 Sep-Oct;13(5):842–846. doi: 10.1093/clinids/13.5.842. [DOI] [PubMed] [Google Scholar]
  14. Goldstein S. T., Juranek D. D., Ravenholt O., Hightower A. W., Martin D. G., Mesnik J. L., Griffiths S. D., Bryant A. J., Reich R. R., Herwaldt B. L. Cryptosporidiosis: an outbreak associated with drinking water despite state-of-the-art water treatment. Ann Intern Med. 1996 Mar 1;124(5):459–468. doi: 10.7326/0003-4819-124-5-199603010-00001. [DOI] [PubMed] [Google Scholar]
  15. Goodgame R. W., Kimball K., Ou C. N., White A. C., Jr, Genta R. M., Lifschitz C. H., Chappell C. L. Intestinal function and injury in acquired immunodeficiency syndrome-related cryptosporidiosis. Gastroenterology. 1995 Apr;108(4):1075–1082. doi: 10.1016/0016-5085(95)90205-8. [DOI] [PubMed] [Google Scholar]
  16. Guarino A., Canani R. B., Casola A., Pozio E., Russo R., Bruzzese E., Fontana M., Rubino A. Human intestinal cryptosporidiosis: secretory diarrhea and enterotoxic activity in Caco-2 cells. J Infect Dis. 1995 Apr;171(4):976–983. doi: 10.1093/infdis/171.4.976. [DOI] [PubMed] [Google Scholar]
  17. Hayes E. B., Matte T. D., O'Brien T. R., McKinley T. W., Logsdon G. S., Rose J. B., Ungar B. L., Word D. M., Pinsky P. F., Cummings M. L. Large community outbreak of cryptosporidiosis due to contamination of a filtered public water supply. N Engl J Med. 1989 May 25;320(21):1372–1376. doi: 10.1056/NEJM198905253202103. [DOI] [PubMed] [Google Scholar]
  18. Heine J., Moon H. W., Woodmansee D. B. Persistent Cryptosporidium infection in congenitally athymic (nude) mice. Infect Immun. 1984 Mar;43(3):856–859. doi: 10.1128/iai.43.3.856-859.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Kehl K. S., Cicirello H., Havens P. L. Comparison of four different methods for detection of Cryptosporidium species. J Clin Microbiol. 1995 Feb;33(2):416–418. doi: 10.1128/jcm.33.2.416-418.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Koch K. L., Phillips D. J., Aber R. C., Current W. L. Cryptosporidiosis in hospital personnel. Evidence for person-to-person transmission. Ann Intern Med. 1985 May;102(5):593–596. doi: 10.7326/0003-4819-102-5-593. [DOI] [PubMed] [Google Scholar]
  21. Korich D. G., Mead J. R., Madore M. S., Sinclair N. A., Sterling C. R. Effects of ozone, chlorine dioxide, chlorine, and monochloramine on Cryptosporidium parvum oocyst viability. Appl Environ Microbiol. 1990 May;56(5):1423–1428. doi: 10.1128/aem.56.5.1423-1428.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Kramer M. H., Herwaldt B. L., Craun G. F., Calderon R. L., Juranek D. D. Surveillance for waterborne-disease outbreaks--United States, 1993-1994. MMWR CDC Surveill Summ. 1996 Apr 12;45(1):1–33. [PubMed] [Google Scholar]
  23. Laxer M. A., D'Nicuola M. E., Patel R. J. Detection of Cryptosporidium parvum DNA in fixed, paraffin-embedded tissue by the polymerase chain reaction. Am J Trop Med Hyg. 1992 Oct;47(4):450–455. doi: 10.4269/ajtmh.1992.47.450. [DOI] [PubMed] [Google Scholar]
  24. Laxer M. A., Timblin B. K., Patel R. J. DNA sequences for the specific detection of Cryptosporidium parvum by the polymerase chain reaction. Am J Trop Med Hyg. 1991 Dec;45(6):688–694. doi: 10.4269/ajtmh.1991.45.688. [DOI] [PubMed] [Google Scholar]
