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Cryptosporidiosis: An Emerging Zoonotic Disease of Global Public Health

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DOI: 10.34172/ijmpes.2021.23

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 IJMPES International Journal of http://ijmpes.com
doi 10.34172/ijmpes.2021.23
Medical Parasitology & Vol. 2, No. 4, 2021, 81-85
eISSN 2766-6492
Epidemiology Sciences
Review Article

Cryptosporidiosis: An Emerging Zoonotic Disease of

Global Public Health Concern
ID ID ID
Mahendra Pal1* , Margo Yonas Shuramo2, Kirubel Paulos Gutama3 , Yagoob Garedaghi4
1
Narayan Consultancy on Veterinary Public Health and Microbiology, Anand, Gujarat, India
2
Degem Woreda Livestock and Fishery Development and Resource Office, North Shoa Zone, Oromia, Ethiopia
3
Adaba District Livestock and Fishery Development and Resource Office, West Arsi Zone, Oromia, Ethiopia
4
Department of Parasitology, Faculty of Veterinary Medicine, Tabriz Medical Sciences, Islamic Azad University,
Tabriz, Iran

Abstract
Cryptosporidiosis is an infectious emerging zoonotic protozoan disease occurring in both human and animal populations all over
the world. Cryptosporidiosis is caused by Cryptosporidium, a tiny parasite that affects humans as well many species of animals.
Although Cryptosporidium parvum and Cryptosporidium hominis (formerly known as C. parvum anthroponotic genotype or
genotype 1) are the most common species causing disease in human beings, Cryptosporidium felis, Cryptosporidium meleagridis,
Cryptosporidium canis, and Cryptosporidium muris infections have also been reported. Waterborne transmission via drinking
water or a swimming pool is common, and outbreaks have been reported in several countries. The most common symptom
of cryptosporidiosis in humans is watery diarrhea. People with weakened immune systems are more susceptible to contract
serious, long-term, and even fatal infections. The laboratory endeavor is required to make a precise diagnosis of the disease. The
demonstration of oocysts of Cryptosporidium in the fecal samples is still used as a simple, easy, and cost-effective technique for
the diagnosis of disease. As a preventative and control measure, appropriate hygienic practices must be practiced everywhere.
Furthermore, the veterinarians play a crucial role in the treatment of disease in domestic animals.
Keywords: Cryptosporidium, Cryptosporidiosis, Parasite, Public health, Zoonoses

Received: December 5, 2021, Accepted: December 12, 2021, ePublished: December 30, 2021

Introduction have all been identified as significant risk factors for

Cryptosporidiosis is a diarrheal disease that mostly cryptosporidiosis in low and middle-income countries.
affects young animals, children, and individuals who Human-to-human or direct contact with sick animals,
are immunocompromised (1). The disease is caused by dirty water, and food are the main mechanisms of
Cryptosporidium, an intracellular protozoan parasite transmission (5). The main objective of this article
first discovered in mice by Tyzzer. The absence of is to review cryptosporidiosis, which is an emerging
sporocysts within the oocysts gave rise to the name life-threatening protozoa zoonosis of public health
Cryptosporidium, which is now placed in the phylum importance.
Apicomplexa and the family Cryptosporiidae (2). The first
case of cryptosporidiosis in man was reported in 1976 (1). Epidemiology
Cryptosporidiosis is a serious disease with high morbidity Cryptosporidiosis is a disease caused by the intracellular
and fatality rates, particularly in the developing countries. parasite Cryptosporidium, which infects a wide range of
The disease is more common in rural regions due to the vertebrate species around the world, including humans.
higher risk of disease spread and the lack of sanitation (3). Cryptosporidium can be found in polluted soil, water,
The disease spreads when susceptible people or animals food, and surfaces from diseased humans or animals (6).
swallow the oocyst, which is commonly found in the The disease is more prevalent in poor countries than in
contaminated water or foods (4). Cryptosporidium industrialized countries due to a lack of resources and
oocysts are shed in large numbers in the feces of sick awareness regarding disease prevention and control.
people or animals, and they are resistant to disinfection Cryptosporidiosis is uncommon in immunocompetent
and environmental stressors. The oocysts can survive persons, but it is responsible for 10%–15% of severe
in temperatures ranging from 30°C to -20°C for up to diarrhea cases in developing countries, particularly in
two weeks. The poor water quality, animal contact, malnourished children under the age of five. In a number
overcrowding, household diarrhea, and open defecation of nations, cryptosporidiosis outbreaks have been

