Cryptosporidium Outbreak Quiz

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Questions and Answers

What was the estimated cost of the Cryptosporidium outbreak in Milwaukee, Wisconsin?

  • $96.2 million (correct)
  • $76.2 million
  • $50 million
  • $120 million

Which Cryptosporidium species is associated with human reservoirs and was first detected in 1976?

  • Cryptosporidium hominis (correct)
  • Cryptosporidium parvum type 2
  • Cryptosporidium meleagridis
  • Cryptosporidium felis

What percentage of individuals infected with Cryptosporidium sought outpatient medical care during the outbreak?

  • 11% (correct)
  • 25%
  • 20%
  • 1%

What was the average hospital stay for individuals hospitalized due to the Cryptosporidium outbreak?

<p>8 days (C)</p> Signup and view all the answers

In the two-year follow-up study, what percentage of death records indicated Cryptosporidium as a contributing cause was associated with AIDS?

<p>85% (D)</p> Signup and view all the answers

Which group of animals is NOT mentioned as a host for the protozoan?

<p>Insects (B)</p> Signup and view all the answers

What is the average incubation period for cryptosporidiosis in individuals?

<p>7 days (A)</p> Signup and view all the answers

What transmission route is primarily associated with this protozoan infection?

<p>Fecal-oral route (A)</p> Signup and view all the answers

What kind of food source is NOT implicated in transmission of this protozoan?

<p>Cooked chicken (B)</p> Signup and view all the answers

What percentage of drinking water samples tested showed contamination with oocysts?

<p>27% (C)</p> Signup and view all the answers

Which group of individuals is more susceptible to severe disease due to this protozoan?

<p>Immunocompromised individuals (D)</p> Signup and view all the answers

What is the diameter range of the thick-walled oocyst of the protozoan?

<p>4-6 ㎛ (C)</p> Signup and view all the answers

How many oocysts are approximately needed to cause an infection?

<p>130 oocysts (A)</p> Signup and view all the answers

What was the significant issue observed at the South water treatment plant during the outbreak?

<p>Increased turbidity levels (A)</p> Signup and view all the answers

Which variant of Cryptosporidium is associated with bovine and human reservoirs?

<p>Cryptosporidium parvum type 2 (C)</p> Signup and view all the answers

What was the primary cause attributed to the economic impact of the cryptosporidiosis outbreak?

<p>Lost productivity (D)</p> Signup and view all the answers

What percentage of individuals infected with cryptosporidiosis did not seek medical care during the outbreak?

<p>88% (D)</p> Signup and view all the answers

Which of the following species of Cryptosporidium is considered an uncommon cause of human infection, especially in HIV infected patients?

<p>Cryptosporidium felis (C)</p> Signup and view all the answers

Which of the following animals is NOT identified as a host for the protozoan?

<p>Horses (D)</p> Signup and view all the answers

What is the likely average incubation period for cryptosporidiosis in adults?

<p>5 days (C)</p> Signup and view all the answers

Which method of transmission is NOT associated with this protozoan?

<p>Skin absorption through cuts (B)</p> Signup and view all the answers

Which food item is explicitly mentioned as an implicated source of infection?

<p>Fresh-pressed apple cider (C)</p> Signup and view all the answers

What characteristic of the thick-walled oocyst aids in the protozoan's infection process?

<p>It is resistant to environmental conditions (C)</p> Signup and view all the answers

What percentage of individuals who were infected with this protozoan were reported to have developed severe disease symptoms?

<p>Varies by individual susceptibility (C)</p> Signup and view all the answers

What is a specific characteristic of the oocysts that contributes to re-infection in hosts?

<p>One in five oocysts are thin-walled (A)</p> Signup and view all the answers

Which of the following groups is particularly at risk for severe disease caused by cryptosporidiosis?

<p>Children and the elderly (D)</p> Signup and view all the answers

What is the primary route through which the protozoan is transmitted?

<p>Fecal-oral route via contaminated food and water (B)</p> Signup and view all the answers

Which of the following food sources is recognized as a potential vehicle for transmission?

<p>Raw vegetables and shellfish (D)</p> Signup and view all the answers

Which characteristic of the protozoan's oocysts aids in re-infection?

<p>Thin-walled oocysts can reinfect the original host. (C)</p> Signup and view all the answers

What average incubation period does cryptosporidiosis typically exhibit in children and the elderly?

<p>5 days (B)</p> Signup and view all the answers

Which of the following environmental sources was reported to show contamination with oocysts?

