Long-term sequelae of sporadic cryptosporidiosis: a follow-up study

Iglói, Zsófia; Mughini‐Gras, Lapo; Lochlainn, Laura Nic; Barrasa, Alicia; Sane, Jussi; Mooij, Sofie H.; Schimmer, Barbara; Roelfsema, Jeroen H.; Pelt, Wilfrid van; Kortbeek, Titia

doi:10.1007/s10096-018-3268-9

Cited by 14 publications

(12 citation statements)

References 25 publications

(29 reference statements)

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“…Five of the 8 qualitative synthesis studies included a control group. A limited evaluation of risk of individual sequelae using the five case-control studies available was undertaken [ 4 , 15 , 17 , 19 , 20 ]. Data were available for 10 sequelae (Table 4 ).…”

Section: Resultsmentioning

confidence: 99%

Health sequelae of human cryptosporidiosis in industrialised countries: a systematic review

2020

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Background Cryptosporidium is a protozoan parasite which is a common cause of gastroenteritis worldwide. In developing countries, it is one of the most important causes of moderate to severe diarrhoea in young children; in industrialised countries it is a cause of outbreaks of gastroenteritis associated with drinking water, swimming pools and other environmental sources and a particular concern in certain immunocompromised patient groups, where it can cause severe disease. However, over recent years, longer-term sequelae of infection have been recognised and a number of studies have been published on this topic. The purpose of this systematic review was to examine the literature in order to better understand the medium- to long-term impact of cryptosporidiosis. Methods This was a systematic review of studies in PubMed, ProQuest and Web of Science databases, with no limitations on publication year or language. Studies from any country were included in qualitative synthesis, but only those in industrialised countries were included in quantitative analysis. Results Fifteen studies were identified for qualitative analysis which included 3670 Cryptosporidium cases; eight studies conducted in Europe between 2004–2019 were suitable for quantitative analysis, including five case-control studies. The most common reported long-term sequelae were diarrhoea (25%), abdominal pain (25%), nausea (24%), fatigue (24%) and headache (21%). Overall, long-term sequelae were more prevalent following infection with Cryptosporidium hominis , with only weight loss and blood in stool being more prevalent following infection with Cryptosporidium parvum . Analysis of the case-control studies found that individuals were 6 times more likely to report chronic diarrhoea and weight loss up to 28 months after a Cryptosporidium infection than were controls. Long-term abdominal pain, loss of appetite, fatigue, vomiting, joint pain, headache and eye pain were also between 2–3 times more likely following a Cryptosporidium infection. Conclusions This is the first systematic review of the long-term sequelae of cryptosporidiosis. A better understanding of long-term outcomes of cryptosporidiosis is valuable to inform the expectations of clinicians and their patients, and public health policy-makers regarding the control and prevention of this infection. Systematic review registration PROSPERO Registration number CRD42019141311

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Section: Resultsmentioning

confidence: 99%

Health sequelae of human cryptosporidiosis in industrialised countries: a systematic review

2020

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“…Since there was no clear evidence that outcomes, their duration, severity or costs differed by sex, analysis were not stratified by gender. We did consider age-specific incidence, as there were differences in health outcomes and demand of resources by age [ 29 , 32 , 35 ]. Finally, for simplicity reasons we decided not to account for the differences in immunocompromised patients, assuming that the population averages for duration and severity would adequately reflect the presence of immunocompromised individuals and their outcomes.…”

Section: Methodsmentioning

confidence: 99%

“…Regarding long-term manifestations, there was evidence of recurrent gastrointestinal symptoms for both Cryptosporidium species up to 1 year after the acute infection [ 32 – 34 , 38 ]. We considered only recurrent diarrhea, and no other gastrointestinal symptoms.…”

Section: Methodsmentioning

confidence: 99%

“…We considered only recurrent diarrhea, and no other gastrointestinal symptoms. Incidence was considered lower in mild cases [ 12 ] as compared to severe and moderate cases [ 24 , 32 – 34 ], and higher in children <15 years [ 13 , 35 ]. The number of recurrent episodes was also higher in children [ 13 , 35 ].…”