*Corresponding Author: Mahendra Pal, Email: palmahendra2@gmail.com

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Pal et al

connected to swimming pools or contaminated drinking Table 1. Cryptosporidium Species With Their Reservoirs

water (7). Cryptosporidiosis is a disease that affects both Cryptosporidium Species Reservoirs
wild and domestic animals. Cryptosporidium causes severe C. hominis Non-human primates
to fatal newborn diarrhea syndrome in farm animals and
C. parvum Ruminants
other young ruminants and has a financial impact (8).
C. ubiquitum Ruminants, rodents, carnivores

Etiology C. andersoni, C. bovis Cattle

Many Cryptosporidium species infect both animals and C. suis, C. scrofarum Pigs, wild boar
humans. Disease outbreaks and morbidity in animals are C. wrairi Guinea pigs
caused by Cryptosporidium parvum, Cryptosporidium
C. felis Cat
andersoni, Cryptosporidium ubiquitum, Cryptosporidium
fragile, Cryptosporidium ducismarci, Cryptosporidium C. canis Dog

serpentis, Cryptosporidium varanii, Cryptosporidium C. meleagridis, C. baileyi, C. galli Birds

xiaoi, Cryptosporidium galli, Cryptosporidium baileyi, C. muris, C. viatorum Rodents
and Cryptosporidium meleagridis. However, C. Note. C. hominis: Cryptosporidium hominis; C. parvum: Cryptosporidium
parvum, Cryptosporidium hominis, C. meleagridis, parvum; C. ubiquitum: Cryptosporidium ubiquitum; C. andersoni:
Cryptosporidium andersoni; C. bovis Cryptosporidium bovis; C. suis:
and Cryptosporidium cuniculus are the most common Cryptosporidium suis; C. scrofarum: Cryptosporidium scrofarum; C.
pathogenic species in humans, causing occasional wrairi: Cryptosporidium wrairi; C. felis: Cryptosporidium felis; C. canis:
cases and outbreaks. C. parvum, which is also the most Cryptosporidium canis; C. meleagridis: Cryptosporidium meleagridis; C.
baileyi: Cryptosporidium baileyi; C. galli: Cryptosporidium galli; C. muris:
significant zoonotic hazard to humans, is the most Cryptosporidium muris; C. viatorum: Cryptosporidium viatorum. Source (11).
common cause of cryptosporidiosis in young mammalian
cattle. C. hominis, mostly associated with human causes of outbreaks include drinking water from a lake
infection as well as non-zoonotic species and genotypes, or river and swimming in a contaminated pool (12). In
is host-adapted with no evidence of animal-to-human addition, inhaling oocysts from the contaminated air
transmission (9). Cryptosporidium is resistant to chlorine, can infect the respiratory tract and produce respiratory
is difficult to filter, and can be found in a wide range of symptoms in both animals and humans (13). Direct
animal species (10). transmission from animal to animal, indirect transmission
via fomites or human transmission, environmental
Hosts pollution, and fecal contamination of feed or water supply
Cryptosporidium is a parasite identified in at least 155 are all possible ways for the spread of disease. C. parvum
mammalian species that causes widespread disease in is not host-specific, and the infection can spread to other
animals. Cryptosporidium oocysts were also discovered animals such as cats through contaminated food (8).
in reptile feces. The majority of amphibian species
investigated as well as more than 30 bird species Clinical Spectrum
have Cryptosporidium oocysts in their feces (7). In Humans
Cryptosporidium ovis and Cryptosporidium ryanae are Although 21 species have been related to human
more common in post-weaned calves than C. parvum, infection, the most prevalent ones found in intestinal
although host-adapted cattle species have yet to be related infections are C. hominis and C. parvum with such
to the disease. C. ubiquitum and C. xiaoi infect lambs symptoms as watery diarrhea, stomach pains, vomiting,
and children. C. ubiquitum has been connected to the nausea, dehydration, and weight loss (15). When
disease in post-weaned lambs, while C. xiaoi infection has exposed to C. parvum, those with CD4 T-cell count
been associated to the highest rates of neonatal diarrhea of less than 150/mL develop a persistent infection with
in goats. The most commonly reported species in dogs severe and occasionally fatal diarrhea. Symptoms are
is Cryptosporidium canis, while the most commonly normally self-limiting in immunocompetent people,
reported species in cats is Cryptosporidium felis, both of whereas diarrhea and dehydration are the most severe
which have no clinical indications. Infectious pathogens in immunocompromised people. Further, disease may
infecting chickens include C. baileyi, C. meleagridis, and be fatal in immunocompromised patients having AIDS
C. galli (8). The reservoirs of various Cryptosporidium (1). C. hominis causes more severe clinical symptoms
species are listed in Table 1. in humans compared to C. parvum, which has a longer
period of symptoms and oocyst shedding (16).
Transmission
Cryptosporidiosis can be transmitted from person to In Animals
person in a variety of ways (Figure 1). The contaminated The main symptoms in animals are determined by the
food and drink, touching the mouth with contaminated animals’ immune system. Calves under the age of six
hands, and oral-anal sexual contact can all spread the weeks are the most susceptible to cryptosporidiosis. The
disease from person to person (1,12). The most prevalent most common symptom is pasty to watery diarrhoea,

