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Health sequelae of human cryptosporidiosis—a 12-month prospective follow-up study

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Abstract

To investigate long-term health sequelae of cryptosporidiosis, with especial reference to post-infectious irritable bowel syndrome (PI-IBS). A prospective cohort study was carried out. All patients with laboratory-confirmed, genotyped cryptosporidiosis in Wales, UK, aged between 6 months and 45 years of age, over a 2-year period were contacted. Five hundred and five patients agreed to participate and were asked to complete questionnaires (paper or online) at baseline, 3 and 12 months after diagnosis. The presence/absence of IBS was established using the Rome III criteria for different age groups. Two hundred and five of 505 cases completed questionnaires (40% response rate). At 12 months, over a third of cases reported persistent abdominal pain and diarrhoea, 28% reported joint pain and 26% reported fatigue. At both 3 and 12 months, the proportion reporting fatigue and abdominal pain after Cryptosporidium hominis infection was statistically significantly greater than after C. parvum. Overall, 10% of cases had sufficient symptoms to meet IBS diagnostic criteria. A further 27% met all criteria except 6 months’ duration and another 23% had several features of IBS but did not fulfil strict Rome III criteria. There was no significant difference between C. parvum and C. hominis infection with regard to PI-IBS. Post-infectious gastrointestinal dysfunction and fatigue were commonly reported after cryptosporidiosis. Fatigue and abdominal pain were significantly more common after C. hominis compared to C. parvum infection. Around 10% of people had symptoms meriting a formal diagnosis of IBS following cryptosporidiosis. Using age-specific Rome III criteria, children as well as adults were shown to be affected.

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Acknowledgements

We thank the staff of the Cryptosporidium Reference Unit for providing case genotyping data and the Communicable Disease Surveillance Centre for identifying and recruiting cases.

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Authors and Affiliations

  1. Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA6 8DP, UK

    B. L. Carter, H. A. Hutchings, B. W. Mason & A. P. Davies

  2. Health Protection, Public Health Wales NHS Trust, Temple of Peace, Cathays Park, 9, Cardiff, Wales, UK

    R. E. Stiff

  3. Cryptosporidium Reference Unit, Public Health Wales Microbiology, Singleton Hospital, 11, Swansea, Wales, UK

    K. Elwin, A. P. Davies & R. M. Chalmers

  4. Public Health Wales Health Protection Team, Matrix House, Northern Boulevard, Swansea Enterprise Park, Swansea, SA6 8DP, UK

    B. W. Mason

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  1. B. L. Carter
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  2. R. E. Stiff
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  3. K. Elwin
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  4. H. A. Hutchings
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  6. A. P. Davies
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  7. R. M. Chalmers
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Correspondence to R. M. Chalmers.

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The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was in place for this study. UK REC reference 12/LO/1659; IRAS project ID 94686.

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All participants gave their signed informed consent to be included in this study.

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B. L. Carter and R. E. Stiff are joint first authors.

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Carter, B.L., Stiff, R.E., Elwin, K. et al. Health sequelae of human cryptosporidiosis—a 12-month prospective follow-up study. Eur J Clin Microbiol Infect Dis 38, 1709–1717 (2019). https://doi.org/10.1007/s10096-019-03603-1

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  • DOI: https://doi.org/10.1007/s10096-019-03603-1

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