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The aim of this study was to determine whether there is an association between Cryptosporidium infections in calves and immunological factors, as well as farm-related factors or the application of the anti-cryptosporidiosis drug Halofuginone. From January to June 2010, 63 cow-calf-pairs from 20 different farms near Zürich, Switzerland have been investigated. Each cowcalf- pair was visited three times within the first 6 weeks of life to collect data of the farm and animals, as well as blood, faecal, colostral and milk samples. An ELISA using sporozoite antigen was developed for the specific detection of anti-Cryptosporidium-IgG in blood- and colostral serum. The IgG concentration in the bloodand colostral serum was determined using radial immuno diffusion test (RID). White blood cell isolation and differential blood cell counts and California Mastitis Test were performed. Bacteriological studies on quarter-milk-samples were carried out. Cryptosporidium oocysts were diagnosed with the modified Ziehl-Neelsen staining, other protozoa with the SAFC method and Eimeria oocysts and helminth eggs were diagnosed with the combined sedimentation/floatation test. ELISAs were performed for the detection of rota- and coronavirus, E. coli F5 and Cryptosporidium spp. in bovine feces (bio-X Diagnostics®, Belgium). The highest prevalence of Cryptosporidium oocysts was 54.0% and found 7 to 20 days post natum, whereas 47.1% were suffering from diarrhea. The transfer of total IgG with the colostrum and the humoral immunity of the calf could not prevent any infection with Cryptosporidium, but the severity of the diarrhea symptoms decreased with increasing total IgG concentrations. Calves housed in open sheds showed significantly more often diarrhea, i. e. they shed more Cryptosporidium oocysts during the first 4 days and 7 to 20 days post natum, respectively. Halofuginone (Halocur®) is approved for prophylaxis against cryptosporidiosis, but it showed no effect on the excretion of Cryptosporidium oocysts in the present study.Ziel dieser Studie war es, einen Zusammenhang zwischen dem Vorkommen von Cryptosporidien und immunologischen Faktoren, sowie Betriebsfaktoren und die Verwendung von Halofuginon, zu untersuchen. Von Januar bis Juni 2010 wurden im Kanton Zürich 63 Mutter- Kalb-Paare aus 20 verschiedenen Betrieben untersucht. Innerhalb von 6 Wochen erfolgten zu ausgewählten Zeitpunkten drei Besuche. Dabei wurden Bestandsdaten erhoben, wie auch Blut-, Kot-, Kolostrum-, respektive Milchproben untersucht. Zum Nachweis von anti-Cryptosporidien-IgG im Blut- und Kolostrum- Serum wurde ein ELISA mit Sporozoiten-Antigen entwickelt. Die IgG-Konzentration im Kolostrum- und Blutserum wurde mittels RID (Radialer Immundiffusionstest) bestimmt. Zusätzlich wurde bei der Kuh und beim Kalb ein Differenzialblutbild erstellt und beim Muttertier ein Schalmtest durchgeführt. Bakteriologische Untersuchungen erfolgten an Vierviertelgemelksproben. Cryptosporidien-Oozysten wurden durch eine modifizierte Ziehl-Neelsen-Färbung, andere Protozoen durch die SAFC-Methode nachgewiesen und mittels kombiniertem Sedimentations-/Flotationsverfahren wurden Helminthen-Eier und Eimeria-Oozysten erfasst. Ein ELISA diente dem Nachweis von Rota- und Coronaviren, E. coli F5 und Cryptosporidium spp. in bovinem Faeces (Bio-X Diagnostics®, Belgien). Die Prävalenz von Cryptosporidien-Infektionen war zwischen dem 7. und 20. Lebenstag der Kälber am höchsten (54.0%), wobei 47.1% dieser Kälber an Durchfall litten. Offenställe steigerten signifikant das Risiko für Durchfall, bzw. für Cryptosporidien-Ausscheidung zwischen dem 1. und 4., bzw. zwischen dem 7. und 20. Lebenstag. Die Übertragung von Total-IgG mit dem Kolostrum und die humorale Immunität des Kalbes konnten keine Infektion mit Cryptosporidien verhindern, der Schweregrad der Durchfallsymptomatik nahm aber mit zunehmender total IgG-Konzentration ab. Der für die Prophylaxe gegen Cryptosporidiose zugelassene Wirkstoff Halofuginon zeigte in dieser Studie keine Wirkung auf die Ausscheidung von Cryptosporidien-Oocysten.Le but de la présente étude était d’étudier s’il existe un rapport entre l’apparition de cryptosporidies et des facteurs immunologiques, des facteurs liés à l’exploitation ainsi qu’à l’usage d’halofuginone. De janvier à juin 2010, on a examiné 63 paires mère-veau provenant de 20 exploitations du canton de Zürich. Au cours de 6 semaines on a effectué, à des moments choisis, trois visites. A ces occasions, des données relatives à l’exploitation ainsi que des échantillons de sang, de selles, de colostrum respectivement de lait ont été collectés. On a développé un test ELISA avec des antigènes de sporozoïtes pour mettre en évidence la présence IgG anti-cryptosporidies dans le sang et dans le colostrum. La concentration en IgG dans le colostrum et dans le sérum a été mesurée avec un test d’immunodiffusion radiale (RID). En outre on a réalisé une image sanguine différentielle des vaches et des veaux et effectué un test de Schalm chez les vaches. Un examen bactériologique a été réalisé sur un échantillon provenant des quatre quartiers. Les oocystes de cryptosporidies ont été mis en évidence au moyen d’une coloration de Ziehlk-Neelsen modifiée, les autres protozoaires ont été mis en évidence par la méthode SAFC et les oeufs d’helminthes ainsi que les oocystes d’Eimeria par un processus de sédimentation-flottation combiné. Un test ELISA a été utilisé pour les rota- et les coronavirus, les E. coli F5 et Cryptosporidium spp. dans les selles des bovins (Bio-X Diagnostics®, Belgique). La prévalence d’infections par des cryptosporidies était maximale entre le 7ème et le 20ème jour de vie des veaux (50.4%), 47.1% de ces veaux souffrant de diarrhée. Les stabulations libres augmentaient de façon significative le risque de diarrhée et d’excrétion de cryptosporidies entre le 1er et le 4ème jour respectivement entre le 7ème et le 20ème jour. La transmission d’IgG et l’immunité humorale des veaux n’empêchaient pas l’infection par des cryptosporidies mais la gravité de la diarrhée diminuait avec l’augmentation de la concentration des IgG totales. L’halofuginone, substance enregistrée pour la prophylaxie de la cryptosporidiose, n’a pas montré, dans cette étude, d’efficacité pour empêcher l’excrétion d’oocystes de cryptosporidies.Lo scopo di questo studio è di indagare sulla correlazione tra la presenza di Cryptosporidium e fattori immunologici e aziendali nonché l’uso di alofuginone. Da gennaio a giugno 2010, nel Canton Zurigo sono state esaminate 63 coppie madre-vitello provenienti da 20 diverse aziende. Nello spazio di 6 settimane sono state eseguite, in momenti determinati, tre visite che hanno raccolto dati sulla mandria e esaminati campioni di sangue, escrementi, colostro e latte. Per rilevare la presenza di anti-IgG Cryptosporidium nel sangue e nel siero di colostro è stato sviluppato un test ELISA con un antigene sporozoite. La concentrazione di IgG nel siero di colostro e nel siero sanguigno è stata determinata mediante RID (test di immunodiffusione radiale). Inoltre, è stato eseguito sulla bovina e sul vitello un emocromo differenziale e sulla vacca madre un CMT. Esami batteriologici sono stati eseguiti su campioni di latte proveniente dai quattro quarti. Oocisti di Cryptosporidium sono stati rilevati da una colorazione di Ziehl-Neelsen, gli altri protozoi con il metodo SAFC mentre con una combinazione di processi di sedimentazione/flottazione sono state rilevate uova di elminti e oocisti di Eimeria. Un test ELISA è stato utilizzato per provare la presenza di Rotavirus e Coronavirus, E. Coli F5 e Cryptosporidium spp nelle feci bovine (Bio-X Diagnostics®, Belgio). La prevalenza di infezioni da Cryptosporidium si situava tra il 7° e il 20° giorno di vita del vitello ad alto livello (54.0%); il 47.1% di questi vitelli soffriva di diarrea. Il rischio di diarrea aumentava significativamente in caso di stalle aperte rispettivamente le secrezioni di Cryptosporidium tra il 1° e il 4° risp. il 7° e il 20° giorno di vita. La trasmissione con il colostro di IgG totali e l’immunità umorale dei vitelli non hanno potuto prevenire l’infezione da Cryptosporidium ma la gravità dei sintomi della diarrea diminuiva con l’aumento della concentrazione di IgG totali. In questo studio, l’approvato principio attivo alofuginone per la profilassi contro la cryptosporidiosi non ha mostrato nessun effetto sulla secrezione di oocisti di Cryptosporidium.