82 Int J Med Parasitol Epidemiol Sci Volume 2, Number 4, 2021

 Pal et al

Figure 1. Presentation of Life Cycle and Transmission of Cryptosporidium From Animal to Humans. Pal (10).

which may be followed by lethargy, inappetence, fever, a specific dye such as acid-fast dye, fluorescence, or
dehydration, and/or poor health. Although the way immunofluorescence can be used to detect oocysts in
animals respond to and recover from infection varies stool samples (21). Acid-fast stained oocyst sporozoites
widely, the majority of infections are eliminated on their are crescent-shaped and occasionally crimson with a
own after a few days. In some cases, the infection could diameter of 4-6 μm. modified Ziehl–Neelsen, modified
be lethal (8). Cryptosporidiosis has been associated with dimethyl sulfoxide, safranin-methylene blue, and
a high rate of morbidity and mortality in both lambs and modified Koster are common acid-fast dyes. Although
kids (17). The commonly observed symptoms include fluorochrome stains are getting increasingly sensitive,
anorexia, apathy/depression, and abdominal pain as well oocyst-like organisms in feces can still be stained (22).
as pasty to watery, yellow, and foul-smelling faeces (18). Oocysts are bound by fluorescent antibodies, and the
However, nasal discharge, sinusitis, dyspnea, pneumonia, disease is diagnosed by ELISA and PCR (1,20).
and conjunctivitis are also recorded in animals (1).
Subclinical infection is typical in animals over one month, Treatment
although it can also afflict younger animals. The disease There is no effective treatment; however, nitazoxanide
can still affect production, lead to lower body condition (500 mg BID for 3 days in adults, 100 mg BID for 3 days in
scores, slower growth, and lower carcass weight and children 1-3 years, and 200 mg BID for 3 days in children
dressing percentage at slaughter (19). 4-11 years) is beneficial in immunocompetent people.
Supportive treatment with opium tincture or loperamide
Diagnosis as well as antidiarrheal medications are necessary for
The best diagnostic procedure for Cryptosporidium severe diarrheic patients (23). The infected animals
isolation and identification depends on the purpose should be treated with symptomatic treatment such as oral
as well as the diagnostic facilities, resources available or parenteral fluid, electrolyte replenishment, nutritional
resources (20). Wet mount followed by staining with support, and anti-diarrheal medication because there is

