Cryptosporidium

What is cryptosporidium? A virus? A bacteria? Something else?

Yes, something else.
Cryptosporidium belongs to a family of organisms referred to as Protozoa. Let’s just say that it belongs to a family of single-celled organisms that are able to cause disease in human beings. For the sake of this discussion, think of it as a kind of parasite.

What kind of illness can Cryptosporidium cause?

In healthy young children, without any significant past medical history that might put them at risk of immunosuppression, Cryptosporidium can be asymptomatic or may cause watery diarrhea (without blood or mucous), abdominal pain, vomiting and often times fever, as well.

What distinguishes this infection from viral and bacterial infections that we are used to is that the diarrhea caused by Cryptosporidium may last a little bit longer. Sometimes diarrhea caused by Cryptosporidium may last as long as 3 weeks, which is roughly the length of time the eggs continue to be excreted in a person’s stool. But here are a few important notes:
1. Most children will be asymptomatic or will have a short diarrheal disease. Longer lasting diarrhea is not as common.
2. In most cases, Cryptosporidium is a self-resolving infection that doesn’t require any treatment other than fever and pain medicine and ensuring adequate food and fluid intake to prevent dehydration. If the diarrhea lasts a little longer than the usual, a low-lactose diet may be helpful as you will learn below.

On the other hand, in children who suffer from significant immune suppression, this pathogen may cause a severe infection, with long-lasting diarrhea and even extraintestinal complications (in the lungs and bile ducts).

How can one get Cryptosporidium?

Very easy.
The pathogen transfers one person to the other through contaminated food and fluids. Cryptosporidium is a very infectious organism, and it is able to easily survive in the environment and infect humans. Most children catch it from their friends, and during summer it usually happens in pools as Cryptosporidium may thrive in chlorinated pools for as long as a week.

Why does it seem like Cryptosporidium infections are on the rise?

The truth is that Cryptosporidium has always been out there. The difference is that we are now better at isolating different pathogens. The PCR technique being used these days is a lot more sensitive at isolating pathogens than the traditional stool cultures. It also provides us with results a lot faster.
Remember how Cryptosporidium infections usually resolve spontaneously within a few days? This just tells us that in the past we may have seen a kid with diarrhea that resolved within a few days, without knowing the name of the pathogen responsible for the infection. And now, with this new testing technique, we are able to name the pathogen.

Can we prevent this infection from happening?

Certainly. Maintaining basic hygiene practices including proper hand washing may be very helpful. Interesting fact – hand sanitizers (alcogels), do not destroy Cryptosporidium and so they cannot serve as an alternative to hand-washing. And as I mentioned above, Cryptosporidium is also resistant to chlorine. If you really want to get rid of Cryptosporidium from contaminated surfaces (for example, at a kindergarten where there were kids who had it), then you need to use hydrogen peroxide.

Does a child with cryptosporidium need to receive any medicine? And if so, what drugs are appropriate?

The reason this question comes up with Cryptosporidium is because it seems like it’s on the rise and parents these days are worried when they realize it has been isolated in their child’s stool, especially when the diarrhea lasts for a while.
Let me cut to the chase – in the majority of cases, in children who are not immunosuppressed, the infection will resolve spontaneously within a few days. And with a little patience, in some of the children, it will resolve just a few days after that.
All these healthy children need is supportive treatment, everything you’ve learned in the post about diarrhea (gastroenteritis) in children.

Remember also that children with diarrhea sometimes suffer from secondary lactose-deficiency. Sometimes the cryptosporidium infection will last for only 5 days but the child continues being exposed to formula when he is unable to absorb lactose (parents fear that he will dehydrate) and this exacerbates the diarrhea. Sometimes, giving your child a break from lactose-containing formula for a short period of time, is helpful. From experience, it will save you a lot of trouble when it comes to long-lasting diarrhea.

How about the less common presentation?

A very small percentage of children, and in very rare cases they may also be healthy children, will suffer from a severe disease that includes diarrhea for 3 weeks or even longer. These children can be treated with Nitazoxanide. The drug dosages are 100 mg, 3 times daily for children aged 1-3 years, 200 mg twice daily for children aged 4-11 years and 500mg twice daily for children 12 years and over. The duration of treatment is 3 days.
There is only one problem. This drug is not available everywhere and needs to be approved before it can be sold. Even then, it is very difficult and complicated to get. On the other hand, there is a relief in knowing that by the time the drug is found and bought, the child has usually improved.
What about children who are immune suppressed? These children need to be seen by an infectious disease specialist. The approach to children with immunosuppression is beyond the scope of this post.

When can children with Cryptosporidium return to daycare?

There are no special rules for Cryptosporidium. Children can return to daycare 24 hours after their infection has resolved, just like in any other diarrheal infection.
If you want to be nice to the world – avoid sending your child into a pool for 2 weeks after their infection has resolved. This is because their body can still shed eggs, and these can survive in pools and infect other children.

To wrap it up – this pathogen is not the new kid in town, it’s just more easily isolated these days with the new lab techniques being used. Lots of children catch it during summer, in swimming pools. In most children, it is self-resolving, and no special treatment is required. Sometimes, it may last a little bit longer, but even then, it is still self-resolving.
Very few and rare cases presenting with severe infection will need treatment.

I hope this post eases your worries.