Persisting post-infection symptoms 2 years after a large waterborne outbreak of Cryptosporidium hominis in northern Sweden

Abstract ObjectivesIn 2010-2011, a waterborne outbreak of the parasite, Cryptosporidium hominis, affected approximately 27,000 inhabitants in the city of Östersund, Sweden. Previous research suggested that post-infectious symptoms, such as gastrointestinal symptoms and joint pain, could persist for up to two years after the initial infection. In this study, we investigated whether the parasite caused post-infectious sequelae for up to five years after the outbreak. This prospective cohort study examined whether individuals infected during the outbreak were more likely than uninfected individuals to report post-infectious symptoms five years later. The participants completed a questionnaire on whether they experienced a list of symptoms. We analysed data using logistic regression and calculated odds ratios with 95% confidence intervals.Results The analysis included 626 individuals. Among the 262 individuals infected during the outbreak, 56.5% reported symptoms at follow-up. Compared to uninfected individuals, infected individuals were significantly more likely to report watery diarrhoea, diarrhoea, swollen joints, abdominal pain, bloating, joint discomfort, acid indigestion, alternating bowel habits, joint pain, ocular pain, nausea, and fatigue at the follow-up, after adjusting for age and sex. Our findings suggested that cryptosporidiosis was mainly associated with gastrointestinal- and joint-related post-infectious symptoms for up to 5 years after the infection.

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Post-infection symptoms following two large waterborne outbreaks of Cryptosporidium hominis in Northern Sweden, 2010–2011

BMC Public Health ◽

10.1186/s12889-015-1871-6 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 31

Author(s):

Moa Rehn ◽

Anders Wallensten ◽

Micael Widerström ◽

Mikael Lilja ◽

Maria Grunewald ◽

...

Keyword(s):

Post Infection ◽

Northern Sweden ◽

Cryptosporidium Hominis

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Detection of Cryptosporidium species and sources of contamination with Cryptosporidium hominis during a waterborne outbreak in north west Wales

Journal of Water and Health ◽

10.2166/wh.2009.185 ◽

2009 ◽

Vol 8 (2) ◽

pp. 311-325 ◽

Cited By ~ 59

Author(s):

Rachel M. Chalmers ◽

Guy Robinson ◽

Kristin Elwin ◽

Stephen J. Hadfield ◽

Euron Thomas ◽

...

Keyword(s):

Wastewater Treatment ◽

Water Supply ◽

Treatment Plant ◽

Small Subunit ◽

Base Flow ◽

Septic Tank ◽

Cryptosporidium Hominis ◽

Genotype I ◽

Waterborne Outbreak ◽

North West

As part of investigations into the cause of a waterborne outbreak of Cryptosporidium hominis infection linked to a mains water supply, surface waters and wastewater treatment plants were tested for Cryptosporidium spp. Oocyst counts in base flow surface water samples ranged from nil to 29 per 10 l. Oocyst counts in effluent from a community wastewater treatment plant were up to 63 fold higher and breakout from one septic tank five logs higher. There were no peak (storm) flow events during the investigation. C. hominis, four named genotypes (cervine, muskrat II, rat, W19) and six new small subunit ribosomal RNA gene sequences were identified. Four of the new sequences were closely related to Cryptosporidium muskrat genotype I, one was closely related to the fox genotype and one to Cryptosporidium canis. C. hominis was found extensively in the catchment, but only at sites contaminated by wastewater, and in the treated water supply to the affected area. All were gp60 subtype IbA10G2, the outbreak subtype. Multiple routes of contamination of the reservoir were identified, resulting in persistent detection of low numbers of oocysts in the final water. This work demonstrates the utility of genotyping Cryptosporidium isolates in environmental samples during outbreak investigations.

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Symptoms and risk factors of Cryptosporidium hominis infection in children: data from a large waterborne outbreak in Sweden

Parasitology Research ◽

10.1007/s00436-017-5558-z ◽

2017 ◽

Vol 116 (10) ◽

pp. 2613-2618 ◽

Cited By ~ 5

Author(s):

Sara Adler ◽

Micael Widerström ◽

Johan Lindh ◽

Mikael Lilja

Keyword(s):

Risk Factors ◽

Cryptosporidium Hominis ◽

Waterborne Outbreak ◽

Hominis Infection

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Analysis of Cured Meat Products for Cryptosporidium Oocysts following Possible Contamination during an Extensive Waterborne Outbreak of Cryptosporidiosis

Journal of Food Protection ◽

10.4315/0362-028x.jfp-11-525 ◽

2012 ◽

Vol 75 (5) ◽

pp. 982-988 ◽

Cited By ~ 6

Author(s):

LUCY J. ROBERTSON ◽

QIRONG HUANG

Keyword(s):

