A case of human cryptosporidiosis in an animal handler has been
reported by Auburn University. About 3 weeks before onset of
symptoms
in mid-July 1981, the patient, a previously healthy 25-year-old
male
free of immune deficiencies, had started a survey of calves for
Cryptosporidium sp. (1). Clinical features of his illness included
nausea and low-grade fever, moderate abdominal cramps, anorexia,
5-10
watery, frothy bowel movements a day, and then constipation.
Fourteen
days after onset, the patient was much improved and was eating a
full
diet. Sheather's sugar-flotation tests showed oocysts of
Cryptosporidium sp. in the first fecal sample collected 56 hours
after
onset of symptoms and in fecal samples collected daily through the
12th day of illness; no oocysts were found after day 12.
Additional
details of this case and the methods for diagnosis of human
cryptosporidiosis have been published (1).
Since the initial report was submitted in September 1981, stool
examinations have been done for 16 other animal handlers at the
university who had contact with animals involved in 3 separate,
unrelated outbreaks of calf cryptosporidiosis. From these 16
persons,
11 additional cases of human cryptosporidiosis were identified.
All
involved previously healthy individuals; no abnormalities were
noted
in their levels of serum globulins at the time of infection, and no
deficiencies in cell-mediated immune response were detected by
lymphocyte-blastogenesis testing. Symptoms occurred within 1-2
weeks
after the individuals had first contact with the infected calves.
Four of these 11 patients had clinical symptoms similar to those
described above; 4 had diarrhea and moderate abdominal cramps; 1
had
fever, constipation, and abdominal cramps; and 2 were asymptomatic.
All diagnoses were based on the presence of Cryptosporidium sp.
oocysts in stool specimens. Cryptosporidium sp. oocysts had been
found in calf feces but were not found in the stools of any other
animals (cats, dogs, goats, pigs, or rats) with which the patients
had
had contact.
Oocysts of Cryptosporidium sp. isolated from the animal
handlers
were found to be morphologically indistinguishable from those
obtained
from naturally and experimentally infected calves. When
Cryptosporidium sp. oocysts isolated from humans and calves were
inoculated orally into mice and rats, the infections produced by
oocysts from the animal handlers were indistinguishable from those
produced by calf oocysts. Oocysts from the animal handlers also
produced cryptosporidiosis in calves that had previously been free
of
Cryptosporidium.
Reported by WL Current, PhD, NC Reese, Dept of Zoology-Entomology,
Auburn University, JV Ernst, PhD, WS Bailey, DVM, ScD, USDA
Regional
Parasite Research Laboratory, Auburn, Alabama; Parasitic Diseases
Div,
Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: Before this report from Alabama, no more than
approximately a dozen cases of human cryptosporidiosis had been
reported in the literature. Of these, 6 involved patients who had
prolonged illness and were shown to be immunologically deficient
(2-7), 2 other patients were undergoing immunosuppressive
chemotherapy
(8-9), and 4 were otherwise apparently healthy (1,10-12). Eight of
these 12 cases (2-9) were diagnosed only after histologic
examination
of small- or large-bowel biopsy material. The human cases at
Auburn
were diagnosed and monitored by the demonstration of
Cryptosporidium
oocysts in fecal flotations (1), as were several of the other
previously reported cases (11-12).
Data presented in this report suggest that cryptosporidiosis
occurs among not only immunologically compromised persons but also
apparently healthy individuals. This information also adds
substantial support to earlier proposals that cryptosporidiosis is
a
zoonosis (1,13) and that Cryptosporidium is not host specific
(1,13,14), as has been reported (15). In the cases discussed
above,
it appears that Cryptosporidium caused the illness of the infected
individuals. Cultures of fecal samples for salmonellae were
negative;
however, techniques for detecting other viral or bacterial
pathogens
were not performed. These data also indicate that calves with
diarrhea due to Cryptosporidium should be considered as potential
sources of human infection and that proper precautions should be
taken
by individuals who have contact with such animals.
References
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of
man and calf: a case report and results of experimental
infections
in mice and rats. Am J Trop Med Hyg 1982;31:226-9.
Lasser KH, Lewin KJ, Ryning FW. Cryptosporidial enteritis in a
patient with congenital hypogammaglobulinemia. Hum Pathol
1979;10:234-340.
Stemmermann GN, Hayashi T, Glober GA, Oishi N, Frankel RI.
Cryptosporidiosis: report of a fatal case complicated by
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Sloper KS, Dourmaskin RR, Bird RB, Slavin C, Wester ADB.
Chronic
malabsorption due to cryptosporidiosis in a child with
immunoglobulin deficiency. Gut 1982; 23:80-2.
Bird RG, Smith MD, Cryptosporidiosis in man: parasite life
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Bird RG. Protozoa and viruses human cryptosporidiosis and
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Lawrence, KS: Society of Protozoologists. (In press).
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Charache P. Cryptosporidiosis in an immunosuppressed
renal-transplant recipient with IgA deficiency. Am J Clin
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Meisel JL, Perera DR, Meligro C, Rubin CE. Overwhelming watery
diarrhea associated with Cryptosporidium in an immunosuppressed
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Nime FA, Burek JD, Page DL, Holscher MA, Yardley JH. Acute
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Tzipori S, Angus KW, Gray EW, Campbell I. Vomiting and
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Anderson BC, Donndelinger T, Wilkins RM, Smith J.
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Tzipori S, Angus KW, Campbell I, Gray EW. Cryptosporidium:
evidence for a single-species genus. Infect Immun
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Moon HW, Bemrick WJ. Fecal transmission of calf cryptosporidia
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Levine ND. Some corrections of coccidian (apicomplexa:
protozoa)
nomenclature. J Parasitol 1980;66:830-4.
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