HIV/AIDS

Updated 26 June 2014

Cryptosporidiosis

One of the opportunistic diseases that can strike down people with HIV/Aids is Cryptosporidiosis (“crypto”) is caused by a germ called Cryptosporidium parvum.

Summary

  • Cryptosporidiosis (“crypto”) is caused by a germ called Cryptosporidium parvum.
  • Crypto spreads very easily through contact with infected human and animal faeces.
  • The germ enters the body through the mouth, and is passed on into the environment via bowel movements.
  • In people with HIV/Aids, crypto can be a severe, long-lasting or even fatal condition.
  • Medicines can reduce the symptoms of crypto, but there is no permanent cure.
  • There are many things you can do to lower your risk of catching crypto, including washing your hands, boiling water, washing and cooking your food, and avoiding oro-anal sex.

What is cryptosporidiosis?
Cryptosporidiosis (“crypto”) is a disease caused by a microscopic parasite, or germ, called Cryptosporidium parvum. It causes diarrhoea, stomach cramps, and fever. In people with advanced HIV/Aids, this diarrhoea can become severe and hard to treat.

How do you catch cryptosporidiosis?
Crypto spreads very easily through contact with infected faeces (stools), or objects that have been contaminated by faecal particles. Crypto is not spread through the blood.

You can catch crypto by putting something in your mouth that has touched the faeces of an infected person or animal. The organism will enter your body through your mouth, move into your intestine and reproduce there. Infected people or animals then pass the infection on through their bowel movements. Cryptosporidium can live in the environment (such as in soil or water) for several months.

When people with normal immune systems contract cryptosporidiosis, they usually suffer diarrhoea for a few days or weeks; it stops by itself without treatment.

How does cryptosporidiosis affect people with HIV?
In persons with HIV, crypto is a more severe and longer-lasting condition. In people with advanced HIV/Aids, the disease can be fatal. If your CD4 cell count is low (below 200), the diarrhoea and other symptoms are more likely to last for a long time. People with a higher CD4 count who are infected may recover from the diarrhoea in a few weeks’ time, but are still able to infect others – even while showing no symptoms.

What are the symptoms of cryptosporidiosis?
Occasionally, a person may be infected with crypto but have no symptoms, or only very minor ones.

More usually, the first symptoms of cryptosporidiosis appear two to 10 days after you have been exposed to the germ. Most infected people have the following common symptoms:

  • Watery diarrhoea
  • Stomach cramps
  • Slight fever

Less commonly:

  • Weight loss
  • Nausea and vomiting
  • Jaundice (yellow discolouration) of the skin and eyes

How is cryptosporidiosis diagnosed?
There are many non-crypto diseases that produce similar symptoms. Therefore, your doctor will have to arrange for laboratory tests to confirm a diagnosis of crypto. A stool sample will be taken. A stool (faeces) sample can be examined under a microscope to determine whether crypto is present.

How is cryptosporidial infection treated?
Anti-retroviral drugs may reduce or temporarily get rid of crypto symptoms. However, crypto is usually not curable, and will recur if your immune system gets weaker.

There are no drugs available to treat cryptosporidium. Drugs that suppress movement of the gut can help to reduce the diarrhoea. These include diphenoxylate hydrochloride (Lomotil), loperamide (Imodium), deodorized tincture of opium (DTO), and camphorated tincture of opium (Paregoric). However, these have side-effects and may be addictive.

If you have severe diarrhoea, you might become dehydrated. It is important to drink liquids to replace fluids and nutrients. In extreme cases, fluids must be replaced through an intravenous (IV) line.

Avoid substances that make the problem worse, such as caffeine, dairy products, alcohol and recreational drugs.

If you are infected, you can reduce the risk of spreading crypto by washing your hands frequently, and by avoiding unsafe sex, preparing food for others and public swimming areas.

How can I help prevent crypto?
There are no drugs that can prevent cryptosporidiosis.

The most common way of getting crypto is by touching your mouth after touching infected stool or contaminated objects. You can get crypto from microscopic particles of faecal matter, so it’s usually not possible to see with the naked eye if something has been contaminated. Therefore, you can minimise your risk of infection by:

Avoiding contact with human or animal faeces, or objects that may have had contact with faeces – even the tiniest amounts.

Washing your hands often with soap and water. Wash hands after using the bathroom, and also after handling animals, touching children in diapers, handling dirty laundry or the bedpan of someone with crypto, and garden soil – even if you have worn gloves.

Wash or cook your food.

  • Wash or peel any raw food, such as fruit and vegetables – these may have touched contaminated soil or water.
  • Cook food when you can – this kills crypto.
  • Avoid food sold on the street.
  • Cooked food, processed or packaged foods are probably safe.
  • Avoid any food that has been prepared or handled by an infected person.

Be careful about the water you drink:

  • Boil water where possible (for at least 10 minutes) – this is the most effective way to kill crypto.
  • Distilled water is safe.
  • Properly filtered water is also safe. But be careful: not all water filters remove crypto. The best filters are the ones that work by reverse osmosis, or that have "absolute" 1-micron pores. Filters collect germs from your water, so you should have a friend who is HIV negative change the filter for you.
  • Do not drink water from lakes, rivers or springs.
  • Only drink tap water if you can be sure it is safe. Otherwise, boil it.
  • Bottled water is less risky than river water, but you still cannot be sure it is safe.
  • Processed drinks in cans or bottles are probably safe.
  • Avoid unpasteurised milk drinks.
  • Avoid swallowing water when you swim.
  • Ice can also contain crypto. To be safe, make ice from boiled water.
  • Hot tea and coffee are safe.

Avoid risky sex. Crypto may be on the skin around the anus, the genital area, and the thighs and buttocks. Avoid kissing or licking the genitals or anus of an infected sex partner. “Rimming” (licking the anus) is extremely likely to spread crypto and should be avoided. Wash your hands well after touching your partner's anus.

Be careful around animals. Always wash your hands with soap and water after touching animals. It is safe to have pets, but you should avoid contact with:

  • Young animals - puppies or kittens younger than six months may have crypto. Older animals can also be infected, but they are less likely to get sick or infect humans.
  • Dogs or cats with diarrhoea.
  • Stray pets.
  • Farm animals, especially young ones such as calves or lambs.
  • Animal faeces. Get an uninfected person to change cat litter, and be careful of animal stool you might get on your shoes.

Be careful when swimming or using public baths and jacuzzis. Crypto can occur in all kinds of water – fresh, salt and chlorinated swimming pool water. Be careful when swimming in lakes and rivers, and avoid water that may be contaminated with human waste. If you do swim, don't swallow any water.

 

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HIV/Aids expert

Dr Sindisiwe van Zyl qualified at the University of Pretoria before working for an HIV/AIDS NPO in Soweto for many years. She was named one of the Mail & Guardian's Top 200 Young South Africans in 2012.

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