Cryptosporidium hominis - Revision history

Aidan at 14:17, 30 August 2023

2023-08-30T14:17:40Z

← Older revision		Revision as of 14:17, 30 August 2023
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	**[[Rifaximin]] and [[albendazole]] need more study		**[[Rifaximin]] and [[albendazole]] need more study

			== Further Reading ==
	{{DISPLAYTITLE:''Cryptosporidium hominis''}}

			* Treatment of human intestinal cryptosporidiosis: A review of published clinical trials. Int J Parasitol. 2021;17:128-138: doi:[https://doi.org/10.1016/j.ijpddr.2021.09.001 10.1016/j.ijpddr.2021.09.001]{{DISPLAYTITLE:''Cryptosporidium hominis''}}
	[[Category:Protozoa]]		[[Category:Protozoa]]
	[[Category:Gastrointestinal infections]]		[[Category:Gastrointestinal infections]]

Aidan: /* Management */

2023-07-21T14:10:10Z

Management

← Older revision		Revision as of 14:10, 21 July 2023
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	*In severely immunocompromised patients, may not be curable without reversing immunosuppression		*In severely immunocompromised patients, may not be curable without reversing immunosuppression
	**Can treat with [[nitazoxanide]] 500 to 1000 mg p.o. twice daily for 14+ days		**Can treat with [[nitazoxanide]] 500 to 1000 mg p.o. twice daily for 14+ days
			*Other medications
			**[[Paromomycin]] likely inferior to nitazoxanide
			***Dose is 500 mg p.o. three to four times daily for 14 days
			**[[Macrolides]] likely ineffective
			**[[Rifaximin]] and [[albendazole]] need more study

	{{DISPLAYTITLE:''Cryptosporidium hominis''}}		{{DISPLAYTITLE:''Cryptosporidium hominis''}}

Aidan at 14:06, 21 July 2023

2023-07-21T14:06:34Z

← Older revision		Revision as of 14:06, 21 July 2023
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	==Management==		==Management==

	*~~Supportive~~ care, including fluids and antimotility agents like loperamide		*For immunocompetent hosts, supportive care, including fluids and antimotility agents like loperamide, is generally adequate
	*In immunocompetent hosts: [[Is treated by::nitazoxanide]] 500 mg p.o. twice daily for 3 days		*In immunocompetent hosts: [[Is treated by::nitazoxanide]] 500 mg p.o. twice daily for 3 days
			**Not approved in Canada, needs SAP
	*In severely immunocompromised patients, may not be curable without reversing immunosuppression		*In severely immunocompromised patients, may not be curable without reversing immunosuppression
	*Can treat with [[nitazoxanide]] 500 to 1000 mg p.o. twice daily for 14+ days		**Can treat with [[nitazoxanide]] 500 to 1000 mg p.o. twice daily for 14+ days

	{{DISPLAYTITLE:''Cryptosporidium hominis''}}		{{DISPLAYTITLE:''Cryptosporidium hominis''}}

Aidan: /* Management */

2023-07-17T19:38:42Z

Management

← Older revision		Revision as of 19:38, 17 July 2023
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	*Supportive care, including fluids and antimotility agents like loperamide		*Supportive care, including fluids and antimotility agents like loperamide
	*In immunocompetent hosts: [[Is treated by::nitazoxanide]] 500 mg po ~~tid~~ for 3 days		*In immunocompetent hosts: [[Is treated by::nitazoxanide]] 500 mg p.o. twice daily for 3 days
	*In severely immunocompromised patients, may not be curable without reversing immunosuppression		*In severely immunocompromised patients, may not be curable without reversing immunosuppression
			*Can treat with [[nitazoxanide]] 500 to 1000 mg p.o. twice daily for 14+ days

	{{DISPLAYTITLE:''Cryptosporidium hominis''}}		{{DISPLAYTITLE:''Cryptosporidium hominis''}}

Aidan: Text replacement - " species]]" to "]]"

2022-02-11T02:34:20Z

Text replacement - " species]]" to "]]"

← Older revision		Revision as of 02:34, 11 February 2022
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	*A member of the [[Cryptosporidium ~~species~~]] which causes diarrheal disease in humans		*A member of the [[Cryptosporidium]] which causes diarrheal disease in humans
	*Similar to [[Cryptosporidium parvum]] which typically infects cows, but can also infect humans		*Similar to [[Cryptosporidium parvum]] which typically infects cows, but can also infect humans

Aidan: /* Clinical Manifestations */

2020-08-05T13:57:04Z

Clinical Manifestations

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-21T03:28:18Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 03:28, 21 July 2020
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	* T-cells are involved, with chronic infection in patients who are CD4-deplete		* T-cells are involved, with chronic infection in patients who are CD4-deplete

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* Incubation period 7 days (range 1 to 30 days)		* Incubation period 7 days (range 1 to 30 days)

