Waterborne Outbreak of Cryptosporidiosis

Smith, H. V.; Girdwood, R. W. A.; Patterson, W.J.; Hardie, R.; Green, L.A; Benton, Charles V.; Tulloch, W. J.; Sharp, J. C. M.; Forbes, G. I.

doi:10.1016/s0140-6736(88)90951-8

Cited by 45 publications

(25 citation statements)

References 2 publications

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“…by consumption of contaminated surface or ground water is well documented and wa-IQBAL AND OTHERS terborne outbreaks have been reported. [22][23][24] However, in spite of the low socioeconomic status of our pediatric population, we did not observe any correlation between cryptosporidiosis and living conditions such as presence of domestic animals at home or water source. Laboratory-confirmed cryptosporidial infections are a small minority because symptoms are often mild or absent and examination of feces is not performed.…”

Section: Discussioncontrasting

confidence: 69%

Cryptosporidium infection in young children with diarrhea in Rawalpindi, Pakistan.

Iqbal

Munir²,

Khan³

1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. Fecal excretion of Cryptosporidium parvum oocysts was determined in 625 children less than five years old who presented at the pediatric clinic of a teaching hospital in Rawalpindi, Pakistan. Single stool specimens were collected from 475 children with acute diarrhea and from 150 children without diarrhea. The Cryptosporidium infection rate was significantly higher in children with diarrhea than in children without diarrhea (10.3% versus 3.3%). The C. parvum infection rate was highest in children 19-24 months of age (21.8%). There was no significant difference in the Cryptosporidium infection rate among male and female children of any age group studied. Sociodemographic information, drinking water supply, and contact with domestic animals had no significant role in the acquisition of C. parvum infection in our study population. The data suggest that C. parvum is relatively endemic in young children in the Rawalpindi area and that C. parvum may be an important pathogen associated with diarrhea.Enteric cryptosporidiosis is prevalent worldwide and causes a variety of problems ranging from acute severe diarrhea to self-limiting diarrhea, mainly in infants and young children, to nosocomial infection leading to fatal cases in immunocompromised persons. [1][2][3] In well-nourished, immunocompetent children, the disease is often short and selflimited. 2 However, this enteric agent is associated with persistent diarrhea in malnourished pediatric 4,5 and with prolonged severe or fatal watery diarrhea in patients with acquired immunodeficiency syndrome. 6 Children may be most susceptible, 4,7 and those less than two years old may have the greatest prevalence. 8 Epidemiologic studies have demonstrated that Cryptosporidium is more prevalent in developing countries (5% to Ͼ 10%) than in developed countries (Ͻ 1% to 3%). 2,3,[9][10][11] In most studies, the isolation rates from healthy persons have been low; however, several recent reports have identified high percentages of asymptomatic infections in children from South Africa 10 and India. 11 In Pakistan, no study has been conducted to determine the C. parvum infection rate in children. In this study, we report the prevalence and importance of C. parvum infection as a causal agent of acute diarrhea among children in Rawalpindi, Pakistan. MATERIALS AND METHODSStudy population. The study was conducted during the period March 1996 to September 1996 in 475 children (250 boys and 225 girls) less than three years of age with acute diarrheal disease presenting at the pediatric clinic of Rawalpindi General Teaching Hospital (RGH). The control group included 150 comparable children presenting at the same clinic with complaints other than gastrointestinal symptoms. This hospital covers a large area of population living in urban as well as in the rural areas. Four hundred twenty-two of the children were severely dehydrated and required admission to the hospital for rehydration. This extremely high rate of dehydration seen in the children is primarily due to the lack of health...

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Section: Discussioncontrasting

confidence: 69%

Cryptosporidium infection in young children with diarrhea in Rawalpindi, Pakistan.

