Preventing Cryptosporidiosis: A Guide for People with Compromised Immune Systems: DPD
Article title: Preventing Cryptosporidiosis: A Guide for People with Compromised Immune Systems: DPD
A Guide for People with Compromised Immune Systems
- Who might be immunocompromised or have a weakened immune system?
- What is
- What are the symptoms of Crypto
- How long after
infection do symptoms appear?
- How long will
- How does Crypto
affect you if your immune system is severely weakened?
- How is Crypto
- I have been
diagnosed with Crypto. Should I worry about spreading the
infections to others?
- What should I do if
I think I have Crypto?
- How is a Crypto
- What is the
treatment for Crypto?
- How can I protect myself from Crypto?
Examples of persons with weakened immune systems include those with AIDS; cancer and transplant patients who are taking certain immunosuppressive drugs; and those with inherited diseases that affect the immune system. The risk of developing severe disease may differ depending on each person's degree of immune suppression. Following all the recommendations in this fact sheet can be a great personal burden, so consult with your health care provider to determine whether your medical condition makes it advisable to follow all of these recommendations.
Cryptosporidiosis (krip-toe-spo-rid-e-o-sis), is a diarrheal disease caused by a microscopic parasite, Cryptosporidium parvum, that can live in the intestine of humans and animals and is passed in the stool of an infected person or animal. Both the disease and the parasite are also known as "Crypto." The parasite is protected by an outer shell that allows it to survive outside the body for long periods of time and makes it very resistant to chlorine disinfection. During the past 2 decades, Crypto has become recognized as one of the most common causes of waterborne disease (drinking water and recreational water) in humans in the United States. The parasite is found in every region of the United States and throughout the world.
Symptoms include diarrhea, loose or watery stool, stomach cramps, upset stomach, and a slight fever. Some people have no symptoms.
Symptoms generally begin 2-10 days after being infected.
In persons with average immune systems, symptoms usually last about 2 weeks; the symptoms may go in cycles in which you may seem to get better for a few day, then feel worse before the illness ends.
In persons with AIDS and in others whose immune system is weakened, Crypto can be serious, long-lasting, and sometimes fatal. If your CD4+ cell count is below 200, Crypto is more likely to cause diarrhea and other symptoms for a long time. If your CD4+ count is above 200, your illness may not last more than 1 to 3 weeks or slightly longer. However, you could still carry the infection, which means that the Crypto parasites are living in your intestine, but are not causing illness. As a carrier of Crypto, you could infect other people. If your CD4+ count later drops below 200, your symptoms may reappear.
Crypto lives in the intestine of infected humans or animals. Millions of Crypto can be released in a bowel movement from an infected human or animal. You can become infected after accidentally swallowing the parasite. Crypto may be found in soil, food, water, or surfaces that have been contaminated with the feces from infected humans or animals. Crypto is not spread by contact with blood. Crypto can be spread:
- By putting something in your mouth or accidentally swallowing something that has come in contact with the stool of a person or animal infected with Crypto.
- By swallowing recreational water contaminated with Crypto. Recreational water is water in swimming pools, hot tubs, Jacuzzis, fountains, lakes, rivers, springs, ponds, or streams that can be contaminated with sewage or feces from humans or animals.
- By eating uncooked food contaminated with Crypto. Thoroughly wash with uncontaminated water all vegetables and fruits you plan to eat raw. See below for information on making water safe.
- By accidentally swallowing Crypto picked up from surfaces (such as toys, bathroom fixtures, changing tables, diaper pails) contaminated with stool from an infected person.
Yes, Crypto can be very contagious. Follow these guidelines to avoid spreading Crypto to others.
- Wash your hands with soap and water after using the toilet, changing diapers, and before eating or preparing food.
- Avoid swimming in recreational water (pools, hot tubs, lakes or rivers, the ocean, etc.) if you have Crypto and for at least 2 weeks after diarrhea stops. You can pass Crypto in your stool and contaminate water for several weeks after your symptoms have ended. This has resulted in many outbreaks of Crypto among recreational water users. Note: you are not protected in a chlorinated pool because Crypto is chlorine resistant and can live for days in pools.
- Avoid fecal exposure during sex.
See your health care provider.
Your health care provider will ask you to submit stool samples to see if you are infected. Because testing for Crypto can be difficult, you may be asked to submit several stool specimens over several days. Because tests for Crypto are not routinely done in most laboratories, your health care provider should specifically request testing for the parasite.
There is no effective treatment. If you have diarrhea, drink plenty of fluids to prevent dehydration. Rapid loss of fluids because of diarrhea can be life-threatening in babies; parents should consult their health care provider about fluid replacement therapy options for babies. Antidiarrheal medicine may help slow down diarrhea, but consult with your health care provider before taking it.
People who are in poor health or who have a weakened immune system are at higher risk for more severe and more prolonged illness. For persons with AIDS, anti-retroviral therapy that improves immune status will also decrease or eliminate symptoms of Crypto infection. Some drugs, such as paromomycin, may reduce the symptoms of Crypto and new drugs are being tested. However, Crypto is usually not cured and may come back if the immune status worsens. See your health care provider to discuss anti-retroviral therapy used to improve immune status.
You can reduce your risk of getting Crypto. The more steps you take, the less likely you are to get infected. These actions will also help protect you against other diseases. Following all the recommendations in this fact sheet can be a great personal burden. Consult with your health care provider to determine whether your medical condition makes it advisable to follow all of these recommendations.
