Background Small numbers of Cryptosporidium parvum oocysts cancontaminate even treated drinking water, and ingestion of oocystscan cause diarrheal disease in normal as well as immunocompromisedhosts. Since the number of organisms necessary to cause infectionin humans is unknown, we performed a study to determine theinfective dose of the parasite in healthy adults.
Methods After providing informed consent, 29 healthy volunteerswithout evidence of previous C. parvum infection, as determinedby the absence of anti-cryptosporidium–specific antibodies,were given a single dose of 30 to 1 million C. parvum oocystsobtained from a calf. They were then monitored for oocyst excretionand clinical illness for eight weeks. Household contacts weremonitored for secondary spread.
Results Of the 16 subjects who received an intended dose of300 or more oocysts, 14 (88 percent) became infected. Aftera dose of 30 oocysts, one of five subjects (20 percent) becameinfected, whereas at a dose of 1000 or more oocysts, seven ofseven became infected. The median infective dose, calculatedby linear regression, was 132 oocysts. Of the 18 subjects whoexcreted oocysts after the challenge dose, 11 had enteric symptomsand 7 (39 percent) had clinical cryptosporidiosis, consistingof diarrhea plus at least one other enteric symptom. All recovered,and there were no secondary cases of diarrhea among householdcontacts.
Conclusions In healthy adults with no serologic evidence ofpast infection with C. parvum, a low dose of C. parvum oocystsis sufficient to cause infection.
Source Information
From the University of Texas Medical School (H.L.D., P.C.O.) and the University of Texas School of Public Health (H.L.D., C.L.C.), Houston; the University of Arizona, Tucson (C.R.S.); the University of South Florida, Tampa (J.B.R.); and the Environmental Protection Agency, Cincinnati (W.J.). Portions of the study were presented at the Clinical Research Meetings, Baltimore, May 1, 1994; the Society of Protozoologists Meeting, Cleveland, June 24, 1994; and the Workshop on Prevention and Control of Waterborne Cryptosporidiosis, Centers for Disease Control and Prevention, Atlanta, September 22, 1994.
Address reprint requests to Dr. DuPont at St. Luke's Episcopal Hospital, 6720 Bertner Ave., MCI-164, Rm. P153, Houston, TX 77030.
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