From root@aspensys.com Wed Jun 21 15:02:39 1995 Date: Wed, 21 Jun 1995 18:16:44 +0500 CENTERS FOR DISEASE CONTROL AND PREVENTION HIV/AIDS PREVENTION CDC NATIONAL AIDS HOTLINE TRAINING BULLETIN ................................................................. June 19, 1995 #145 This is a statement from the Centers for Disease Control and Prevention (CDC) concerning cryptosporidiosis (krip-to-spo- rid-e-o-sis). Persons with severely weakened immune systems should be aware that they may be at risk of severe disease if they are infected with Cryptosporidium and they need to be aware of ways to reduce this risk. People at risk for severe cryptosporidiosis include people with AIDS; people with cancer who are taking drugs that weaken the immune system; people with organ or bone marrow transplants who are taking drugs that weaken the immune system; and people who are born with genetically weakened immune systems. People who are uncertain as to whether they fall in these categories should consult with their health care provider. Cryptosporidium is spread by contact with the stools of infected people or animals, by hand-to-mouth spread from surfaces that are contaminated with infected stool, by swallowing contaminated water in a swimming pool or lake, by drinking contaminated water, or by eating contaminated uncooked foods. The level of risk from drinking tap water is unknown, but in most situations this risk is thought to be very low. The risk probably varies from city to city and by time of the year, and depends on the quality of the source water (whether it contains human sewage or animal waste) and the quality of the water treatment process. This report provides information for people with severely weakened immune systems who want to reduce their risk of getting cryptosporidiosis from drinking water. The only sure method is to boil water. Other methods include using certain types of home water filters or drinking certain types of bottled water. What is cryptosporidiosis? Cryptosporidiosis is a disease caused by the parasite Cryptosporidium parvum, which as late as 1976 was not known to cause disease in humans. Until 1993, when over 400,000 people in Milwaukee, WI, became ill with diarrhea after drinking water contaminated with the parasite, few people had heard of either cryptosporidiosis or the single-celled intestinal protozoon that causes it. Since the Milwaukee outbreak, concern about the safety of drinking water in the United States has increased, and new attention has been focused on determining and reducing the risk for cryptosporidiosis from community and municipal water supplies. How is cryptosporidiosis spread? Cryptosporidiosis is spread by putting something in the mouth that has been contaminated with the stool of an infected person or animal. In this way, people swallow the Cryptosporidium parasite, which is too small to be seen with the naked eye. A person can become infected by drinking contaminated water or eating raw or undercooked food contaminated with Cryptosporidium oocysts (an egg-like form of the parasite that is the infectious stage); direct contact with the droppings of infected animals or stool of infected humans; or hand-to-mouth transfer of oocysts from surfaces that may have become contaminated with microscopic amounts of stool from an infected person or animal. What are the symptoms of cryptosporidiosis? Two to ten days after infection by the parasite, symptoms may appear. Although some persons may not have symptoms, others have watery diarrhea, headache, abdominal cramps, nausea, vomiting, and low-grade fever. These symptoms may lead to weight loss and dehydration. In otherwise healthy persons, these symptoms usually last 1 to 2 weeks, at which time the immune system is able to stop the infection. In persons with suppressed immune systems, such as persons who have AIDS or recently have had an organ or bone marrow transplant, the infection may continue and become life-threatening. What should you do if you suspect that you have cryptosporidiosis? See your physician. Since the routine stool examination used for most parasites usually fails to detect Cryptosporidium, a stool specimen should be examined using stains/tests available especially for this parasite. It is important for persons with a poorly functioning immune system to seek medical attention early in the course of their disease. What is the treatment for cryptosporidiosis? No safe and effective cure is available for cryptosporidiosis. People who have normal immune systems improve without taking antibiotic or antiparasitic medications. The treatment recommended for this diarrheal illness is to drink plenty of fluids and to get extra rest. Physicians may prescribe medication to slow the diarrhea during recovery. Who is at risk? Persons at increased risk for cryptosporidiosis include child care workers; diaper-aged children who attend child care centers; persons exposed to human feces by sexual contact; and caregivers who might come in direct contact with feces while caring for a person infected with cryptosporidiosis at home or in a medical facility. Once infected, persons with suppressed immune systems, such as cancer chemotherapy patients, are at risk for severe disease. How can you prevent cryptosporidiosis? Avoid water or food that may be contaminated. Wash hands after using the toilet and before handling food. If you work in a child care center where you change diapers, be sure to wash your hands thoroughly with plenty of soap and warm water after every diaper change, even if you wear gloves. During communitywide outbreaks caused by contaminated drinking water, boil drinking water for 1 minute to kill the Cryptosporidium parasite. Allow water to cool before drinking it. HIV-infected persons should avoid drinking water directly from lakes or rivers; avoid unpasteurized milk or milk products; avoid exposure to calves and lambs and places where these animals are raised; wash hands after contact with pets; and wash hands after gardening or other contact with soil. Because any sexual activity that brings a person in contact with the feces of an infected partner greatly increases the risk for cryptosporidiosis, HIV-infected persons and AIDS patients should follow gsafer sexg guidelines and avoid sexual practices that may result in contact with feces. If you are a caregiver of cryptosporidiosis patients, wash hands after bathing patients, emptying bedpans, changing soiled linen, or otherwise coming in contact with the stools of patients. If you have cryptosporidiosis, wash your hands often to prevent spreading the disease to other members of your household. For more information on cryptosporidiosis, see the following sources: Cordell RL, Addiss DG. Cryptosporidiosis in child care settings: a review of the literature and recommendations for prevention and control. Pediatr Infect Dis J. 1994;13(4):310-17. Dubey JP, Speer CA, Fayer R. Cryptosporidiosis of man and animals. Boston: CRC Press, 1990. LeChevallier MW, Norton WD, Lee RG. Giardia and Cryptosporidium spp. in filtered drinking water supplies. Appl Environ Microbiol 1991;57(9):2617-21. MacKenzie WR, Hoxie NJ, Proctor ME, Gradus MS, Blair KA, Peterson DE, Kazmierczak JJ, Addiss DG, Fox KR, Rose JB, Davis JP. A massive outbreak in Milwaukee of Cryptosporidium infection transmitted through the filtered public water supply. N Engl J Med 1994; 331:161-7. Rose JB, Gerba CP, and Jakubowski W. Survey of potable water supplies for Cryptosporidium and Giardia. Environmental Science and Technology 1991;25(8):1393-1400. Smith PD, Quinn TC, Strober W, Janoff EN, Masur H. Gastrointestinal infections in AIDS. Ann Intern Med 1992;116:63-77. Disclaimer: CDC Hotline Training Bulletins The information in the "CDC Hotline Training Bulletins" is provided by CDC and NIH for use by the CDC National AIDS Hotline in responding to general questions from the public about HIV and AIDS. The bulletins are not intended to be comprehensive discussions of the subject areas. Treatment and drug therapy options change as new research and clinical experiences broaden scientific knowledge. Therefore, persons seeking information on drug therapy should refer to the product information sheet included in all drug packages for the most current and accurate information about a particular drug, especially if the drug is new or infrequently used. HIV-infected individuals should consult their personal physician for specific concerns about their health. For persons desiring more information on a specific topic, public, medical, and university libraries can provide excellent references. The AIDS Clinical Trials Information Service (800-874-2572) can provide information about ongoing HIV/AIDS clinical trials; the HIV/AIDS Treatment Information Service (800-448-0440) can assist with information about the latest treatments for persons with HIV infection or AIDS.