FDA's Bad Bug Book
Cryptosporidium parvum, a single-celled animal, i.e., a protozoa, is an obligate intracellular parasite. It has been given additional species names when isolated from different hosts. It is currently thought that the form infecting humans is the same species that causes disease in young calves. The forms that infect avian hosts and those that infect mice are not thought capable of infecting humans. Cryptosporidium sp. infects many herd animals (cows, goats, sheep among domesticated animals, and deer and elk among wild animals). The infective stage of the organism, the oocyst is 3 um in diameter or about half the size of a red blood cell. The sporocysts are resistant to most chemical disinfectants, but are susceptible to drying and the ultraviolet portion of sunlight. Some strains appear to be adapted to certain hosts but cross-strain infectivity occurs and may or may not be associated with illness. The species or strain infecting the respiratory system is not currently distinguished from the form infecting the intestines.
Intestinal cryptosporidiosis is characterized by severe watery diarrhea but may, alternatively, be asymptomatic. Pulmonary and tracheal cryptosporidiosis in humans is associated with coughing and frequently a low-grade fever; these symptoms are often accompanied by severe intestinal distress. Intestinal cryptosporidiosis is self-limiting in most healthy individuals, with watery diarrhea lasting 2-4 days. In some outbreaks at day care centers, diarrhea has lasted 1 to 4 weeks. To date, there is no known effective drug for the treatment of cryptosporidiosis.
Cryptosporidium sp. could occur, theoretically, on any food touched by a contaminated food handler. Incidence is higher in child day care centers that serve food. Fertilizing salad vegetables with manure is another possible source of human infection. Large outbreaks are associated with contaminated water supplies. Direct human surveys indicate a prevalence of about 2% of the population in North America. Serological surveys indicate that 80% of the population has had cryptosporidiosis.
The extent of illness associated with reactive sera is not known. Since 1984, cryptosporidiosis has been associated with outbreaks of diarrheal illness in child day care centers throughout the United States and Canada. During 1987 a waterborne outbreak in Georgia produced illness in an estimated 13,000 individuals, and exposure to contaminated drinking water was the major distinction between those that were ill and those that were not. This was the first report of disease transmission by a municipal water system that was in compliance with all state and federal standards.