<p>Drinking water from treatment plants (D)</p> Signup and view all the answers

What is the average infectious dose of oocysts known to cause infection?

<p>130 oocysts (B)</p> Signup and view all the answers

What is the primary challenge in treating infections in immunocompromised individuals?

<p>More severe disease and harder treatment (C)</p> Signup and view all the answers

Which of the following is a typical diameter range for the thick-walled oocysts?

<p>4-6 ㎛ (B)</p> Signup and view all the answers

How do sporozoites in the intestine contribute to the infection process after excystation?

<p>They mature and divide asexually to produce merozoites. (A)</p> Signup and view all the answers

Which group of animals is most likely a host for the protozoan based on the information provided?

<p>Reptiles, birds, mammals and humans (D)</p> Signup and view all the answers

What was a prominent factor indicated by the audits regarding individuals who contracted cryptosporidiosis?

<p>Most individuals did not seek any medical care. (B)</p> Signup and view all the answers

Which factors contributed significantly to the economic cost of the cryptosporidiosis outbreak?

<p>Lost productivity due to illness. (A)</p> Signup and view all the answers

What was the timeline of water treatment plant issues during the outbreak?

<p>The South plant showed increases in turbidity starting March 21st. (D)</p> Signup and view all the answers

Which developmental history is correct regarding the identification of Cryptosporidium?

<p>First human cases reported in 1976. (A)</p> Signup and view all the answers

Which species of Cryptosporidium is primarily linked with bovine reservoirs?

<p>Cryptosporidium parvum. (D)</p> Signup and view all the answers

What was the duration of hospitalization for infected individuals experiencing severe symptoms?

<p>Averaged 8 days. (D)</p> Signup and view all the answers

In the two-year follow-up study, what percentage of death records cited cryptosporidiosis as a contributing cause?

<p>54%. (A)</p> Signup and view all the answers

Which group of Cryptosporidium is recognized as uncommon but notable in HIV infected patients?

<p>Cryptosporidium meleagridis. (B)</p> Signup and view all the answers

What percentage of the population affected by the cryptosporidiosis outbreak lived outside of Milwaukee?

<p>30%. (A)</p> Signup and view all the answers

Which factor was a significant public health response during the outbreak?

<p>Issuing a boil water order. (A)</p> Signup and view all the answers

Flashcards

Milwaukee Crypto Outbreak

A large-scale foodborne illness outbreak in Milwaukee, Wisconsin in 1993 caused by contaminated water.

Cryptosporidium

A microscopic parasite causing waterborne illness (Cryptosporidiosis).

Cryptosporidiosis Symptoms

Symptoms of the illness include diarrhea, which typically don't require medical intervention in 88% of infected people. In severe cases, hospitalization might occur.

Milwaukee Water Treatment Plants

Water treatment facilities in Milwaukee, Wisconsin that were implicated in the 1993 outbreak.

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High Crypto Infections in AIDS Patients

Cryptosporidium infection more frequently affects individuals with compromised immune systems, like those with AIDS.

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Protozoan Transmission

Cryptosporidium protozoan spreads through fecal-oral contact, contaminated water, food, or close contact with infected animals/people.

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Incubation Period

The time between infection and the onset of symptoms, typically 2-14 days (average 7 days).

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Infectious Dose

The small number of oocysts required to cause infection (as few as 30, average 130).

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Cryptosporidium Oocysts

Round, thick-walled structures (4-6 µm) that contain the protozoan and are passed in feces.

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Excystation

The process where the oocysts release the sporozoites—the infectious stage of the parasite—inside the small intestine.

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Immunocompromised Individuals

People with weakened immune systems, more susceptible to severe cryptosporidiosis.

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Environmental Contamination

Cryptosporidium is found worldwide in the environment, such as in drinking water.

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Infection Process

Ingestion triggers release of sporozoites, which invade intestinal cells, reproduce asexually and then sexually, thus forming oocysts that are eventually passed into the environment.

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Cryptosporidium hominis

A species of Cryptosporidium primarily associated with human infections.

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Cryptosporidium parvum

A species of Cryptosporidium associated with both human and bovine (cattle) infections.

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Cryptosporidium Transmission

Cryptosporidium spreads through contaminated water, food, or close contact with infected individuals or animals. The primary method is fecal-oral transmission.

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Cryptosporidium and AIDS

Individuals with AIDS (weakened immune systems) are more susceptible to severe Cryptosporidium infections, including rare species like C. felis and C. meleagridis.

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Cryptosporidium's Favorite Homes

This protozoan can be found in various animals including fish, amphibians, reptiles, birds, and mammals, including humans.

