Cryptosporidium enteritis

  • Definition
    • Cryptosporidium enteritis is an infection of the small intestine that causes diarrhea. The parasite cryptosporidium causes this infection.

  • Alternative Names
    • Cryptosporidiosis

  • Causes
    • Cryptosporidium has recently been recognized as a cause of diarrhea worldwide in all age groups. It has a greater effect on people with a weakened immune system, including:

      • People who take medicines to suppress their immune system
      • People with HIV or AIDS
      • Transplant recipients

      In these groups, this infection is not just bothersome. It also can lead to severe and life-threatening loss of muscle and body mass (wasting) and malnutrition.

      The major risk factor is drinking water that is contaminated with feces (stool). People at higher risk include:

      • Animal handlers
      • Men who have sex with men
      • People who are in close contact with infected people
      • Young children

      Outbreaks have been linked to:

      • Drinking from contaminated public water supplies
      • Drinking unpasteurized cider
      • Swimming in contaminated pools and lakes

      Some outbreaks have been very large.

  • Symptoms
    • Symptoms of infection include:

      • Abdominal cramping
      • Diarrhea, which is often watery, large-volume, and occurs many times a day
      • General sick feeling (malaise)
      • Malnutrition and weight loss (in severe cases)
      • Nausea
  • Exams and Tests
    • These tests may be done:

      • Antibody test to see if cryptosporidium is in the stool
      • Intestinal biopsy (rare)
      • Stool exam with special techniques (AFB staining)
      • Stool exam using a microscope to look for the parasites and their eggs
  • Treatment
    • There are several treatments for cryptosporidium enteritis.

      Drugs such as nitazoxanide have been used in children and adults. Other drugs that are sometimes used include:

      • Atovaquone
      • Paromomycin

      These drugs often help only for a little while. It is common for the infection to return.

      The best approach is to improve immune function in people who have a weakened immune system. In people with AIDS, this can be done by using highly active antiviral therapy. It can lead to a complete remission of cryptosporidium enteritis.

  • Outlook (Prognosis)
    • In healthy people, the infection will clear up, but it can last up to a month. In people with a weakened immune system, long-term diarrhea may cause weight loss and malnutrition.

  • Possible Complications
    • These complications can occur:

      • Inflammation of a bile duct
      • Inflammation of the gallbladder
      • Inflammation of the liver (hepatitis)
      • Malabsorption (not enough nutrients being absorbed from the intestinal tract)
      • Inflammation of the pancreas (pancreatitis)
      • Loss of body mass that causes extreme thinness and weakness (wasting syndrome)
  • When to Contact a Medical Professional
    • Contact your health care provider if you develop watery diarrhea that does not go away within a few days, especially if you have a weakened immune system.

  • Prevention
    • Proper sanitation and hygiene, including handwashing, are important measures for preventing this illness.

      Certain water filters can also reduce risk by filtering out the cryptosporidium eggs. However, the pores of the filter must be smaller than 1 micron to be effective. If you have a weakened immune system, ask your provider if you need to boil your water.

  • References
    • Huston CD. Intestinal protozoa. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier; 2016:chap 113.

      Lima AAM, Guerrant RL. Cryptosporidiosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 350.

      White AC Jr. Cryptosporidiosis (Cryptosporidium species). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 284.

      Wright SG. Protozoan infections of the gastrointestinal tract. Infect Dis Clin N Am. 2012;26(2):323-339. PMID: 22632642