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      Sporadic Cryptosporidiosis, North Cumbria, England, 1996–2000

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          Abstract

          Risk factors for sporadic cryptosporidiosis were determined in 152 patients and 466 unmatched controls who resided in two local government districts in North Cumbria, North West England, from March 1, 1996, to February 29, 2000. Risk was associated with the usual daily volume of cold unboiled tap water drunk (odds ratio [OR] 1.40, 95% confidence intervals [CI] 1.14 to 1.71 per pint consumed per day [p = 0.001]) and short visits to farms (OR 2.02, 95% CI 1.04 to 3.90, p = 0.04). Fifty-six (84%) of 67 fecal specimens from patients obtained from January 1, 1998, and February 29, 2000, were Cryptosporidium parvum genotype 2 (animal and human strain). Livestock fecal pollution of water sources appears to be the leading cause of human sporadic cryptosporidiosis in this population and shows the need for better protection of water catchments from livestock and improved drinking water treatment in this area of England.

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          Epidemiology of Cryptosporidium: transmission, detection and identification.

          Daniel Upton, Ronald Fayer, U Morgan (2000)
          There are 10 valid species of Cryptosporidium and perhaps other cryptic species hidden under the umbrella of Cryptosporidium parvum. The oocyst stage is of primary importance for the dispersal, survival, and infectivity of the parasite and is of major importance for detection and identification. Because most oocysts measure 4-6 microm, appear nearly spherical, and have obscure internal structures, there are few or no morphometric features to differentiate species and in vitro cultivation does not provide differential data as for bacteria. Consequently, we rely on a combination of data from three tools: morphometrics, molecular techniques, and host specificity. Of 152 species of mammals reported to be infected with C. parvum or an indistinguishable organism, very few oocysts have ever been examined using more than one of these tools. This paper reviews the valid species of Cryptosporidium, their hosts and morphometrics; the reported hosts for the human pathogen, C. parvum; the mechanisms of transmission; the drinking water, recreational water, and food-borne outbreaks resulting from infection with C. parvum; and the microscopic, immunological, and molecular methods used to detect and identify species and genotypes.
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            Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance. The Infectious Intestinal Disease Study Executive.

            P Roderick, Rita C. L. B. Rodrigues, P. Wall … (1999)
            To establish the incidence and aetiology of infectious intestinal disease in the community and presenting to general practitioners. Comparison with incidence and aetiology of cases reaching national laboratory based surveillance. Population based community cohort incidence study, general practice based incidence studies, and case linkage to national laboratory surveillance. 70 general practices throughout England. 459 975 patients served by the practices. Community surveillance of 9776 randomly selected patients. Incidence of infectious intestinal disease in community and reported to general practice. 781 cases were identified in the community cohort, giving an incidence of 19.4/100 person years (95% confidence interval 18.1 to 20.8). 8770 cases presented to general practice (3.3/100 person years (2.94 to 3.75)). One case was reported to national surveillance for every 1.4 laboratory identifications, 6.2 stools sent for laboratory investigation, 23 cases presenting to general practice, and 136 community cases. The ratio of cases in the community to cases reaching national surveillance was lower for bacterial pathogens (salmonella 3.2:1, campylobacter 7.6:1) than for viruses (rotavirus 35:1, small round structured viruses 1562:1). There were many cases for which no organism was identified. Infectious intestinal disease occurs in 1 in 5 people each year, of whom 1 in 6 presents to a general practitioner. The proportion of cases not recorded by national laboratory surveillance is large and varies widely by microorganism. Ways of supplementing the national laboratory surveillance system for infectious intestinal diseases should be considered.
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              Effects of ozone, chlorine dioxide, chlorine, and monochloramine on Cryptosporidium parvum oocyst viability.

              D G Korich, J R Mead, M Madore … (1990)
              Purified Cryptosporidium parvum oocysts were exposed to ozone, chlorine dioxide, chlorine, and monochloramine. Excystation and mouse infectivity were comparatively evaluated to assess oocyst viability. Ozone and chlorine dioxide more effectively inactivated oocysts than chlorine and monochloramine did. Greater than 90% inactivation as measured by infectivity was achieved by treating oocysts with 1 ppm of ozone (1 mg/liter) for 5 min. Exposure to 1.3 ppm of chlorine dioxide yielded 90% inactivation after 1 h, while 80 ppm of chlorine and 80 ppm of monochloramine required approximately 90 min for 90% inactivation. The data indicate that C. parvum oocysts are 30 times more resistant to ozone and 14 times more resistant to chlorine dioxide than Giardia cysts exposed to these disinfectants under the same conditions. With the possible exception of ozone, the use of disinfectants alone should not be expected to inactivate C. parvum oocysts in drinking water.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (iso-abbrev): Emerging Infect. Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): June 2004
                Volume: 10
                Issue: 6
                Pages: 1007-1015
                Affiliations
                [* ]Carlisle and District Primary Care Trust, Rosehill, Carlisle, United Kingdom;
                [† ]Communicable Disease Surveillance Centre, London, United Kingdom;
                [‡ ]University of Wales, Aberystwyth, Ceredigion, Wales, United Kingdom;
                [§ ]Singleton Hospital, Swansea, Wales, United Kingdom;
                []Cumberland Infirmary, Carlisle, United Kingdom;
                [# ]United Utilities, Great Sankey, Warrington, United Kingdom;
                [** ]West Cumberland Hospital, Whitehaven, United Kingdom
                Author notes
                Address for correspondence:Mark Reacher, Consultant Epidemiologist, Health Protection Agency-Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, U.K.; fax: 44-0-20-8200-7868; email: Mark.Reacher@ 123456hpa.org.uk
                Article
                Publisher ID: 03-0325
                DOI: 10.3201/10.3201/eid1006.030325
                PMC ID: 3323151
                PubMed ID: 15207050
                SO-VID: 11555766-defa-4acb-be80-3be9cc3236ee
                History
                Categories
                Subject: Research
                Subject: Research

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: cryptosporidium, cryptosporidiosis, sporadic,, risk factors, case-control study, water, water treatment , public water supplies, diarrhea, immune suppressions
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: cryptosporidium, cryptosporidiosis, sporadic, , risk factors, case-control study, water, water treatment , public water supplies, diarrhea, immune suppressions

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