Int J Med Parasitol Epidemiol Sci Volume 2, Number 4, 2021 83

Pal et al

no approved treatment for them (24). It is necessary to Ethical issues

develop safe, effective, and cheap chemotherapeutic Ethical issues have been fully observed while collecting information
and writing this article.
agents for the treatment of disease in humans and animals.
Funding
Prevention and Control No financial support was received from any organization.
Understanding the distribution of Cryptosporidium
References
species and subtypes, mechanisms of transmission, and
1. Pal M. Zoonoses. 2nd ed. Jaipur, India; Satyam Publishers:
sources of infection is crucial for disease prevention and 2007.
control. The main prevention methods include drinking 2. Xiao L, Fayer R, Ryan U, Upton SJ. Cryptosporidium
treated water, eating cooked food when traveling to taxonomy: recent advances and implications for public
areas where food supplies are unsafe, treating swimming health. Clin Microbiol Rev 2004;17(1):72-97. doi: 10.1128/
cmr.17.1.72-97.2004
pool water with cleaning agents, not allowing diarrheal
3. Kotloff KL. The burden and etiology of diarrheal illness in
patients to swim, washing hands after visiting toilets or developing countries. Pediatr Clin North Am 2017;64(4):799-
changing diapers for children, and having safe sex by 814. doi: 10.1016/j.pcl.2017.03.006
using protection methods (25,26). Since it is difficult to 4. Pal M, Bulcha MR, Lema AG, Bulcha SR. Cryptospordiosis:
treat cryptosporidiosis, reducing the amount of oocysts an infectious emerging protozoan zoonosis of public health
significance. MOJ Biol Med 2021;6(4):161-3.
may assist to decrease the severity of the infection and
5. Gaibova H, Mamedova S. Anthropogenic influence on the
allow for the development of immunity in young animals formation of intestinal coccidia (Sporozoa, Apicomplexa) in
and children through proper colostrum feeding. When reptiles of Azerbaijan. Amur Zool J 2020;11:1-4.
dealing with diarrheal children and animals, more 6. Feng Y, Xiao L. Molecular epidemiology of cryptosporidiosis
caution is required in terms of personal cleanliness (24). It in China. Front Microbiol 2017;8:1701. doi: 10.3389/
fmicb.2017.01701
is advised that immunocompromised persons and infants 7. Lebbad M, Winiecka-Krusnell J, Stensvold CR, Beser J. High
should not handle the animals suffering from diarrhea Diversity of Cryptosporidium species and subtypes identified in
(1). cryptosporidiosis acquired in Sweden and abroad. Pathogens
2021;10(5):523. doi: 10.3390/pathogens10050523
Conclusion 8. Tomazic M, Garro C, Schnittger L. Cryptosporidium. In:
Florin-Christensen M, Schnittger L, eds. Parasitic Protozoa of
Cryptosporidium is a gastrointestinal parasite that affects Farm Animals and Pets. Cham, Switzerland: Springer; 2018.
humans and animals worldwide. The most prevalent 9. Gaibova H, Iskenderova N, Gurbanova T. Review of the
and ubiquitous Cryptosporidium zoonotic species are C. modern state of the emeridcoccides of terrestrial vertebrates
hominis and C. parvum. The disease can be transmitted of Azerbaijan. In: Proceedings of the XIX International
Scientific Conference with Elements of the Scientific School
directly or indirectly from animals to humans. Oocysts are
of Young Scientists. Makhachkala, Russia: Biological diversity
distributed via the fecal-oral route. It is an opportunistic Caucasus and South Russia; 2017. p. 423-5.
infection that can cause many problems from diarrhea to 10. Pal M, Tafese W, Tilahun G, Anberber M. Cryptosporidiosis: an
life-threatening death in immunocompromised people. emerging food and waterborne protozoan disease of global
Cryptosporidium parasites can be found in both wild and significance. Beverage & Food World 2016;43(1):43-5.
11. Ryan U, Zahedi A, Feng Y, Xiao L. An update on zoonotic
domestic animals, making them a potential biological
Cryptosporidium species and genotypes in humans. Animals
reservoir. The oocysts are resistant to the environment (Basel) 2021;11(11):3307. doi: 10.3390/ani11113307
and can be easily transmitted to humans through 12. Efstratiou A, Ongerth J, Karanis P. Evolution of monitoring
contaminated water and foods. Control and prevention for Giardia and Cryptosporidium in water. Water Res
require high levels of personal hygiene. It is emphasized to 2017;123:96-112. doi: 10.1016/j.watres.2017.06.042
13. Mor SM, Ascolillo LR, Nakato R, Ndeezi G, Tumwine JK,
carry out further work on the pathogenesis, epidemiology,
Okwera A, et al. Expectoration of Cryptosporidium parasites
diagnostic methods, and vaccinology. in sputum of human immunodeficiency virus-positive and
-negative adults. Am J Trop Med Hyg 2018;98(4):1086-90.
Acknowledgements doi: 10.4269/ajtmh.17-0741
We are highly grateful to Professor R.K. Narayan for his prudent 14. Center for Disease Control and Prevention (CDC).
suggestions during the preparation of the manuscript. The computer Cryptosporidiosis. Atlanta, USA: CDC; 2019.
help by my students are also highly appreciated. This study is 15. Holubová N, Zikmundová V, Limpouchová Z, Sak B, Konečný
dedicated to the scientists who have done commendable research R, Hlásková L, et al. Cryptosporidium proventriculi sp. n.
work in the field of cryptosporidiosis. (Apicomplexa: Cryptosporidiidae) in Psittaciformes birds. Eur
J Protistol 2019;69:70-87. doi: 10.1016/j.ejop.2019.03.001
Authors’ Contributions 16. Bushen OY, Kohli A, Pinkerton RC, Dupnik K, Newman RD,
All the authors contributed equally to the completion of this study. Sears CL, et al. Heavy cryptosporidial infections in children
They read the final manuscript and approved it before the final in northeast Brazil: comparison of Cryptosporidium hominis
submission. and Cryptosporidium parvum. Trans R Soc Trop Med Hyg
2007;101(4):378-84. doi: 10.1016/j.trstmh.2006.06.005
Conflict of Interests 17. Cacciò SM, Sannella AR, Mariano V, Valentini S, Berti F,
There was no conflict of interests among the authors. Tosini F, et al. A rare Cryptosporidium parvum genotype