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Cryptosporidium Transmission Routes

The parasite spreads through the fecal-oral route, contaminating water, food, and close contact with infected individuals or animals.

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Cryptosporidium's Favorite Foods

Raw vegetables, basil, cilantro, fresh-pressed apple cider, chicken salad, and shellfish are potential sources of the parasite.

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Incubation Period (IP)

The time between infection and symptom onset is typically 2-14 days with an average of 7 days. Children and the elderly may experience shorter IP of about 5 days.

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Cryptosporidium and Immune Systems

While it can affect individuals of all ages, immunocompromised individuals are more susceptible to severe infection, treatment difficulties, and complications.

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Cryptosporidium's Life Cycle

After ingestion, the parasite's oocyst releases sporozoites that invade intestinal cells, multiply asexually, then sexually, forming new oocysts that are passed out in feces.

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Cryptosporidium Oocysts - Infectious Agents

These round, thick-walled structures (4-6 µm in diameter) are passed through feces into the environment and can immediately cause infection.

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Cryptosporidium - Infectious Dose

A small number of oocysts can cause infection. As few as 30 oocysts have been known to cause infection, with an average infectious dose of around 130 oocysts.

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Cryptosporidium's Home

This parasite infects various animals, including fish, amphibians, reptiles, birds, and mammals, like humans.

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How Crypto Spreads

Transmission occurs through the fecal-oral route, via contaminated water, food, or close contact with infected individuals.

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Crypto's Favorite Foods?

Raw vegetables, basil, cilantro, fresh-pressed apple cider, chicken salad, and shellfish are potential sources of Crypto.

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Time to Get Sick?

The incubation period (IP) is 2 to 14 days, with an average of 7. Children and elderly experience a shorter IP of 5 days.

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Crypto's Weakness

Immunocompromised individuals are more vulnerable to severe infections and complications.

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Crypto's Life Cycle

After ingestion, the parasite's oocyst releases sporozoites that invade intestinal cells, multiply asexually, then sexually, forming new oocysts.

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Crypto's Tiny Armor

The round, thick-walled oocyst (4-6 µm) is passed in feces and is immediately infectious.

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How Many To Get Sick?

As few as 30 oocysts can cause infection, the average infectious dose is about 130.

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Crypto's Worldwide Reach

Environmental contamination is common, with oocysts being found in drinking water globally.

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Cryptosporidium Outbreak in Milwaukee

A major outbreak of cryptosporidiosis in Milwaukee, Wisconsin in 1993, affecting over 400,000 people.

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Cryptosporidium Prevalence

Cryptosporidium was first identified in 1907, but human cases were not reported until 1976.

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Cryptosporidium hominis vs. parvum

Cryptosporidium parvum type 1 is now called Cryptosporidium hominis and associated with human infections, while type 2 is now called Cryptosporidium parvum and associated with both human and bovine infections.

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Milwaukee Water Treatment Plant Issue

The South plant in Milwaukee experienced increased turbidity levels, indicating potential contamination shortly before the outbreak.

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Cryptosporidiosis Economic Impact

The Milwaukee outbreak resulted in a substantial economic loss, mainly due to lost productivity.

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Cryptosporidium Resistance

Cryptosporidium oocysts are resistant to many disinfectants and can survive for long periods in the environment.

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Cryptosporidium Severity

Cryptosporidium infections can be more severe in immunocompromised individuals, leading to prolonged illness and complications.

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Turbidity

A measure of the cloudiness or haziness of water, indicating the presence of suspended particles like Cryptosporidium oocysts.

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Cryptosporidiosis Transmission

Spread of Cryptosporidium infection - usually through the fecal-oral route, via contaminated water, food, or close contact.

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Cryptosporidiosis and AIDS

Individuals with AIDS (weakened immune systems) are more susceptible to severe Cryptosporidium infections, including rare species like C. felis and C. meleagridis.

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Cryptosporidiosis Incubation Period

The time between infection and the onset of symptoms, typically 2-14 days, with an average of 7 days.

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Study Notes

Cryptosporidium

  • Cryptosporidium was first isolated in 1907, but the first human cases were reported in 1976.
  • Cryptosporidium parvum type 1 is now referred to as Cryptosporidium hominis and is associated with human reservoirs.
  • Cryptosporidium parvum type 2 is now referred to as Cryptosporidium parvum and is associated with bovine and human reservoirs.
  • Cryptosporidium felis, C. meleagridis, and a new cervine (deer) genotype are uncommon causes of human infection, but are seen more commonly in HIV-infected patients.
  • The protozoan is found in fish, amphibians, reptiles (snakes, lizards, tortoises), wild and domesticated birds (chickens, turkeys, ducks, canaries, cockatiels), and mammals (rodents, cats, dogs, sheep, goats, pigs, deer, cows, and humans).

