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Human Cryptosporidiosis -- Alabama

A case of human cryptosporidiosis in an animal handler has been reported by Auburn University. About 3 weeks before onset of symptoms in mid-July 1981, the patient, a previously healthy 25-year-old male free of immune deficiencies, had started a survey of calves for Cryptosporidium sp. (1). Clinical features of his illness included nausea and low-grade fever, moderate abdominal cramps, anorexia, 5-10 watery, frothy bowel movements a day, and then constipation. Fourteen days after onset, the patient was much improved and was eating a full diet. Sheather's sugar-flotation tests showed oocysts of Cryptosporidium sp. in the first fecal sample collected 56 hours after onset of symptoms and in fecal samples collected daily through the 12th day of illness; no oocysts were found after day 12. Additional details of this case and the methods for diagnosis of human cryptosporidiosis have been published (1).

Since the initial report was submitted in September 1981, stool examinations have been done for 16 other animal handlers at the university who had contact with animals involved in 3 separate, unrelated outbreaks of calf cryptosporidiosis. From these 16 persons, 11 additional cases of human cryptosporidiosis were identified. All involved previously healthy individuals; no abnormalities were noted in their levels of serum globulins at the time of infection, and no deficiencies in cell-mediated immune response were detected by lymphocyte-blastogenesis testing. Symptoms occurred within 1-2 weeks after the individuals had first contact with the infected calves. Four of these 11 patients had clinical symptoms similar to those described above; 4 had diarrhea and moderate abdominal cramps; 1 had fever, constipation, and abdominal cramps; and 2 were asymptomatic. All diagnoses were based on the presence of Cryptosporidium sp. oocysts in stool specimens. Cryptosporidium sp. oocysts had been found in calf feces but were not found in the stools of any other animals (cats, dogs, goats, pigs, or rats) with which the patients had had contact.

Oocysts of Cryptosporidium sp. isolated from the animal handlers were found to be morphologically indistinguishable from those obtained from naturally and experimentally infected calves. When Cryptosporidium sp. oocysts isolated from humans and calves were inoculated orally into mice and rats, the infections produced by oocysts from the animal handlers were indistinguishable from those produced by calf oocysts. Oocysts from the animal handlers also produced cryptosporidiosis in calves that had previously been free of Cryptosporidium. Reported by WL Current, PhD, NC Reese, Dept of Zoology-Entomology, Auburn University, JV Ernst, PhD, WS Bailey, DVM, ScD, USDA Regional Parasite Research Laboratory, Auburn, Alabama; Parasitic Diseases Div, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Before this report from Alabama, no more than approximately a dozen cases of human cryptosporidiosis had been reported in the literature. Of these, 6 involved patients who had prolonged illness and were shown to be immunologically deficient (2-7), 2 other patients were undergoing immunosuppressive chemotherapy (8-9), and 4 were otherwise apparently healthy (1,10-12). Eight of these 12 cases (2-9) were diagnosed only after histologic examination of small- or large-bowel biopsy material. The human cases at Auburn were diagnosed and monitored by the demonstration of Cryptosporidium oocysts in fecal flotations (1), as were several of the other previously reported cases (11-12).

Data presented in this report suggest that cryptosporidiosis occurs among not only immunologically compromised persons but also apparently healthy individuals. This information also adds substantial support to earlier proposals that cryptosporidiosis is a zoonosis (1,13) and that Cryptosporidium is not host specific (1,13,14), as has been reported (15). In the cases discussed above, it appears that Cryptosporidium caused the illness of the infected individuals. Cultures of fecal samples for salmonellae were negative; however, techniques for detecting other viral or bacterial pathogens were not performed. These data also indicate that calves with diarrhea due to Cryptosporidium should be considered as potential sources of human infection and that proper precautions should be taken by individuals who have contact with such animals.

References

  1. Reese NC, Current WL, Ernst JV, Bailey WS. Cryptosporidiosis of man and calf: a case report and results of experimental infections in mice and rats. Am J Trop Med Hyg 1982;31:226-9.

  2. Lasser KH, Lewin KJ, Ryning FW. Cryptosporidial enteritis in a patient with congenital hypogammaglobulinemia. Hum Pathol 1979;10:234-340.

  3. Stemmermann GN, Hayashi T, Glober GA, Oishi N, Frankel RI. Cryptosporidiosis: report of a fatal case complicated by disseminated toxoplasmosis. Am J Med 1980;69:637-42.

  4. Weinstein L, Edelstein SM, Madara JL, Falchuk KR, McManus BM, Trier JR. Intestinal cryptosporidiosis complicated by disseminated cytomegalovirus infection. Gastroenterology 1981;81:584-91.

  5. Sloper KS, Dourmaskin RR, Bird RB, Slavin C, Wester ADB. Chronic malabsorption due to cryptosporidiosis in a child with immunoglobulin deficiency. Gut 1982; 23:80-2.

  6. Bird RG, Smith MD, Cryptosporidiosis in man: parasite life cycle and fine structural pathology. J Pathol 1980;132:217-33.

  7. Bird RG. Protozoa and viruses human cryptosporidiosis and concomitant viral enteritis. In: Parasitological topics, E.U. Canning (ed). Society of Protozoologists Sp. Pub. No. 1. Lawrence, KS: Society of Protozoologists. (In press).

  8. Weisburger WR, Hutcheon DF, Yardley JH, Roche JC, Hillis WD, Charache P. Cryptosporidiosis in an immunosuppressed renal-transplant recipient with IgA deficiency. Am J Clin Pathol 1979;72:473-8.

  9. Meisel JL, Perera DR, Meligro C, Rubin CE. Overwhelming watery diarrhea associated with Cryptosporidium in an immunosuppressed patient. Gasteroenterology 1976;70:1156-60.

  10. Nime FA, Burek JD, Page DL, Holscher MA, Yardley JH. Acute enterocolitis in a human being infected with protozoan Cryptosporidium: Gastroenterology 1976;70:592-8.

  11. Tzipori S, Angus KW, Gray EW, Campbell I. Vomiting and diarrhea associated with Cryptosporidium infection. N Engl J Med 1980;303:818.

  12. Anderson BC, Donndelinger T, Wilkins RM, Smith J. Cryptosporidiosis in a veterinary student. J Am Vet Med Assoc 1982:30:408-9.

  13. Tzipori S, Angus KW, Campbell I, Gray EW. Cryptosporidium: evidence for a single-species genus. Infect Immun 1980;30:884-6.

  14. Moon HW, Bemrick WJ. Fecal transmission of calf cryptosporidia between calves and pigs. Vet Pathol 1981;18:248-55.

  15. Levine ND. Some corrections of coccidian (apicomplexa: protozoa) nomenclature. J Parasitol 1980;66:830-4.



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