  25. LeChevallier M. W., Norton W. D., Lee R. G. Occurrence of Giardia and Cryptosporidium spp. in surface water supplies. Appl Environ Microbiol. 1991 Sep;57(9):2610–2616. doi: 10.1128/aem.57.9.2610-2616.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. LeChevallier M. W., Schulz W., Lee R. G. Bacterial nutrients in drinking water. Appl Environ Microbiol. 1991 Mar;57(3):857–862. doi: 10.1128/aem.57.3.857-862.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Lima A. A., Soares A. M., Freire Júnior J. E., Guerrant R. L. Cotransport of sodium with glutamine, alanine and glucose in the isolated rabbit ileal mucosa. Braz J Med Biol Res. 1992;25(6):637–640. [PubMed] [Google Scholar]
  28. Mac Kenzie W. R., Hoxie N. J., Proctor M. E., Gradus M. S., Blair K. A., Peterson D. E., Kazmierczak J. J., Addiss D. G., Fox K. R., Rose J. B. A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply. N Engl J Med. 1994 Jul 21;331(3):161–167. doi: 10.1056/NEJM199407213310304. [DOI] [PubMed] [Google Scholar]
  29. McAnulty J. M., Fleming D. W., Gonzalez A. H. A community-wide outbreak of cryptosporidiosis associated with swimming at a wave pool. JAMA. 1994 Nov 23;272(20):1597–1600. [PubMed] [Google Scholar]
  30. Millard P. S., Gensheimer K. F., Addiss D. G., Sosin D. M., Beckett G. A., Houck-Jankoski A., Hudson A. An outbreak of cryptosporidiosis from fresh-pressed apple cider. JAMA. 1994 Nov 23;272(20):1592–1596. [PubMed] [Google Scholar]
  31. Modigliani R., Bories C., Le Charpentier Y., Salmeron M., Messing B., Galian A., Rambaud J. C., Lavergne A., Cochand-Priollet B., Desportes I. Diarrhoea and malabsorption in acquired immune deficiency syndrome: a study of four cases with special emphasis on opportunistic protozoan infestations. Gut. 1985 Feb;26(2):179–187. doi: 10.1136/gut.26.2.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Moore A. C., Herwaldt B. L., Craun G. F., Calderon R. L., Highsmith A. K., Juranek D. D. Surveillance for waterborne disease outbreaks--United States, 1991-1992. MMWR CDC Surveill Summ. 1993 Nov 19;42(5):1–22. [PubMed] [Google Scholar]
  33. Navarrete S., Stetler H. C., Avila C., Garcia Aranda J. A., Santos-Preciado J. I. An outbreak of Cryptosporidium diarrhea in a pediatric hospital. Pediatr Infect Dis J. 1991 Mar;10(3):248–250. doi: 10.1097/00006454-199103000-00016. [DOI] [PubMed] [Google Scholar]
  34. Navin T. R., Juranek D. D. Cryptosporidiosis: clinical, epidemiologic, and parasitologic review. Rev Infect Dis. 1984 May-Jun;6(3):313–327. doi: 10.1093/clinids/6.3.313. [DOI] [PubMed] [Google Scholar]
  35. Neill M. A., Rice S. K., Ahmad N. V., Flanigan T. P. Cryptosporidiosis: an unrecognized cause of diarrhea in elderly hospitalized patients. Clin Infect Dis. 1996 Jan;22(1):168–170. doi: 10.1093/clinids/22.1.168. [DOI] [PubMed] [Google Scholar]
  36. Newman R. D., Jaeger K. L., Wuhib T., Lima A. A., Guerrant R. L., Sears C. L. Evaluation of an antigen capture enzyme-linked immunosorbent assay for detection of Cryptosporidium oocysts. J Clin Microbiol. 1993 Aug;31(8):2080–2084. doi: 10.1128/jcm.31.8.2080-2084.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Newman R. D., Wuhib T., Lima A. A., Guerrant R. L., Sears C. L. Environmental sources of Cryptosporidium in an urban slum in northeastern Brazil. Am J Trop Med Hyg. 1993 Aug;49(2):270–275. doi: 10.4269/ajtmh.1993.49.270. [DOI] [PubMed] [Google Scholar]
  38. Newman R. D., Zu S. X., Wuhib T., Lima A. A., Guerrant R. L., Sears C. L. Household epidemiology of Cryptosporidium parvum infection in an urban community in northeast Brazil. Ann Intern Med. 1994 Mar 15;120(6):500–505. doi: 10.7326/0003-4819-120-6-199403150-00009. [DOI] [PubMed] [Google Scholar]