1. Wash your hands.
Washing your hands often with soap and water is probably the single most important step you can take to prevent Crypto and other illnesses. Always wash your hands before eating and preparing food. Wash your hands well after touching children in diapers; after touching clothing, bedding, toilets, or bed pans soiled by someone who has diarrhea; after gardening; any time you touch pets or other animals; and after touching anything that might have had contact with even the smallest amounts of human or animal stool, including dirt in your garden and other places. Even if you wear gloves when you do these activities you should still wash well when you finish. Children should be supervised by adults to make sure they wash their hands well.
2. Practice safer sex.
Infected people may have Crypto on their skin in the anal and genital areas, including the thighs and buttocks. However, since you cannot tell if someone has Crypto, you may want to take these precautions with any sex partner:
"Rimming" (kissing or licking the anus) is so likely to spread infection that you should avoid it, even if you and your partner wash well before.
Always wash your hands well after touching your partner's anus or rectal area.
3. Avoid touching farm animals.
If you touch a farm animal, particularly a calf, lamb, or other young animal, or visit a farm where animals are raised, wash your hands well with soap and water before preparing food or putting anything in your mouth. Do not touch the stool of any animal. After you visit a farm or other area with animals, have someone who is not immunocompromised clean your shoes, or wear disposable gloves if you clean them yourself. Wash your hands after taking off the gloves.
4. Avoid touching the stool of pets.
Most pets are safe to own. However, someone who is not immunocompromised should clean their litter boxes or cages, and dispose of the stool. If you must clean up after a pet, use disposable gloves. Wash your hands afterwards. The risk of getting Crypto is greatest from pets that are less than 6 months old, animals that have diarrhea, and stray animals. Older animals can also have Crypto, but they are less likely to have it than younger animals. If you get a puppy or kitten that is less than 6 months old, have the animal tested for Crypto before bringing it home. If any pet gets diarrhea, have it tested for Crypto.
5. Avoid swallowing water when swimming in the ocean, lakes, rivers, or pools, and when using hot tubs.
When swimming in lakes, rivers, or pools, and when using hot tubs, avoid swallowing water. Several outbreaks of Crypto have been traced to swallowing contaminated water while swimming. Crypto can live in chlorinated swimming pools and waterparks for days. Crypto also can remain alive in salt water for several days, so swimming in polluted ocean water may also be unsafe.
For more information about recreational water illnesses (RWIs) .
6. Wash and/or cook your food.
Fresh vegetables and fruits may be contaminated with Crypto. Therefore, wash well all vegetables or fruit you will eat uncooked. If you take extra steps to make your water safe (see below for ways to do so), use this safe water to wash your fruits and vegetables. When you can, peel fruit that you will eat raw, after washing it. Do not eat or drink unpasteurized milk or dairy products. Cooking kills Crypto. Therefore, cooked food and heat-processed foods are probably safe if, after cooking or processing, they are not handled by someone infected with Crypto, or exposed to possibly contaminated water.
7. Drink safe water.
Do not drink water directly from lakes, rivers, streams, or springs. Because you cannot be sure if your tap water contains Crypto, you may wish to avoid drinking tap water, including water or ice from a refrigerator, which is usually made with tap water. Because public water quality and treatment vary throughout the United States, always check with the local health department and water utility to see if they have issued any special notices about the use of tap water by immunocompromised persons. You may also wish to take some additional measures: boiling your water, filtering your water with certain home filters, or drinking certain types of bottled water. Processed carbonated (bubbly) drinks in cans or bottles are probably safe, but drinks made at a fountain might not be because they are made with tap water. If you choose to take these extra measures, use them all the time, not just at home. If the public health department advises boiling the water, do not drink tap water unless you boil it. You could also use one of the bottled waters described below.
A. Boiling water: Boiling is the best extra measure to ensure that your water is free of Crypto and other germs. Heating water at a rolling boil for 1 minute kills Crypto, according to CDC* and EPA** scientists. After the boiled water cools, put it in a clean bottle or pitcher with a lid and store it in the refrigerator. Use the water for drinking, cooking, or making ice. Water bottles and ice trays should be cleaned with soap and water before use. Do not touch the inside of them after cleaning. If you can, clean water bottles and ice trays yourself.
B. Filtering tap water: Not all available home water filters remove Crypto. All filters that have the words "reverse osmosis" on the label protect against Crypto. Some other types also work, but not all filters that are supposed to remove objects 1 micron or larger from water are the same. Look for the words "absolute 1 micron." Some "1 micron" and most "nominal 1 micron" filters will not work against Crypto. Also look for the words "Standard 53" and the words "cyst reduction" or "cyst removal" for an NSF-tested filter that works against Crypto.
To find out if a particular filter removes Crypto, contact NSF International (3475 Plymouth Road, P.O. Box 130140, Ann Arbor, MI 48113-0140, tel: 1-800-673-8010, fax: 1-313-769- 0109), an independent testing group. Ask NSF for a list of "Standard 53 Cyst Filters." Check the model number on the filter you intend to buy to make sure it is exactly the same as the number on the NSF list. Look for the NSF trademark on filters, but be aware that NSF tests filters for many different things. Because NSF testing is expensive, many filters that may work against Crypto have not been tested. Reverse-osmosis filters work against Crypto whether they have been tested by NSF or not. Many other filters not tested by NSF also work if they have an absolute pore size of 1 micron or smaller.
designed to remove Crypto
(any of the four messages below on a package label indicate that the filter should be able to remove Crypto)
Reverse-osmosis (with or without NSF testing)
pore size of 1 micron or smaller
(with or without NSF testing)
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