Cryptosporidium Oocyst ◽

Meat Products ◽

Recovery Efficiency ◽

Northern Sweden ◽

High Fat ◽

Simple Method ◽

Waterborne Outbreak ◽

Cryptosporidium Oocysts ◽

Cured Meat ◽

Food Matrices

An outbreak of waterborne cryptosporidiosis in a town in northern Sweden during winter 2010 resulted in the potential exposure of cured meat products to Cryptosporidium oocysts during their manufacture. The purpose of this work was to develop a method for analyzing cured meat products for contamination with Cryptosporidium oocysts and use this method to analyze potentially contaminated product samples. A simple method of elution, concentration, separation, and detection was used, based on work with other food matrices but adapted for the relatively high fat content of cured meat surfaces. Using spiking experiments, the recovery efficiency of this method was found to be over 60%. In the analysis of the potentially contaminated products, only one putative Cryptosporidium oocyst was detected, and this was sufficiently deformed so that it could not be confirmed as an oocyst; if it was an oocyst, it was considered to have been probably deformed and inactivated prior to analysis. Based on the results of the analyses, together with data on the probable extent of contamination of the products and on our knowledge of factors, such as water activity, which affect oocyst survival, the products were safely released to the market.

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Sick leave due to diarrhea caused by contamination of drinking water supply with Cryptosporidium hominis in Sweden: a retrospective study

Journal of Water and Health ◽

10.2166/wh.2017.311 ◽

2017 ◽

Vol 16 (5) ◽

pp. 704-710 ◽

Cited By ~ 2

Author(s):

Frida Ridderstedt ◽

Micael Widerström ◽

Johan Lindh ◽

Mikael Lilja

Keyword(s):

Drinking Water ◽

Sick Leave ◽

Sick Child ◽

Watery Diarrhoea ◽

Waterborne Diseases ◽

Cryptosporidium Hominis ◽

Waterborne Outbreak ◽

Potential Impact ◽

Absence From Work

Abstract We investigated sick leave from work, studies, preschool, and kindergarten occurring between 1 November 2010 and 31 January 2011 and associated with a waterborne outbreak of diarrhea caused by Cryptosporidium hominis in late November 2010 in Östersund, Sweden with 45.2% of 60,000 residents being symptomatic. A questionnaire defining acute watery diarrhoea and/or ≥3 diarrhea episodes/day as cryptosporidiosis was sent to 1,508 residents in late January 2011 (response rate 69.2%). Among adults aged 18–60 years, 24.0% took sick leave for a mean of 4.6 (SD ± 4.0) days due to cryptosporidiosis, and an additional 10.6% were absent from work a mean of 4.0 (±2.2) days to care for symptomatic children. Among children (aged ≤17 years), 35.0% stayed home sick from kindergarten/preschool or school/university for a mean of 5.2 (±3.8) days resulting in 5.1 (±4.4) days of absence from work per sick child shared between parents/guardians. The estimated total number of sick leave days was 50,000 for adults and 20,700 for children, with an estimated direct cost of €7 million for employers. The potential impact on society of sick leave caused by waterborne diseases must be considered in decisions regarding the quality of drinking water.

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The Fine Structure of Replicating Simian Adenoviruses in LLC-MK2

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100100846 ◽

1968 ◽

Vol 26 ◽

pp. 220-221

Author(s):

Matias Pardo ◽

Malcolm Slifkin ◽

Leonard Merkow ◽

Marie Sanchez

Keyword(s):

Tissue Culture ◽

Post Infection ◽

Cesium Chloride ◽

Longitudinal Section ◽

Tubular Structures ◽

Virus Particles ◽

Ultrastructural Studies ◽

Culture Cells ◽

Simian Adenovirus ◽

Infectivity Titer

The simian adenoviruses SV20, SV30 and SA7 have been found to be oncogenic in the Syrian hamster. The growth characteristics and replicative cycle of these viruses in tissue culture therefore appeared appropriate to investigate. Cesium chloride purified simian adenovirus with an infectivity titer of 100 TCID50, was inoculated into monolayers of LLC-MK2 cells. Cells were fixed in osmium tetroxide and embedded for ultrastructural studies at 1, 3, 6, 9, 18, 24, 48, 72, 120 and 192 hours post-infection.At the first hour post-infection, virus particles were adsorbed to the plasmalemma and found within the peripheral cytoplasm of many LLC-MK2 cells (Fig. 1). Although the first detection of infectious virus occurred at 14 hours and infectivity titers did not reach a maximum until 30 hours, intranuclear virus particles were observed by 3 hours in typical adenovirus crystalline array (Fig. 2) by means of electron microscopy. These typical honeycomb arrayed virus particles at 3 hours provided evidence of significant replication in approximately 5 percent of tissue culture cells examined. Simultaneously, a classical nuclear inclusion manifested by peripheral condensation of nuclear chromatin was evident by light microscopy. As early at 6 to 9 hours, unusual intranuclear concentric membranes formed “tubes” which contained linear arranged virus particles (Fig. 3). In transverse or tangential sections, these “tubes” appeared cochlear-like in shape. In longitudinal section, these intranuclear tubular structures contained individual virus particles at various stages of maturation in a linear arranged order. This arrangement resembled “peas in a pod”.

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