The aim of this study was to investigate seasonal patterns and age-associated trends of the main bacterial, viral, and parasitic enteric pathogens in Southwest Germany.From January 2002 through December 2008 a total of 99,057 patients were tested for Norovirus, Rotavirus, bacterial pathogens, Cryptosporidium parvum (C. parvum), and Giardia lamblia (G. lamblia).All these pathogens were detected throughout the whole year. But there were distinctive seasonal patterns of activity of the following pathogens being detected: norovirus was detected mainly from September through April. The highest rotovirus activity was observed from December through June. But bacterial pathogens und C. parvum were found mainly from June to November. The percentage of positive results during the months with the highest activity was 10 - 49% for norovirus, 25% - 41% for rotavirus, 14 - 18% for bacterial infection and 3 - 4 % for C. parvum. G. lamblia and adenovirus were found throughout the year in 7 - 15% and 3 - 10% of samples, respectively. Moreover, the detection rate of different pathogens depended on patient age. In infants younger than one year, rotavirus, norovirus and adenovirus were most frequently isolated pathogenes. Stool samples from kindergarden- and school-age children were positive largely for bacterial pathogens such as Salmonella and Campylobacter particularly in late summer or early autum. In patients older than 60 years, norovirus, rotavirus, and toxin producing Clostridium difficile strains were the most common pathogens.In view of the age and season related frequency of detection of enteric pathogens, a step-by-step diagnosis of gastrointestinal tract infections is recommended. Considering that most pathogens are detected sporadically over the whole year, the analysis of negative samples should be appropriately expanded. The knowledge of seasonal occurrence can also be applied to improve the application of hygienic measures.