Aidan: /* Epidemiology */ typo

2019-12-02T23:41:07Z

Epidemiology: typo

← Older revision		Revision as of 23:41, 2 December 2019
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	* Transmitted fecal-oral via environmental contamination (such as recreational water), and can be spread person-to-person		* Transmitted fecal-oral via environmental contamination (such as recreational water), and can be spread person-to-person
	** Outbreaks are most commonly associated with drinking water, even when properly treated		** Outbreaks are most commonly associated with drinking water, even when properly treated
	** Daycares (more common than [[Giardia]]		** Daycares (more common than [[Giardia]])
	** Also seen with petting zoos and cider		** Also seen with petting zoos and cider
	** Higher rates of transmission in MSM		** Higher rates of transmission in MSM

Aidan: /* Diagnosis */

2019-10-10T13:45:31Z

Diagnosis

← Older revision		Revision as of 13:45, 10 October 2019
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	== Diagnosis ==		== Diagnosis ==

			* Stool microscopy
		⚫	** Seen on modified acid-fast staining (70% sensitive)
			** Can do immunofluorescence as well (more sensitive)
	* Stool antigen		* Stool antigen
⚫	* ~~Stool~~ ~~with~~ ~~immunofluorescence or with~~ acid-fast staining (70% sensitive)
	* PCR		* PCR

Aidan: /* Immunocompetent adults */

2019-10-10T13:43:06Z

Immunocompetent adults

← Older revision		Revision as of 13:43, 10 October 2019
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	* Associated with waterborne outbreaks, travel, animal contacts, or child contacts		* Associated with waterborne outbreaks, travel, animal contacts, or child contacts
	* Watery (to mucoid) diarrhea and malabsorption		* Watery (to mucoid) diarrhea and malabsorption, more lower bowel symptoms
	* May also have abdominal cramping, nausea or vomiting, and fever		* May also have abdominal cramping, nausea or vomiting, and fever
	* Lasts 5 to 14 days, but up to 100		* Lasts 5 to 14 days, but up to 100

← Older revision		Revision as of 13:57, 5 August 2020
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	* A member of the [[Cryptosporidium species]] which causes diarrheal disease in humans		*A member of the [[Cryptosporidium species]] which causes diarrheal disease in humans
	* Similar to [[Cryptosporidium parvum]] which typically infects cows, but can also infect humans		*Similar to [[Cryptosporidium parvum]] which typically infects cows, but can also infect humans

	== Background ==		==Background==

	=== Microbiology ===		===Microbiology===

	* Protozoan parasite in the genus [[Cryptosporidium species\|''Cryptosporidium'']]		*Protozoan parasite in the genus [[Cryptosporidium species\|''Cryptosporidium'']]

	=== Epidemiology ===		===Epidemiology===

	* Infects humans, but can also infect cows, mice, gnotobiotic pigs, and rarely other species		*Infects humans, but can also infect cows, mice, gnotobiotic pigs, and rarely other species
	* Transmitted fecal-oral via environmental contamination (such as recreational water), and can be spread person-to-person		*Transmitted fecal-oral via environmental contamination (such as recreational water), and can be spread person-to-person
	** Outbreaks are most commonly associated with drinking water, even when properly treated		**Outbreaks are most commonly associated with drinking water, even when properly treated
	** Daycares (more common than [[Giardia]])		**Daycares (more common than [[Giardia]])
	** Also seen with petting zoos and cider		**Also seen with petting zoos and cider
	** Higher rates of transmission in MSM		**Higher rates of transmission in MSM
	* Resistant to chlorination and can survive in the environment up to 6 months		*Resistant to chlorination and can survive in the environment up to 6 months
	* In developing countries, primarily affects children less than 5 years		*In developing countries, primarily affects children less than 5 years
	* In developed countries, primarily affects adults, related to travel		*In developed countries, primarily affects adults, related to travel
	** Causes 2-6% of traveller's diarrhea		**Causes 2-6% of traveller's diarrhea