Section: Methodsmentioning

confidence: 99%

“…Joint pain was found to follow infection by C . hominis [ 20 , 21 , 32 ], but evidence was weaker in case of C . parvum [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

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Accounting for long-term manifestations of Cryptosporidium spp infection in burden of disease and cost-of-illness estimations, the Netherlands (2013–2017)

et al. 2019

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BackgroundBurden of disease (BoD) estimations are increasingly used to prioritize public health interventions. Previous Cryptosporidium BoD models accounted only for acute episodes, while there is increasing evidence of long-term manifestations. Our objective was to update Cryptosporidium BoD and cost-of-illness (COI) models and to estimate BoD and COI for the Netherlands in years 2013–2017.MethodsWe performed a scoping literature review and drew an outcome tree including long-term manifestations for which sufficient evidence was found, such as recurrent diarrhea and joint pain. We chose the Disability-Adjusted Life Year (DALY) metric to synthesize years of life lost due mortality (YLLs) and years lived with disability due to non-fatal outcomes (YLDs). For the costs, we adopted a societal perspective accounting for direct healthcare costs, patient costs and productivity losses. Uncertainty was managed using Latin Hypercube sampling (30,000 iterations).ResultsIn the Netherlands in 2017, we estimated 50,000 Cryptosporidium cases (95% uncertainty interval (UI): 15,000–102,000), 7,000 GP visits, 300 hospitalizations and 3 deaths, resulting in 137 DALYs (95%UI: 54–255) and €19.2 million COI (95%UI: €7.2 million– €36.2 million). Estimates were highest for 2016 (218 DALYs and €31.1 million in COI), and lowest in 2013 (100 DALYs and €13.8 million in COI). Most of the BoD was attributable to YLD (≈80% of DALYs). The most important cost was productivity losses (≈90% of total COI). Long-term manifestations, including recurring diarrhea and joint pain, accounted for 9% of the total DALYs and 7% of the total COI.ConclusionCurrent evidence supports the inclusion of long-term manifestations in Cryptosporidium models, which contribute close to 10% of the total DALYs and costs. This may be an underestimation, as we were conservative in our assumptions. Cryptosporidium should be considered a priority organism with respect to public health surveillance, even in industrialized countries with high hygiene standards.

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Outbreak of Cryptosporidium hominis in northern Sweden: persisting symptoms in a 5-year follow-up

et al. 2022

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In 2010–2011, a waterborne outbreak of the parasite, Cryptosporidium hominis, affected approximately 27,000 inhabitants in the city of Östersund, Sweden. Previous research suggested that post-infectious symptoms, such as gastrointestinal symptoms and joint pain, could persist for up to 2 years after the initial infection. In this study, we investigated whether the parasite caused post-infectious sequelae for up to 5 years after the outbreak. Prospective cohort study. A randomly selected cohort of individuals residing in Östersund at the time of the outbreak was sent a postal questionnaire in 2011. Responders were sent a follow-up questionnaire in 2016 and completed items on whether they experienced a list of symptoms. We examined whether outbreak cases were more likely than non-cases to report post-infectious symptoms 5 years later. We analysed data using logistic regression and calculated odds ratios with 95% confidence intervals. The analysis included 626 individuals. Among the 262 individuals infected during the outbreak, 56.5% reported symptoms at follow-up. Compared to non-cases, outbreak cases were more likely to report watery diarrhoea, diarrhoea, swollen joints, abdominal pain, bloating, joint discomfort, acid indigestion, alternating bowel habits, joint pain, ocular pain, nausea, and fatigue at the follow-up, after adjusting for age and sex. Our findings suggested that cryptosporidiosis was mainly associated with gastrointestinal- and joint-related post-infectious symptoms for up to 5 years after the infection.

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Long-term sequelae of sporadic cryptosporidiosis: a follow-up study

Cited by 14 publications

References 25 publications

Health sequelae of human cryptosporidiosis in industrialised countries: a systematic review

Health sequelae of human cryptosporidiosis in industrialised countries: a systematic review

Accounting for long-term manifestations of Cryptosporidium spp infection in burden of disease and cost-of-illness estimations, the Netherlands (2013–2017)

Outbreak of Cryptosporidium hominis in northern Sweden: persisting symptoms in a 5-year follow-up

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