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

  • B. L. Carter
  • R. E. Stiff
  • K. Elwin
  • H. A. Hutchings
  • B. W. Mason
  • A. P. Davies
  • R. M. ChalmersEmail author
Original Article


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.


Cryptosporidiosis Sequelae Cryptosporidium hominis Cryptosporidium parvum Irritable bowel syndrome 



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.

Compliance with ethical standards

Conflict of interest

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.

Informed consent

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


  1. 1.
    Davies A, Chalmers R (2009) Cryptosporidiosis. Br Med J 339:b4168CrossRefGoogle Scholar
  2. 2.
    Public Health England (2017) Cryptosporidium data 2006 to 2015 November 2016 - national laboratory data for residents of England and WalesGoogle Scholar
  3. 3.
    Ehsan M, Akter M, Ahammed M, Ali M, Ahmed M (2016) Prevalence and clinical importance of Cryptosporidium and Giardia in humans and animals. Bangladesh J Vet Med 14:109–122CrossRefGoogle Scholar
  4. 4.
    Hunter P, Hughes S, Woodhouse S, Nicholas R, Syed Q, Chalmers R et al (2004) Health sequelae of human cryptosporidiosis in immunocompetent patients. Clin Infect Dis 39(4):504–510CrossRefGoogle Scholar
  5. 5.
    Widerström M, Schönning C, Lilja M, Lebbad M, Ljung T, Allestam G et al (2014) Large outbreak of Cryptosporidium hominis infection transmitted through the public water supply, Sweden. Emerg Infect Dis 20(4):581–589CrossRefGoogle Scholar
  6. 6.
    Mac Kenzie W, Schell W, Blair K, Addiss D, Peterson D, Hoxie N et al (1995) Massive outbreak of waterborne Cryptosporidium infection in Milwaukee, Wisconsin: recurrence of illness and risk of secondary transmission. Clin Infect Dis 21(1):57–62CrossRefGoogle Scholar
  7. 7.
    Hunter P, Nichols G (2002) Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients. Clin Microbiol Rev 15(1):145–154CrossRefGoogle Scholar
  8. 8.
    Parry S, Forgacs I (2005) Intestinal infection and irritable bowel syndrome. Eur J Gastroenterol Hepatol 17(1):5–9CrossRefGoogle Scholar
  9. 9.
    Khaldi S, Gargala G, Le Goff L, Parey S, Francois A, Fioramonti J et al (2009) Cryptosporidium parvum isolate-dependent postinfectious jejunal hypersensitivity and mast cell accumulation in an immunocompetent rat model. Infect Immun 77(11):5163–5169CrossRefGoogle Scholar
  10. 10.
    Stiff RE et al (2017) Long-term health effects after resolution of acute Cryptosporidium parvum infection: a 1-year follow-up of outbreak-associated cases. J Med Microbiol 66(11):1607–1611CrossRefGoogle Scholar
  11. 11.
    Rehn M, Wallensten A, Widerström M, Lilja M, Grunewald M, Stenmark S et al (2015) Post-infection symptoms following two large waterborne outbreaks of Cryptosporidium hominis in Northern Sweden, 2010–2011. BMC Public Health 15(1):529CrossRefGoogle Scholar
  12. 12.
    Insulander M, Silverlås C, Lebbad M, Karlsson L, Mattsson J, Svenungsson B (2012) Molecular epidemiology and clinical manifestations of human cryptosporidiosis in Sweden. Epidemiol Infect 141(05):1009–1020CrossRefGoogle Scholar
  13. 13.
    Iglói Z et al (2018) Long-term sequelae of sporadic cryptosporidiosis: a follow-up study. Eur J Clin Microbiol 1–8Google Scholar
  14. 14.
    Drossman D (2006) The functional gastrointestinal disorders and the Rome III process. Gastroenterology 130(5):1377–1390CrossRefGoogle Scholar
  15. 15.
    Hadfield SJ, Robinson G, Elwin K, Chalmers RM (2011) Detection and differentiation of Cryptosporidium spp. in human clinical samples by use of real-time PCR. J Clin Microbiol 49(3):918–924CrossRefGoogle Scholar
  16. 16.
    Tosini F, Drumo R, Elwin K, Chalmers RM, Pozio E, Cacciò SM (2010) The CpA135 gene as a marker to identify Cryptosporidium species infecting humans. Parasitol Int 59(4):606–609CrossRefGoogle Scholar
  17. 17.
    Jiang J, Alderisio KA, Xiao L (2005) Distribution of Cryptosporidium genotypes in storm event water samples from three watersheds in New York. Appl Environ Microbiol 71:4446–4454CrossRefGoogle Scholar
  18. 18.
    Hay E, Winfield J, McKendrick M (1987) Reactive arthritis associated with Cryptosporidium enteritis. Br Med J 295(6592):248CrossRefGoogle Scholar
  19. 19.
    Shepherd R, Smail P, Sinha G (1989) Reactive arthritis complicating cryptosporidial infection. Arch Dis Child 64(5):743–744CrossRefGoogle Scholar
  20. 20.
    Sing A, Bechtold S, Heesemann J, Belohradsky B, Schmidt H (2003) Reactive arthritis associated with prolonged cryptosporidial infection. J Inf Secur 47(2):181–184Google Scholar
  21. 21.
    Cron RQ, Sherry DD (1995) Reiter’s syndrome associated with cryptosporidial gastroenteritis. J Rheumatol 22(10):1962–1963Google Scholar
  22. 22.
    Hawkins SP, Thomas RP, Teasdale C (1987) Acute pancreatitis: a new finding in Cryptosporidium enteritis. Br Med J (Clin Res Ed) 294(6570):483CrossRefGoogle Scholar
  23. 23.
    Norby S, Bharucha A, Larson M, Temesgen Z (1998) Acute pancreatitis associated with Cryptosporidium parvum enteritis in an immunocompetent man. Clin Infect Dis 27(1):223–224CrossRefGoogle Scholar
  24. 24.
    Printza N, Sapountzi E, Dotis J, Papachristou F (2013) Hemolytic uremic syndrome related to Cryptosporidium infection in an immunocompetent child. Pediatr Int 55(6):788–790CrossRefGoogle Scholar
  25. 25.
    Lilja M, Widerström M, Lindh J (2018) Persisting post-infection symptoms 2 years after a large waterborne outbreak of Cryptosporidium hominis in northern Sweden. BMC Res Notes 11:625CrossRefGoogle Scholar
  26. 26.
    Jones J, Boorman J, Cann P, Forbes A, Gomborone J, Heaton K et al (2000) British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome. Gut 47(Suppl II):ii1–ii19Google Scholar
  27. 27.
    Neal KR, Hebden J, Spiller R (1997) Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome: postal survey of patients (see comments). BMJ 314:779–782CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Swansea University Medical SchoolSwansea UniversitySwanseaUK
  2. 2.Health Protection, Public Health Wales NHS TrustCardiffWales, UK
  3. 3.Cryptosporidium Reference Unit, Public Health Wales MicrobiologySingleton HospitalSwanseaWales, UK
  4. 4.Public Health Wales Health Protection Team, Matrix HouseSwanseaUK

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