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Cryptosporidium parvum
 

Cryptosporidium parvum

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  • 15.2.09

Cryptosporidium parvum Cryptosporidium parvum Presentation Transcript

  • Cryptosporidium parvum Dr Kamran Afzal Asst Prof Microbiology
  • Protozoa
  • Etiologic Agent
    • Phylum: Apicomplexa
    • Class: Sporozoa
    • Order: Coccidiida
    • Family: Cryptosporidiidae
    • Genus: Cryptosporidium
    • Species: C. parvum , C. hominis
  • Morphology
    • Anterior apical complex
  • Introduction
    • Coccidian protozoan parasite
    • E.E. Tyzzerin described in1907
    • First case of human cryptosporidiosis in 1976
    • Association with AIDS in the early 1980s
    • No safe and effective treatment
    • Cryptosporidium infects several different hosts, survives most environments, inhabits all climates
  • Epidemiology
    • Worldwide distribution
    • Affected patients - 3 days to 95 years old
    • Prevalence Non-AIDS:
    • 4.9% (developed countries)
    • 7.9% (underdeveloped countries)
    • AIDS:
    • 14% (developed countries)
    • 24% (underdeveloped countries)
    • Mortality: 80%
  • Transmission
    • Reservoir: Humans, cattle, other domestic animals
    • Food and water contaminated by livestock mammal or human feces containing cysts
    • Outbreaks -drinking water from lakes and rivers, swimming pools, untreated groundwater, well water
    • Cysts survive water chlorination
  • Mode of Transmission
    • Fecal-oral
    • Waterborne
    • Foodborne
    • Community
      • Person to person, esp. child care settings
    • Hospital
      • Patients to health care staff, patient-to-patient
    • Aerosol infection
  • Life Cycle
    • Excystation -release of the four sporozoites
    • Invasion of intestinal epithelial cells
    • Asexual life cycle
    • Sexual life cycle
      • Differentiation of micro and macrogametes
    • Development of oocysts
    • Formation of new, infectious sporozoites
  • Life Cycle
  •  
  • Life Cycle
  • Pathogenesis
    • Sporozoites adhere to the intestinal mucosa
    • Cells release cytokines
    • Increased intestinal secretion of sodium and chloride, water absorption is inhibited
    • Epithelial cells damaged by:
      • Parasite invasion and multiplication
      • T cell-mediated-villus atrophy
    • May produce up to 10-20 liters of watery stools per day
  • Oocysts
    • Oocysts are 4-5 microns
    • Oocysts survive extreme conditions
      • Oocysts infective for 2-6 months in environment
    • Oocysts in stool appear with onset of symptoms
    • Oocysts are immediately infectious
      • Infection may result from 10 oocysts
    • Oocysts shed for several weeks after symptoms resolve
    • Asymptomatic infections appear to be common
  • Susceptible Individuals
    • Immunocompromised
    • AIDS patients
    • Young children and elderly patients
    • Pregnant women
  • Clinical Symptoms
    • Incubation period: 1-14 days
    • Voluminous diarrhea leading to weight loss and dehydration, abd cramps, fever, nausea and vomiting
    • Bile duct infection can produce jaundice
    • Self-limited disease in immuno-competent individuals
    • In immunocompromised host, degree of immunodeficiency correlates with severity:
        • Severe acute diarrhea
        • Chronic diarrhea over months (<50 CD4 count)
        • Self-resolving disease
    • Malabsorption can contribute to the wasting syndrome in AIDS patients
  • Lab Diagnosis
    • Oocysts in stool by
      • Modified ZN staining
    • Oocysts in stool by
      • Fluorescent antibody
      • staining
    • Anti-cryptosporidial
    • IgM and IgG by ELISA or ICT
    • PCR
  • Histopathology
    • No safe and effective therapy
    • General supportive care - Rehydration and replacement of electrolytes
    • Spiramycin – partial response
    • Paromomycin decreases the intensity of infection, improve intestinal functions
    • Relapse after treatment is common
    Treatment
  • Prevention
    • Boiling and microfiltration of drinking water
    • Micro filtration removes oocysts from the water supply
    • Low levels of chlorine does not kill cysts
      • C. parvum 240,000 times resistant to chlorination than Giardia
      • Chlorine dioxide -ineffective for oocysts
  • Waterborne Prevention
    • Do not swallow recreational water
      • Lakes, rivers, streams, untested wells
    • Do not drink untreated water
      • Travelers and hikers
      • Boil water for 15 minutes or use filter rated for “cyst removal”
      • Don’t rely on chemical treatments
    • Do not swim with GI infection
  • Foodborne Prevention
    • Wash vegetables with detergent soap
    • Proper human/animal waste disposal
    • No bare hand contact of ready-to-eat foods
    • No food workers with GI illness
      • Until 2 weeks after end of diarrhea
    • Handwashing-handwashing-handwashing
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