In the first part of the present study, a total of 109 faeces samples collected from calves suffering from diarrhoea were examined for Cryptosporidium parvum oocytes and 39 (35.8%) of them were found to be positive. On the basis of oocyte counts, 14 (36%) samples were assessed as mildly infected and 25 (64%) samples as heavily infected. The occurrence of the disease was more common in winter (56.4%) than during other seasons (autuma 0%, summer 15.4% spring 28.2%. In the present study, the ionophore polyetherantibiotic Lasalocid-Na, that is licensed as a feed additive (Bovatec, 15% Lasalocid-Na, Roche AG) in Turkey, was administered to 11 calves naturally infected with Cryptosporidium and its therapeutic effect was evaluated. Lasalocid-Na (8 mg/ kg BW) was given once daily for 3 days added to the milk. The clinical parameters of infected calves were evaluated before and 3 days after the treatment in 24 hour intervals. The oocyst counts of faeces of calves with cryptosporidiosis were between 15 x 10(6) and 96 x 10(6)/mL before treatment. No oocystes were found in faecal samples of 3 calves (27.3%) after 48 hours and 4 (40%) calves after 72 hours of treatment, respectively. The number of oocytes in the faeces of the remaining calves varied between 90 and 1.2 x 10(6)/mL during the respective period. The number of oocystes before treatment was significantly higher than the number of oocytes after treatment. One of the calves died 56 h after the first treatment despite the treatment. The pH of venous blood was decreased prior to treatment as expected. The lowest pH was 6.83, the lowest bicarbonate concentration was 3.80 mmol/l and the lowest base excess was -31.2 mmol/l. After the treatment, pH, pCO2, HCO3- and BE values of the venous blood increased significantly and reached physiological values before discharge. The differences between the values assessed before the treatment and at the 2nd, 3rd, and 4th sampling time were statistically significant. Number of leucocyte and haemoglobin concentration before the treatment were significantly higher than the values after treatment (p0.01). These values returned back to physiological ranges 72 hours after first treatment. Lasalocid-Na was rather well tolerated. Side effects such as the decline of the suckling reflex and intoxication symptoms in respect to present administration form and dosage were found only in one calf (9%). Treatment procedure in the present study with Lasalocid-Na was found to be suitable in combination with an adequate infusion therapy for the treatment of calves on farms with problems related to cryptosporidiosis. Although the use of Lasolacid-Na for the treatment of Cryptosporidium infection in the EU is banned, it might be used as an alternative drug outside of the EU since it has a successful effect for preventing reinfections.

