Cryptosporidium parvum infections in a cohort of veterinary students in Sweden.

In March 2013, a veterinary student tested positive for Cryptosporidium; four classmates reported similar gastrointestinal symptoms. We aimed to identify source(s) and risk factors for Cryptosporidium infection in university persons symptomatic between 21 January and 14 April 2013. Sixty-four (79%) students from a cohort of 81 fourth-year veterinary students completed questionnaires, identifying 13 cases; four were Cryptosporidium parvum GP60 subtype IIaA16G1R1b, two were IIdA24G1, seven did not submit stool samples. Thirteen cases attended the university's field clinic before symptom onset (13/37 attendees, 35%); 11 visited at least one of four farms where students recalled seeing calves with diarrhoea. C. parvum subtype IIaA16G1R1b was identified in calves at one of the farms. Entering pens of calves with diarrhoea [relative risk (RR) 7·6, 95% confidence interval (CI) 1·7-33·5] and eating in clinic cars (RR 9·1, 95% CI 1·3-65·8) were associated with being a case. Washing hands at least twice per farm visit (0 cases, P = 0·03) was protective. This outbreak investigation was notable for rapid and effective collaboration between public health, veterinary and environmental sectors, leading to swift identification of a microbiological and epidemiological link between cases, infected calves and their farms. We recommend frequent hand-washing using proper technique and dissuasion from eating in clinic cars to minimize possible exposure to contaminated surfaces.

Cryptosporidium spp. in calves and cows from organic and conventional dairy herds.

A cohort study was performed to investigate cryptosporidial prevalence and species distribution in 13 organic and 13 conventional dairy herds. Faecal samples were collected from 221 calves and 259 cows. Management routines were recorded at farm inspection and through a questionnaire. Samples were concentrated using sodium chloride flotation and cryptosporidial oocysts were detected by epifluorescence microscopy. Molecular analysis was used to determine species and subtypes. A multivariable model for factors associated with calves being Cryptosporidium spp. positive was built. Cryptosporidium spp.-positive animals were identified in all herds. Prevalences were similar in organic and conventional calves (44·7% vs. 52·3%), as well as in cows (3·1% vs. 3·8%), P > 0·05. Cryptosporidium bovis, C. ryanae and C. parvum were identified. C. ryanae was identified in a calf younger than the described prepatent period. The multivariable model included four significant variables; calf age, cleanliness of bedding, cleaning routines for group pens and farmers' attitudes towards biosecurity.

Molecular epidemiology and clinical manifestations of human cryptosporidiosis in Sweden.

This study describes the epidemiology and symptoms in 271 cryptosporidiosis patients in Stockholm County, Sweden. Species/genotypes were determined by polymerase chain reaction-restriction fragment-length polymorphism (PCR-RFLP) of the Cryptosporidium oocyst wall protein (COWP) and 18S rRNA genes. Species were C. parvum (n=111), C. hominis (n=65), C. meleagridis (n=11), C. felis (n=2), Cryptosporidium chipmunk genotype 1 (n=2), and a recently described species, C. viatorum (n=2). Analysis of the Gp60 gene revealed five C. hominis allele families (Ia, Ib, Id, Ie, If), and four C. parvum allele families (IIa, IIc, IId, IIe). Most C. parvum cases (51%) were infected in Sweden, as opposed to C. hominis cases (26%). Clinical manifestations differed slightly by species. Diarrhoea lasted longer in C. parvum cases compared to C. hominis and C. meleagridis cases. At follow-up 25-36 months after disease onset, 15% of the patients still reported intermittent diarrhoea. In four outbreaks and 13 family clusters, a single subtype was identified, indicating a common infection source, which emphasizes the value of genotyping for epidemiological investigations.

Is there a need for improved Cryptosporidium diagnostics in Swedish calves?

Cryptosporidium parvum is a common pathogen in preweaned calves but in Sweden Cryptosporidium bovis, which is considered apathogenic, is the most common species in this age group and it has been identified in diarrhoeal samples, indicating that it could be a cause of diarrhoea. In routine diagnostic procedures, infection is determined by microscopy, which is not sufficient to differentiate these species. We investigated whether routine Cryptosporidium diagnostic procedures need improvement to include species determination. The relation of Cryptosporidium spp. and subtype with the clinical picture and other pathogens was also investigated. A total of 782 diarrhoeal calf samples were analysed and Cryptosporidium infection was diagnosed in 198 samples. Cryptosporidium parvum was identified in 178, C. bovis in six and mixed C. bovis/C. parvum in seven samples. Twenty-seven C. parvum subtypes were identified, of which 16 were newly described. Except for three herds, only one subtype per herd was identified. Cryptosporidium parvum-positive calves were younger than C. bovis-positive calves and most C. parvum infections were seen at 1-3 weeks of age. Oocyst counts were higher in C. parvum samples. Yellow faecal colour was associated with C. parvum infection. Watery faeces had no greater association with C. parvum infection, but C. parvum subtype family IIa was more common than subtype family IId in watery faecal samples. No other pathogens were detected in the six C. bovis-infected calves, indicating a pathogenic potential. Our results show that species determination does not need to be included in routine Cryptosporidium diagnostic procedures in order to estimate the clinical relevance of infection in diarrhoeal calves. The maximum age when analysis for clinical cryptosporidiosis is performed can be lowered to 6 weeks of age. However, the indicated pathogenic potential of C. bovis warrants further attention.