  39. Nime F. A., Burek J. D., Page D. L., Holscher M. A., Yardley J. H. Acute enterocolitis in a human being infected with the protozoan Cryptosporidium. Gastroenterology. 1976 Apr;70(4):592–598. [PubMed] [Google Scholar]
  40. Parks E. T., Miles D. A., Van Dis M. L., Williamson G. F., Razmus T. F., Bricker S. L. Effects of filtration, collimation, and target-receptor distance on artificial approximal enamel lesion detection with the use of RadioVisioGraphy. Oral Surg Oral Med Oral Pathol. 1994 Apr;77(4):419–426. doi: 10.1016/0030-4220(94)90207-0. [DOI] [PubMed] [Google Scholar]
  41. Ravn P., Lundgren J. D., Kjaeldgaard P., Holten-Anderson W., Højlyng N., Nielsen J. O., Gaub J. Nosocomial outbreak of cryptosporidiosis in AIDS patients. BMJ. 1991 Feb 2;302(6771):277–280. doi: 10.1136/bmj.302.6771.277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Rush B. A., Chapman P. A., Ineson R. W. Cryptosporidium and drinking water. Lancet. 1987 Sep 12;2(8559):632–633. doi: 10.1016/s0140-6736(87)93029-7. [DOI] [PubMed] [Google Scholar]
  43. Sears C. L., Guerrant R. L. Cryptosporidiosis: the complexity of intestinal pathophysiology. Gastroenterology. 1994 Jan;106(1):252–254. doi: 10.1016/s0016-5085(94)95891-2. [DOI] [PubMed] [Google Scholar]
  44. Smith H. V., Girdwood R. W., Patterson W. J., Hardie R., Green L. A., Benton C., Tulloch W., Sharp J. C., Forbes G. I. Waterborne outbreak of cryptosporidiosis. Lancet. 1988 Dec 24;2(8626-8627):1484–1484. doi: 10.1016/s0140-6736(88)90951-8. [DOI] [PubMed] [Google Scholar]
  45. Stehr-Green J. K., McCaig L., Remsen H. M., Rains C. S., Fox M., Juranek D. D. Shedding of oocysts in immunocompetent individuals infected with Cryptosporidium. Am J Trop Med Hyg. 1987 Mar;36(2):338–342. doi: 10.4269/ajtmh.1987.36.338. [DOI] [PubMed] [Google Scholar]
  46. Ungar B. L., Soave R., Fayer R., Nash T. E. Enzyme immunoassay detection of immunoglobulin M and G antibodies to Cryptosporidium in immunocompetent and immunocompromised persons. J Infect Dis. 1986 Mar;153(3):570–578. doi: 10.1093/infdis/153.3.570. [DOI] [PubMed] [Google Scholar]
  47. Vakil N. B., Schwartz S. M., Buggy B. P., Brummitt C. F., Kherellah M., Letzer D. M., Gilson I. H., Jones P. G. Biliary cryptosporidiosis in HIV-infected people after the waterborne outbreak of cryptosporidiosis in Milwaukee. N Engl J Med. 1996 Jan 4;334(1):19–23. doi: 10.1056/NEJM199601043340104. [DOI] [PubMed] [Google Scholar]
  48. Weber R., Bryan R. T., Bishop H. S., Wahlquist S. P., Sullivan J. J., Juranek D. D. Threshold of detection of Cryptosporidium oocysts in human stool specimens: evidence for low sensitivity of current diagnostic methods. J Clin Microbiol. 1991 Jul;29(7):1323–1327. doi: 10.1128/jcm.29.7.1323-1327.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. White A. C., Jr, Chappell C. L., Hayat C. S., Kimball K. T., Flanigan T. P., Goodgame R. W. Paromomycin for cryptosporidiosis in AIDS: a prospective, double-blind trial. J Infect Dis. 1994 Aug;170(2):419–424. doi: 10.1093/infdis/170.2.419. [DOI] [PubMed] [Google Scholar]
  50. Zu S. X., Li J. F., Barrett L. J., Fayer R., Shu S. Y., McAuliffe J. F., Roche J. K., Guerrant R. L. Seroepidemiologic study of Cryptosporidium infection in children from rural communities of Anhui, China and Fortaleza, Brazil. Am J Trop Med Hyg. 1994 Jul;51(1):1–10. doi: 10.4269/ajtmh.1994.51.1. [DOI] [PubMed] [Google Scholar]

Articles from Emerging Infectious Diseases are provided here courtesy of Centers for Disease Control and Prevention

RESOURCES