The prevalence of cryptosporidia, rotavirus, bovine coronavirus and Escherichia coli F5 (K99) in dairy calves with diarrhea and in healthy calves was established in a limited area served by a veterinary practice. Immuno-chromatographic rapid tests (FASTest Strips) were applied in the field and their results were compared to the ones obtained with standard methods (modified Ziehl-Neelsen stain, antigen-ELISA and cultivation). In 78% of the calves with diarrhea (n=46) and in 29% of the healthy calves (n=14), one or two agents were isolated. Of the diseased calves, 43% excreted cryptosporidia and in 46% rotavirus was isolated. Bovine corona virus and Escherichia coli F5 (K99) seemed to be of minor importance in the investigated population. Compared to the modified Ziehl-Neelsen stain or the antigen-ELISA, the FASTest Strips CRYPTO and ROTA were of very high diagnostic specificity of 100% each and their diagnostic sensitivity was 75% and 57%, respectively. Due to the low number of cases, the results of the FASTest Strips BCV and E.coli-K99 could not be interpreted. Although the diagnostic sensitivity of the FASTest Strips CRYPTO and ROTA--evaluated with standard methods--was not very high, their use in calves with acute diarrhea is recommended.

13 species and several genotypes have been described so far within the genus Cryptosporidium. All of them have very small stages which makes morphological differentiation difficult. The most common species is C. parvum, an enteric pathogen with a broad host spectrum including man and domestic mammals. Molecular biological studies on isolates of C. parvum and other species have shown that the species is likely not to be monophyletic but consists of several species with different host spectra. Based on DNA marker sequences one human and various animal genotypes can be differentiated. Infections of immunocompetent patients with C. parvum are usually associated with the human genotype, while infections of immunodeficient (HIV-positive) patients can also be correlated with various animal genotypes or even primarily animal pathogenic species of Cryptosporidium (e.g., C. felis). According to our current knowledge cryptosporidia are zoonotic agents; however, an animal source of human infections cannot automatically be assumed. Parasites from human patients with low infectivity for cattle and laboratory rodents could be isolated which are not considered as zoonotic.

Ill., graph. Darst., Kt

Nowadays, the parasitic zoonose organisms Giardia lamblia und Cryptosporidium spp. are among the most relevant pathogens of drinking water-associated disease outbreaks. These pathogens are transmitted via a fecal-oral route; in both cases the dose of infection is low. Apart from person-to-person or animal-to-person transmissions, the consumption of contaminated food and water are further modes of transmission. The disease is mainly characterized by gastrointestinal symptoms. In industrialized countries, the prevalence rate of giardiasis is 2-5 % and of cryptosporidiosis 1-3%. Throughout the world, a large number of giardiasis and cryptosporidiosis outbreaks associated with drinking water were published; in 2001 the first case in Germany was identified. Giardia and Cryptosporidium are detected in surface water and sporadically in unprotected groundwater. Use of these waters for drinking water abstraction makes high demands on the technology of the treatment process: because of the disinfectant resistance of the parasites, safe elimination methods are needed, which even at high contamination levels of source water guarantee safe drinking water. Further measures for prevention and control are implementation of the HACCP concept, which includes the whole chain of procedures of drinking water supply from catchment via treatment to tap and a quality management system.

A review is given on Cryptosporidiosis, Giardiosis, Toxoplasmosis, Toxocarosis, Trichinellosis and Taeniosis.

Infection of snakes with cryptosporidia is known to occur as hypertrophic gastritis associated with postprandial regurgitation. This is a report of a severe and fatal intestinal cryptosporidiosis in a group of snakes (Pituophis melanoleucus sayi) kept at a zoological garden. The clinical and pathological findings are described and discussed in this paper. Pathohistologically fibrinous, diphtheroid and necrotizing enteritides were diagnosed. Histological examination was completed by electron microscopy. Transmission electron microscopic examination revealed numerous cryptosporidia in close contact to the luminal surface of the intestinal epithelial cells. Different cryptosporidial stages developing in parasitophorous vacuoles occurred. By scanning electron microscopy the superficial localisation of the cryptosporidia in the damaged brush border of the intestinal epithelial cells was demonstrated. In addition, the ultrastructural examination of the small intestine of three animals revealed adenovirus-like particles.