Cryptosporidium Outbreak (Milwaukee, 1993)

  • Between March and April 1993, 403,000 people in Milwaukee, Wisconsin, contracted cryptosporidiosis.
  • Two water treatment plants serving 800,000 residents and 10 other municipalities were involved.
  • The South plant showed increased turbidity starting March 21st, with significantly higher levels from March 23rd to April 5th.
  • A boil water order was issued on April 7th.
  • The plant was temporarily shut down on April 9th.

Cryptosporidium Outbreak: Impact

  • A medical record audit from the 4-month period before and after the outbreak showed 88% of infected individuals did not seek medical care.
  • 11% sought out patient medical care.
  • 1% were hospitalized (average stay was 8 days).
  • The estimated cost of the outbreak was approximately 96.2 million, with 67% attributed to lost productivity.
  • A 2-year follow-up study identified 54 death records where cryptosporidiosis was a contributing or underlying cause of death. 85% were associated with AIDS.

Transmission

  • Transmission is primarily via the fecal-oral route, including contaminated drinking or recreational water, and food.
  • Close contact with infected humans or other species (e.g., petting zoos) can also transmit the infection.
  • Environmental contamination is common worldwide. A study showed oocysts in 27% of drinking water samples from 66 inspected treatment plants.
  • Implicated food sources include raw vegetables, basil, cilantro, fresh-pressed apple cider, chicken salad, and shellfish. A 1996 CDC report linked an infected caterer changing a diaper and preparing chicken salad to an outbreak involving 50 infected people.

Infection Process

  • The incubation period (IP) ranges from 2 to 14 days, with an average of 7 days.
  • Children and the elderly experience a shorter IP of about 5 days.
  • Cryptosporidiosis affects all ages, but the most severe cases are in immunocompromised individuals.
  • Immunocompromised individuals are more susceptible to infection, harder to treat, and more likely to experience severe sequelae.
  • The round, thick-walled oocyst is 4-6 µm in diameter.
  • After ingestion, enzymes and bile salts trigger excystation, releasing 4 sporozoites that enter intestinal cells.
  • Sporozoites mature and asexually divide, producing merozoites. Merozoites either reinvade intestinal cells or begin sexual maturation into a zygote and sporulated oocyst.
  • Approximately 1 in 5 oocysts have a thin wall and help re-infect the host.
  • The remaining thick-walled oocysts exit via feces into the environment.
  • The mechanism of disease is unknown. As few as 30 oocysts can cause infection, with an average infectious dose of about 130 oocysts.
  • Oocysts are immediately infectious after excretion.

Symptoms

  • Immunologically competent individuals typically experience illness for 2–14 days, with a median duration of 1–53 days.
  • The major symptom is diarrhea, with an average of 12 stools per day (less than 25 L/day).
  • Oocyst excretion can continue for several months after diarrhea stops.
  • Other symptoms may include nausea, fever, vomiting, and cramping.
  • C. hominis infections can also cause joint pain, eye pain, recurrent headaches, dizziness, and fatigue.

Pathology

  • In immunocompetent hosts, the organism is limited to the intestine and appendix.
  • In immunocompromised individuals, the organism can be found in the GI tract, hepato-biliary system, and respiratory tract.
  • Illness is typically self-limiting in healthy individuals, managed by oral rehydration and antidiarrheals.
  • Immunocompromised hosts with CD4+ cell counts greater than 200 /mm³ usually experience an acute illness that resolves.
  • CD4+ cell counts less than 100 /mm³ may experience chronic, potentially lifelong illness.
  • Extra-intestinal forms are also common.
  • CD4+ cell counts less than 50 /mm³ might have a life-threatening, fulminating form of cryptosporidiosis.
  • In the acute phase, up to 109 oocysts may be released per day. This excretion may last for months after symptoms resolve. Three independent stool samples are recommended for diagnosis due to intermittent excretion.

Control

  • Environmental control methods include improved filtration, ozonation, and ultraviolet (UV) light.
  • Current chemotherapy is suboptimal. Paramomycin for a week may be used in severe cases. HAART is a better strategy for AIDS patients.
  • Oocysts are resistant to chlorine, cidex, and lysol. Water treatment facilities may not protect immunocompromised people, who should utilize reverse osmosis, boiling water for a minute, or submicron filters.

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