84 Int J Med Parasitol Epidemiol Sci Volume 2, Number 4, 2021

 Pal et al

associated with infection of lambs and zoonotic transmission comparison of direct immunofluorescence and
in Italy. Vet Parasitol 2013;191(1-2):128-31. doi: 10.1016/j. conventional staining methods for detection of Giardia and
vetpar.2012.08.010 Cryptosporidium spp. in human fecal specimens. J Clin
18. de Graaf DC, Vanopdenbosch E, Ortega-Mora LM, Abbassi Microbiol 1995;33(6):1632-4. doi: 10.1128/jcm.33.6.1632-
H, Peeters JE. A review of the importance of cryptosporidiosis 1634.1995
in farm animals. Int J Parasitol 1999;29(8):1269-87. doi: 23. Sparks H, Nair G, Castellanos-Gonzalez A, White AC Jr.
10.1016/s0020-7519(99)00076-4 Treatment of Cryptosporidium: what we know, gaps, and
19. Sweeny JP, Ryan UM, Robertson ID, Yang R, Bell K, Jacobson C. the way forward. Curr Trop Med Rep 2015;2(3):181-7. doi:
Longitudinal investigation of protozoan parasites in meat lamb 10.1007/s40475-015-0056-9
farms in southern Western Australia. Prev Vet Med 2011;101(3- 24. Innes EA, Chalmers RM, Wells B, Pawlowic MC. A one
4):192-203. doi: 10.1016/j.prevetmed.2011.05.016 health approach to tackle cryptosporidiosis. Trends Parasitol
20. Ahmed SA, Karanis P. Comparison of current methods 2020;36(3):290-303. doi: 10.1016/j.pt.2019.12.016
used to detect Cryptosporidium oocysts in stools. Int J 25. Firouzivand Y, Garedaghi Y, Hassanzadeh Khanmiri H.
Hyg Environ Health 2018;221(5):743-63. doi: 10.1016/j. Prevalence of Cryptosporidium in children under 13 years
ijheh.2018.04.006 of age with acute diarrhea in Tabriz, Iran. Int J Med Parasitol
21. Sarkar R, Kattula D, Francis MR, Ajjampur SS, Prabakaran Epidemiol Sci 2021;2(1):19-22. doi 10.34172/ijmpes.2021.05
AD, Jayavelu N, et al. Risk factors for cryptosporidiosis among 26. Manyazewal A, Francesca S, Pal M, Gezahegn M, Tesfaye
children in a semi urban slum in southern India: a nested M, Lucy M, et al. Prevalence, risk factors and molecular
case-control study. Am J Trop Med Hyg 2014;91(6):1128-37. characterization of Cryptosporidium infection in cattle in
doi: 10.4269/ajtmh.14-0304 Addis Ababa and its environs, Ethiopia. Vet Parasitol Reg Stud
22. Alles AJ, Waldron MA, Sierra LS, Mattia AR. Prospective Reports 2018;13:79-84. doi: 10.1016/j.vprsr.2018.03.005

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