You’ve no doubt heard in the press recently that hundreds of thousands of residents within the Lancashire area have been told to boil their water before drinking it after the water company United Utilities found a bug within the treatment works close to Preston. The bug identified was Cryptosporidium and causes sickness and diarrhea. United Utilities issued a warning to residents within Blackpool, Chorley, Preston, South Ribble, Flyde and Wyre to ensure they boil their water before drinking, preparing food and brushing their teeth as a precautionary measure. They’ve been instructed to carry this out until further notice. 

The bug was detected during routine tests within the Franklaw water treatment works after which the following statement was released by Kate Brierley of Public Health England, “We would remind people in the affected areas to follow the advice from United Utilities and boil their drinking water and allow to cool before use. The levels of cryptosporidium detected in the water supply is low and the advice to boil the water is as a precaution. There is no specific treatment for cryptosporidiosis. In most cases the symptoms of abdominal pain and diarrhoea settle in a few days. However, in a few cases cryptosporidiosis can be unpleasant with diarrhoea lasting for several weeks. It is important to drink plenty of fluids to avoid dehydration.” With this in mind, let’s take a closer look at just what cryptosporidium actually is. 

What is cryptosporidium?

Cryptosporidium enteritis is actually an infection within the small intestine caused by a parasite known as cryptosporidium. The infection affects intestines of mammals and is typically an acute and rather short-term infection. It’s usually spread via the fecal-oral route, more often than not through contaminated water, which is the very case in Lancashire. The main symptom you may notice of cryptosporidium is a self-limiting diarrhea for those with an intact immune system. For those with compromised immune systems, such as patients suffering from Aids, the symptoms can be quite severe and often fatal. Cryptosporidium is also commonly isolated within patients presenting with diarrhea and testing positive for HIV. A man named Tyzzer, who named it coccidian, first spoke about the organism in 1907.

Today there are many known species of Cryptosporidium that exist and infect humans and a wide range of other mammals. The parasite itself actually has protection thanks to the hard outer shell that gives it the ability to survive outside of the body for long periods of time and make it very resistant to the chlorine disinfection used in most water treatment works. Cryptosporidium has only recently been recognised as a worldwide cause of diarrhea in all age categories. Crypto, as it’s known for short, is spread by you having contact with excrement that contains it however you can also contract crypto by putting something in your mouth that has touched the excrement of a person or animal that was infected by disease. 

Cryptosporidiosis is now known to be the cause of over half of all water-bourne diseases attributed to parasites. In developing countries such as Africa and India, 8-19% of diarrhea diseases can be linked back to cryptosporidium. The age group that would appear to be most affected would be those ranging from 1 to 9 years old. 

Symptoms and causes of cryptosporidium 

Symptoms are the things that you (the patient) would sense or describe whilst signs are something that other people, such as a doctor, would notice. A good example of this would be drowsiness; this could be a symptom for you while dilated pupils could be a sign. You’ll begin to notice symptoms of cryptosporidiosis around two to ten days after infection with the average being around seven days. Symptoms can last in some cases up to two weeks or even a month. There are three different possible forms of the infection within those considered to be immunocompetent people.

This disease can be asymptomatic or cause acute diarrhea lasting for a few weeks. The diarrhea will usually be very watery and contain a little mucus. It’s very rare that you’ll find blood or leukocytes within the diarrhea. Along with watery diarrhea you may notice some stomach pains or cramps as well as a mild fever. Other such symptoms can include nausea, vomiting, malabsorption and severe dehydration. Individuals that are asymptomatic are still infectious and as a result should be careful not to pass on the infection to others. Even after symptoms subside, an individual still has the ability to infect others for a number of weeks. 

When it comes to the causes of cryptosporidium, infection is usually through contaminated material such as earth, food or in the most current case – water. The material in question would have been in contact with feces of an infected individual or animal. Millions of crypto organisms otherwise known as oocysts, can be released into the bowel movement of an infected mammal and will therefore infect those who accidently ingest the oocysts.