To determine retrospectively the clinical features and course of HIV-associated intestinal Cryptosporidium infection and its response to paromomycin.Case notes of all patients treated for cryptosporidiosis over a two-year period at an HIV out-patient clinic were analysed (26 men, four women; median CD4-lymphocyte count: 20/microliter). Median follow-up time was 6(1-22) months.15 patients had persistent diarrhoea, two remained asymptomatic, seven had a remission and in five the disease took a fulminant course with severe diarrhoea ending in death within 4 months. 15 of the patients died during the period of observation, eight of them of cryptosporidiosis-associated cachexia. Mean survival time was about one year. Eight patients had multiple intestinal infections at the time the diagnosis was made and seven developed them later, which correlated with the poorer survival chances. Four patients had proven and 13 probably cryptosporidiosis-associated involvement of the biliary tract, but this did not affect the survival chances. 21 of 28 patients with diarrhoea were treated with paromomycin. In 13 of them there was for a time complete or partial response to treatment, but no response in eight. Those who responded well or partially to paromomycin had a significantly better survival chance than those without response. There was no correlation between the severity of immunosuppression and the severity of the cryptosporidiosis-associated diarrhoea, the response to paromomycin and the worse survival chance in the presence of multiple intestinal infections.The reasons for the different courses taken by HIV-associated cryptosporidiosis and the different therapeutic responses remain unclear. There is no known causal treatment, but 60% of patients improved temporarily on paromomycin.

The frequency of serious infections due to Pseudomonas aeruginosa is increasing among patients with advanced HIV infection; most of the cases are community-acquired. Early diagnosis and adequate treatment--usually with the combination of an anti-pseudomonas beta-lactam antibiotic and an aminoglycoside--have a crucial bearing on prognosis. The good in vitro activity of aminoglycosides against mycobacteria contrasts with the need for intravenous administration and toxicity. In patients with Mycobacterium avium complex infection, amikacin should be given only in the event of difficulty with an oral regimen and only on a temporary basis. Similar rules apply to the treatment of multiresistant tuberculosis with streptomycin or amikacin. Paromomycin is not absorbed by the gastrointestinal tract when taken orally, constitutes the treatment of choice against cryptosporidiosis and serves as an alternative against Entamoeba histolytica and Giardia lamblia. Topical treatment with paromomycin ointment can be used in cutaneous leishmaniasis.

From 1987 to 1992 stool samples of 3235 diarrheic children at the age from 1 to 14 years in the Leipzig district were examined for Cryptosporidium spp. In 58 patients (= 1.8%) oocysts have been detected. Most of the positive children (= 81%) were less than 7 years old. A seasonal increasing of prevalence was observed in August and in the following months. According to anamnestic informations of treating physicians all patients were immunocompetent. The clinical symptomatology comprised diarrhoea, vomiting, fever and stomach ache. Animal contacts were known in 52% of the patients. Stool examinations for diagnosis of Cryptosporidium are recommended in unclear diarrhoeas, also in immunocompetent patients. The role of Cryptosporidium spp. as opportunists in immunodeficiency is especially commented.

We report the case of a 46-year old HIV-infected patient who suffered from severe recurrent diarrhoea for 18 months. In stool cultures cryptosporidiae were identified. The cryptosporidial enteritis was unresponsive to therapy. In the further course of cryptosporidial infection the patient developed HIV-associated cholangitis with increasing upper abdominal pain, progredient laboratory cholestasis and morphological changes indicating posthepatic cholestasis. Papillary stenosis with erosive papilitis caused by cryptosporidia was diagnosed. Sphincterotomy significantly improved the clinical status of the patient. Cholangitis with associated crytosporidial infection in a HIV-infected patient ist discussed and necessary diagnostic and differential therapeutic approaches are described.

