
Environmental Encyclopedia 3
Cryptosporidium
nursing homes. Persons who work with animals or touch
soils or objects contaminated with feces can contract crypt-
osporidiosis.
Infection with Cryptosporidium can also occur by
drinking water that is contaminated with oocysts. The first
report of spread of cryptosporidiosis through a municipal
drinking water system was in 1987 in Carrollton, Georgia,
where 13,000 people, out of a total population of 65,000,
became ill. In 1993, a municipal drinking water system in
Milwaukee, Wisconsin, became contaminated with Crypt-
osporidium, and 400,000 people became ill. Four thousand
people were hospitalized, at a cost of $54 million, and 100
people died, including some persons with AIDS. Both water
systems had met all state and drinking water standards.
There have also been more than a dozen outbreaks reported
in the United Kingdom. These outbreaks demonstrated the
risks of waterborne cryptosporidiosis, for unfortunately
Cryptosporidium oocysts are resistant to many environmental
stresses and chemical disinfectants such as
chlorine
that are
used in municipal drinking water systems and swimming
pools (swallowing a small amount of water while swimming
in a chlorinated pool can cause cryptosporidiosis). The mech-
anism that protects oocysts from
chlorination
has not yet
been positively identified—the oocyst membrane may be
protective, or an oocyst may pump
toxins
from its cell before
the toxins can cause harm.
Oocysts are present in most surface bodies of water
in the United States, many of which are sources of public
drinking water. They become more prevalent during periods
of
runoff
(generally from March-June during spring rains
in North America) or when
wastewater
treatment plants
become overloaded or break down. Properly drilled and
maintained
groundwater wells
, with intact well casings,
proper
seals
, and above-ground caps, are not likely to con-
tain Cryptosporidium because of natural
filtration
through
soil
and
aquifer
materials.
The detection of Cryptosporidium oocysts is unreliable,
for recovery and enumeration of oocysts from water samples
is difficult. Concentration techniques for oocysts in water
samples are poor, and detection methods often measure algae
and other debris in addition to oocysts. The volume of water
required to concentrate oocysts for detection can range from
26–264 gal (100–1,000 l). Determination of whether oocysts
are infective and viable or a member of the species that
causes disease is not easy to accomplish. The development
of more accurate, rapid and improved assays for oocysts
is required, for present tests are time-consuming, highly
subjective, and dependent on the skills of the analyst.
In addition, the number of oocysts (the effective dose)
required to cause cryptosporidiosis has not yet been well-
defined and requires more investigation. Studies to date have
suggested that the 50% infectious dose may be around 132
340
oocysts, and in some cases, as few as 30 oocysts (infections
have also occurred with the ingestion of a single oocyst).
Human susceptibility to Cryptosporidium likely varies be-
tween individuals and between various Cryptosporidium
strains.
Therefore protection of drinking water supplies from
contamination by Cryptosporidium requires multiple ap-
proaches. Filtration of drinking water supplies is the only
reliable conventional treatment method. Water in a treat-
ment plant is mixed with coagulants that aid in the settling
of particles in water; removal can be enhanced by using sand
filtration.
Ozone
disinfection can kill Cryptosporidium but
ozone does not leave a residual in the distribution system
as chlorine does, which provides protection of treated water
to the point of use but does not neessarily kill Cryptosporidium
anyway.
Watershed
protection to prevent contamination from
entering water sources is also important in protection of
drinking water supplies. Regulation of septic systems and
best management practices
can be used to control runoff
of human and animal wastes.
An individual can also take steps to ensure that drink-
ing water is safe. Boiling water (bringing water to a rolling
boil for at least one minute) is the best way to kill Cryptospori-
dium. After boiling, the water should be stored in the refrig-
erator in a clean bottle or pitcher with lid; care should be
taken to avoid touching the inside of the bottle or lid to
prevent re-contamination. Point-of-use
filters
, either
attached to a faucet, or the pour-through type, can also be
used to remove Cryptosporidium from water. Only filters
with an absolute, rather than a nominal, pore size of one
micron or smaller should be used to remove oocysts. Reverse
osmosis filters are also effective. Lists of filters and reverse
osmosis filters that will remove Cryptosporidium oocysts can
be obtained from NSF International, an independent non-
profit testing agency.
The use of bottled water is not necessarily safer than
tap water, as water from a surface water source has the same
risks of containing oocysts as tap water from that source,
unless it has been treated with appropriate treatment tech-
nologies, such as distillation, pasteurization, reverse osmosis,
or filtration with an absolute one micron rating, before bot-
tling. Bottled water from deep groundwater wells has a low
likelihood of being contaminated with oocysts, so the labels
on water bottles should be examined before use to determine
water source and treatment methods.
Food can also be a source of Cryptosporidium. In 1996,
in the Northeastern United States, unpasteurized apple cider
and juice was associated with Cryptosporidium infections. In
1997, in Spokane, Washington, members of a group at-
tending a dinner banquet become ill with cryptosporidiosis.
The parasite may be present in uncooked or unwashed fruits