Iqbal

Munir²,

Khan³

1999

The American Journal of Tropical Medicine and Hygiene

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“…As mentioned above, a number of waterborne outbreaks have been documented (86,107,129,271,290,291). The first documented waterborne outbreak of cryptosporidiosis occurred in San Antonio, Tex., and was linked to sewage leakage into well water (86).…”

Section: Waterborne Transmissionmentioning

confidence: 99%

“…In 1983, an accidental laboratory infection demonstrated that a human isolate of C. parvum could be transmitted from one person to another (33). Since that time, outbreaks of cryptosporidiosis among children in day-care centers have been reported (2,3,56,62,93,131,172,217,237,254,292,301), hospital-acquired infections have been investigated (28,167,203,204), a number of waterborne outbreaks have been documented (86,107,129,271,290,291), and this protozoan is now recog-CLIN. MICROBIOL.…”

Section: Sources Of Human Infectionmentioning

confidence: 99%

“…The only significant risk factor associated with illness was exposure to the public water supply which was filtered and chlorinated, and, according to records kept during the outbreak, the treatment facility was operating within established Environmental Protection Agency (EPA) guidelines. In 1988 and 1989, two additional Cryptosporidium-related waterborne outbreaks were reported in Ayshire, Scotland, and Oxfordshire-Swindon, England (290,291).…”

Section: Waterborne Transmissionmentioning

confidence: 99%

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Cryptosporidiosis

1991

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Before 1982, only eight case reports of human cryptosporidiosis and fewer than 30 papers on Cryptosporidium spp. appeared in the biomedical literature. At that time, cryptosporidiosis was thought to be an infrequent infection in animals and rarely an opportunistic infection in humans. The concept of Cryptosporidium spp. as pathogens has changed dramatically within the past 8 years because of improved diagnostic techniques, increased awareness within the biomedical community, and the development of basic research programs in numerous laboratories. Presently, greater than 1,000 publications including over 400 case reports in the biomedical literature address Cryptosporidium spp. and cryptosporidiosis. Cryptosporidium parvum is now thought to be one of the three most common enteropathogens causing diarrheal illness in humans worldwide, especially in developing countries. It is likely that cryptosporidiosis was previously included in the 25 to 35% of diarrheal illness with unknown etiology. Because of the severity and length of diarrheal illness and because no effective therapy has been identified, cryptosporidiosis is one of the most ominous infections associated with AIDS. The role of C. parvum as an enteropathogen is well established; documentation of its role as a cause of hepatobiliary and respiratory diseases is now appearing in the literature. Our present understanding of the natural history, epidemiology, biology, and immunology of Cryptosporidium spp. as well as the clinical features, pathogenicity, and treatment of cryptosporidiosis are reviewed here.

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“…The infection is contracted through ingestion of oocysts (9,10). This can occur following contact with infected animals or by ingestion of contaminated water or foodstuffs (11)(12)(13)(14)(15)(16). Person-to-person spread also occurs (17)(18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

An outbreak of waterborne cryptosporidiosis in Swindon and Oxfordshire

et al. 1991

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SUMMARYAn outbreak of cryptosporidiosis resulted in 516 cases in Wiltshire and Oxfordshire. The outbreak caused widespread interest and led to an official inquiry. The majority of cases were in children; 8% of cases were admitted to hospital and the median duration of illness was 3 weeks. The geographical distribution of cases matched the distribution of water supplies from three treatment works and cryptosporidium oocysts were found at these works and in the treated water. Attack rates in electoral wards supplied by the three treatment works were significantly higher than in other wards. The cause of the outbreak appeared to be the failure of normal treatment to remove oocysts. Measures at the treatment works reduced the number of oocysts detected in treated water, after which the outbreak came to an end. The conclusion of the investigations was that cryptosporidiosis is a risk of conventionally treated public water supplies.

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Waterborne Outbreak of Cryptosporidiosis

Cited by 45 publications

References 2 publications

Cryptosporidium infection in young children with diarrhea in Rawalpindi, Pakistan.

Cryptosporidium infection in young children with diarrhea in Rawalpindi, Pakistan.

Cryptosporidiosis

An outbreak of waterborne cryptosporidiosis in Swindon and Oxfordshire

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