Postmortem investigation was performed on 54 scouring (soon after onset of diarrhea) and 23 healthy suckling piglets. The animals were 1 to 4 weeks of age and were collected from 27 herds. In 21 herds diarrhea had been observed for a long time in piglets in this age group. Coccidia were found in 34 piglets, rotavirus in 2, cryptosporidia in 2, enterotoxigenic E. coli in 6, attaching and effacing E. coli in 1, Cl. perfringens type C in 1, Campylobacter coli in 53 and C. hyointestinalis in 8 piglets. Some of these microorganisms were isolated from healthy piglets as well. TGE- and PED-Virus antigen, as well as Salmonella were not recovered from any of the pigs. Results of the histopathological and enzyme histochemical investigations were in agreement with data from the literature. They confirmed and emphasized the role of coccidia as enteropathogenic agents in the animals examined. On the other hand evidence was shown, that C. coli is non-pathogenic. The role of C. hyointestinalis could not be fully elucidated. At least one sort of enteropathogenic agent was detected in about 68% (n = 37) of the scouring pigs or was present in 81% (n = 17) of the herds, respectively.

Entamoeba histolytica, Giardia lamblia, Cryptosporidium parvum, Isospora belli, Balantidium coli, and Microsporidia spp. are cosmopolitan parasites. They often cause diarrheal diseases. The waterborn transmission of all these parasites is possible (41). Surface water supplies used for drinking water are potential sources of contamination. Giardia lamblia and Cryptosporidium spp. have received great attention in industrialized countries during the last years because they are the etiological agents of waterborne diseases. The life cycles of Giardia lamblia and Cryptosporidium are described with a special reference to drinking water technologies aimed at removing these parasites.

Cryptosporidium has been found to be a common cause of gastroenteritis during the last years. The natural course of the disease in immunocompromised patients is often met by serious complications. A general therapy recommendation has not been reported so far. We report of a two-year-old boy, who was immunocompromised by a multidrug cytostatic chemotherapy. The patient suffered from a long lasting most severe gastroenteritis, caused by cryptosporidium. There was a good clinical response to spiramycin, a treatment suggested in the literature.

In this epidemiological study 100 litters of Southern Germany were investigated. 70 litters were kept on farms and 30 litters originated from mother cats kept indoors. At least 9 species were detected in litters from farms, 77.1% of these litters were infected with T. cati, 1.4% with hookworms, 10% with Capillaria, 10% with H. taeniaeformis, 67.1% with I. felis, 48.6% with I. rivolta, 17.1% with Toxoplasma/Hammondia, 4.3% with C. parvum and 1.4% with Giardia. In litters kept indoors only 5 species were established. 3.3% were infected with T. cati, 46.6% with I. felis, 33.3% with I. rivolta, 6.6% with Giardia and 3.3% with C. parvum. Analogous differences as regards to the keeping conditions existed also for the mother cats.

A prospective case-control study was performed in urban and periurban areas of Basel to investigate the epidemiology of Cryptosporidium sp., an intestinal coccidian parasite. 455 children with diarrhoea, who attended paediatric and general practices, participated in the study. Oocysts of the parasite were detected in stool specimens of 21 (4.6%) patients using auramine-fluorescence and modified Ziehl-Neelson staining. Another ten infected people were found during separate investigations of outbreaks in a Kindergarten and in two families. Serial stool stains were performed to determine the period of oocyst shedding. The median duration of diarrhoea was six days and ranged from 1 to 25 days. In contrast, shedding of oocysts of Cryptosporidium sp. lasted for 12.5 days and was significantly longer than the period of diarrhoea (p = 0.02). Compared with control patients suffering from diarrhoea of other origin, respiratory symptoms were significantly (p = 0.02) more frequent in children with cryptosporidiosis (42% vs 13%). In comparison with healthy controls, prior contact with a person suffering from diarrhoea and travel to a Mediterranean country were the most important risk factors for cryptosporidiosis. An illustrative case is described in detail. It is concluded that cryptosporidial infection of the respiratory tract may also occur in immunocompetent children. The possibility of a long period of oocyst shedding is important for the planning of hygiene measures both in individuals and public health.

Within the past few years, microorganisms of the Genus Cryptosporidium have been recognized as an important pathogen to humans. A possible mode of transmission is represented by the presence of Cryptosporidium-oocysts in water. Meanwhile several outbreaks of diarrheal illness caused by the contamination of drinking water by Cryoptosporidium have been documented; an infection can be life-threatening for immunosuppressed patients. This article reviews the organism causing Cryptosporidiosis, his ecology, the clinical feature, the sources of infection and the epidemiology. The remarkable resistance of the oocysts to disinfectants, such like chlorine, their survival for a long time and the low infectious dose shows evidently that the conservative guidelines in treatment and quality control of drinking water should be discussed newly.