The oocysts must be transferred to the mouth and subsequently swallowed. It’s especially prevalent in those who spend their time around fresh water such as those taking part in recreational water sports. Other potential sources include insufficiently treated water supplies, the Franklaw water treatment works being a prime example. The high resistance of cryptosporidium oocysts to disinfectants such as chlorine is what allows them to survive for longer periods of time and still pose an infectious threat. Outbreaks have happened in day care centres through nappy changes however most recently we have United Utilities in the Lancashire area.

Diagnosing and treating cryptosporidium

There are a number of different steps your doctor can take in order to correctly diagnose the cryptosporidium infection. First and foremost, your symptoms will be observed after an incubation period of around five to ten days. More often than not, as mentioned previously, the patient will experience very watery diarrhea accompanied by abdominal pain and mild fever. This can last for around another five to ten days within immune-competent people.

Secondly, a doctor will examine your stool sample under a microscope. If you have cryptosporidium then red-stained oocysts will be present on a blue-green background when placed in a modified acid-fast stain. Blood cells will however be absent. During this examination, the stool sample will also be used to help rule out other possible pathogen. 

Antigen-detection examinations can be carried out in order to confirm a diagnosis of cryptosporidiosis. The most sensitive of tests happens to be a Polymerase Chain Reaction however this isn’t always available. Other possible tests include enzyme-linked immunosorbent assays and immunofluorescent assays. A physician may even use an ultrasound in order to check for biliary cryptosporidiosis and an infection within the bile system can be shown by dilated and irregular bile ducts along with a thickened gallbladder. Lastly, a doctor will confirm a diagnosis of cryptosporidiosis with the help of an Endoscopic Retrograde Cholangiopancreatography or an ERCP. The ERCP is often required in order to detect any inflammation of the bile duct too.

Treatment options for cryptosporidiosis can range. There are several different options beginning with nitazoxanide drugs that can be used safely in children and adult patients. Sadly however, these drugs will often only help for a little while. It’s not uncommon for the infection to return after use. One of the best approaches is to help improve your immune system if you have a weakened immune system already.

This can be achieved with the help of highly active antiviral therapy and will often result in complete remission of cryptosporidium enteritis. As a last resort, a lactose-free diet should be adhered to if it can be tolerated. In some instances, intravenous fluids may also be required in order to fend off dehydration due to severe diarrhea. Antibiotics are very rarely helpful and are usually reserved for those suffering from a severe case of this disease with a weakened immune system. You may find that relapses will also happen.

Preventing cryptosporidiosis

Aside from the advice given by United Utilities to boil your water before ingesting it, you should also be mindful to ensure you practice good hygiene and sanitation yourself. An example of this would be washing your hands after visiting the bathroom and before eating. Sadly, despite water treatment companies telling us our water is of good quality, incidents will occur where this isn’t the case and the issues surrounding the water supply within the Lancashire area are a prime example. 

There is a way in which you can protect yourself permanently and that’s by distilling all the water you will drink, prepare food in and use to brush your teeth. This may sound like a lot of hard work but actually it couldn’t be further from the truth. Distillation works by essentially boiling the water out of the contaminants, including bacteria, viruses and parasites such as cryptosporidium. The water is boiled and as it does so, the steam rises. The contaminants it contains, including the cryptosporidium bug, have much higher boiling points and as a result remain behind in the boiling chamber.

The steam that rises is collected within a coil like device and subsequently sent into a collection chamber where it cools and begins to return to its liquid form. The process of distillation is the only process in the world that has the ability to create 99.8% pure water. This means you can have pure, clean, infection-free water available to you twenty four hours a day, seven days a week and you can have it all from the comfort of your own home. Make Water Pure are the leading suppliers of water distillers in Europe, providing high quality counter top water distillers ideal for placing in the kitchen or office. The distillers get to work with minimal fuss (just press one button) and create minimal noise. Four litres of distilled water can be created in less than four hours too. Removing cryptosporidium however, happens to be just one of the many benefits of a water distiller. Contact Make Water Pure today to find out more. 

Korich, DG; Mead, JR; Madore, MS; Sinclair, NA; Sterling, CR (1990). “Effects of ozone, chlorine dioxide, chlorine, and monochloramine on Cryptosporidium parvum oocyst viability” Applied and Environmental Microbiology 56 (5): 1423–8. PMC 184422. PMID 2339894.

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