	=== Life Cycle ===		===Life Cycle===

	* Host ingests an '''oocyst''' (needing as few as 10 to cause disease)		*Host ingests an '''oocyst''' (needing as few as 10 to cause disease)
	* The oocyst excyst in the stomach and proximal small bowel, releasing four '''sporozoites'''		*The oocyst excyst in the stomach and proximal small bowel, releasing four '''sporozoites'''
	* Sporozoites bind to the intestinal epithelial cells and becomes vacuolized by the host cell membrane		*Sporozoites bind to the intestinal epithelial cells and becomes vacuolized by the host cell membrane
	* In the '''parasitophorous vacuole''', they reproduce asexually into further sporozoites, which divide into '''type I meronts'''		*In the '''parasitophorous vacuole''', they reproduce asexually into further sporozoites, which divide into '''type I meronts'''
	* The type I meronts mature and release motile '''merozoites'''		*The type I meronts mature and release motile '''merozoites'''
	* The merozoites again attach to the intestinal epithelial cells		*The merozoites again attach to the intestinal epithelial cells
	* Merozoites then either reproduce asexually, as above, or sexually		*Merozoites then either reproduce asexually, as above, or sexually
	** Sexual reproduction involves a '''macrogamont''' and '''microgamont''', which form a '''zygote'''		**Sexual reproduction involves a '''macrogamont''' and '''microgamont''', which form a '''zygote'''
	** The zygote develops into an oocyst which contains four sporozoites		**The zygote develops into an oocyst which contains four sporozoites
	* Oocysts may be involved in auto-inoculation (if thin-walled) or environmental contamination (if thick-walled)		*Oocysts may be involved in auto-inoculation (if thin-walled) or environmental contamination (if thick-walled)

	=== Pathophysiology ===		===Pathophysiology===

	* Infection activates nuclear factor kappa B (NF-κB), which activates a large response		*Infection activates nuclear factor kappa B (NF-κB), which activates a large response
	* Infection results in increased permeability of the intestinal mucosa		*Infection results in increased permeability of the intestinal mucosa
	* T-cells are involved, with chronic infection in patients who are CD4-deplete		*T-cells are involved, with chronic infection in patients who are CD4-deplete

	== Clinical Manifestations ==		==Clinical Manifestations==

	* Incubation period 7 days (range 1 to 30 days)		*Incubation period [[Usual incubation period::7 days]] (range [[Incubation period range::1 to 30 days]])

	=== Immunocompetent adults ===		===Immunocompetent adults===

	* Associated with waterborne outbreaks, travel, animal contacts, or child contacts		*Associated with waterborne outbreaks, travel, animal contacts, or child contacts
	* Watery (to mucoid) diarrhea and malabsorption, more lower bowel symptoms		*Watery (to mucoid) diarrhea and malabsorption, more lower bowel symptoms
	* May also have abdominal cramping, nausea or vomiting, and fever		*May also have abdominal cramping, nausea or vomiting, and fever
	* Lasts 5 to 14 days, but up to 100		*Lasts 5 to 14 days, but up to 100
	* However, recurs in about 40% and can become an intermittent or chronic diarrhea similar to irritable bowel syndrome		*However, recurs in about 40% and can become an intermittent or chronic diarrhea similar to irritable bowel syndrome

	=== Childhood diarrhea ===		===Childhood diarrhea===

	* Causes about 10-15% of acute childhood diarrhea in developing countries		*Causes about 10-15% of acute childhood diarrhea in developing countries
	* Presents with watery diarrhea, cramps, and nausea and vomiting		*Presents with watery diarrhea, cramps, and nausea and vomiting
	* May also have fever, cough, dyspnea, and foul-smelling stool		*May also have fever, cough, dyspnea, and foul-smelling stool
	* Can turn into chronic diarrhea and malabsorption		*Can turn into chronic diarrhea and malabsorption

	=== People living with HIV ===		===People living with HIV===

	* Most cases are asymptomatic or mild and self-limited		*Most cases are asymptomatic or mild and self-limited
	* Chronic infection more common in HIV with CD4 <150, lasting up to 6 months		*Chronic infection more common in HIV with CD4 <150, lasting up to 6 months
	* May also involve extraintestinal cryptosporidiosis, such as biliary or respiratory disease		*May also involve extraintestinal cryptosporidiosis, such as biliary or respiratory disease

	=== Other immunocompromised patients ===		===Other immunocompromised patients===

	* May present similarly to HIV		*May present similarly to HIV
	* Includes solid organ transplant, hematopoietic stem cell transplant, and hyper-IgM syndrome		*Includes solid organ transplant, hematopoietic stem cell transplant, and hyper-IgM syndrome

	== Diagnosis ==		==Diagnosis==

	* Stool microscopy		*Stool microscopy
	** Seen on modified acid-fast staining (70% sensitive)		**Seen on modified acid-fast staining (70% sensitive)
	** Can do immunofluorescence as well (more sensitive)		**Can do immunofluorescence as well (more sensitive)
	* Stool antigen		*Stool antigen
	* PCR		*PCR

	== Management ==		==Management==

	* Supportive care, including fluids and antimotility agents like loperamide		*Supportive care, including fluids and antimotility agents like loperamide
	* In immunocompetent hosts: [[Is treated by::nitazoxanide]] 500 mg po tid for 3 days		*In immunocompetent hosts: [[Is treated by::nitazoxanide]] 500 mg po tid for 3 days
	* In severely immunocompromised patients, may not be curable without reversing immunosuppression		*In severely immunocompromised patients, may not be curable without reversing immunosuppression

	{{DISPLAYTITLE:''Cryptosporidium hominis''}}		{{DISPLAYTITLE:''Cryptosporidium hominis''}}