Parasites, once an exclusively tropical problem, are rare causes of diarrhea in our countries. Increasing tourism and immune deficiencies due to treatment or to Aids lead to an increase of intestinal parasites in western countries. The most frequent pathogenic parasites are Giardia lamblia and Entamoeba histolytica but other organisms like Cryptosporidia seem to be of increasing importance and have to be considered in diarrhea of unknown origin.

Within the past few years, microorganisms of the Genus Cryptosporidium have been recognized as an important pathogen to humans. A possible mode of transmission is represented by the presence of Cryptosporidium-oocysts in water. Meanwhile several outbreaks of diarrheal illness caused by the contamination of drinking water by Cryptosporidium have been documented; an infection can be life-threatening for immunosuppressed patients. This article reviews the organism causing Cryptosporidiosis, his ecology, the clinical feature, the sources of infection and the epidemiology. The remarkable resistance of the oocysts to disinfectants, such like chlorine, their survival for a long time and the low infectious dose shows evidently that the conservative guidelines in treatment and quality control of drinking water should be discussed newly.

Coccidia infections occurring in cats (Isospora, Cryptosporidium, Toxoplasma, Hammondia, Sarcocystis), peculiarities of their life cycles, and diagnostic, prophylactic and therapeutic possibilities are described; the problems of Toxoplasma infections of cats are intensively discussed. If the oocystshedding cat is suspected to be the source of infection for the owner, only both coproscopical and serological results allow an appropriate advice.

In a 13-year-old boy--with haemophilia A, positive tests for HTLV-III antibodies, and lymphocytopenia--there occurred watery voluminous stools which persisted over many months. Cryptosporidia were demonstrated microscopically in the stool. Cryptosporidiosis should be considered in patients with acquired immune deficiency who have diarrhoea.

Investigations for cryptosporidia were carried out on 250 fecal samples from 131 HIV-positive patients between December 1985 and July 1986 with kinyoun carbolfuchsin staining. Cryptosporidial oocysts could be detected in six homosexual men. All of the cryptosporidia excretors had symptoms of enteritis. The clinical course and the prognosis depended on the immunological resistance of the host. Five patients with pronounced immune defect had therapy-resistant chronic diarrhea. In one patient with a slight immune defect, the cryptosporidial infection cured spontaneously. A spacial separation of cryptosporidia excretors and patients with weakened resistance is to be considered in view of the possible severe progress form with low tendency to cure and the still lacking specific chemotherapy.

Cryptosporidiosis in Children. During an 11-month survey, Cryptosporidium oocysts were found in the stools of 20 of 142 children admitted with gastroenteritis. Five of these 20 patients also excreted other enteropathogens. The clinical findings in 18 children infected with cryptosporidia could be analyzed. All patients were immunocompetent. Watery diarrhea, vomiting and anorexia were the most frequent symptoms. Differences in the clinical findings were observed between children aged one to two years and older children. The older children remained ill for 4.1 days compared to 19.9 days in the younger children. The younger children also presented a history of recurrent diarrhea. Problems of etiology and therapy are discussed. Cryptosporidia should be considered as a cause of diarrhea in children.

Among 200 hospitalized patients treated for HIV infections there were 98 with gastrointestinal symptoms, independent of the stage of the disease. Only 22 had abnormal stool findings. But histological examination and culture of endoscopically obtained biopsies revealed opportunistic infection in 62, of whom 28 had a cytomegalovirus infection. Mycobacterium avium-intracellulare was found in the gastrointestinal mucosa of 25 patients, but its clinical significance is unclear. In 33 of the 98 patients previously classified as positive for HIV or AIDS-related complex, endoscopic demonstration of an opportunistic infection required amendment of their HIV stage. In over 60% endoscopy revealed mucosal changes. A distinction from Crohn's disease or ulcerative colitis could only be made by histology or exclusion of the causative microorganism. Demonstration of the causative microorganism from the biopsy is thus essential in patients with gastrointestinal symptoms, because specific treatment is in principle possible and successful for some opportunistic infections.

While intestinal parasites are infrequent causes of acute diarrhea, investigations in travellers, children, homosexuals and immunocompromised persons who have had diarrhea for more than 2-4 weeks should include stool analyses for intestinal parasites. Intestinal helminthiases are treated with pyrantel pamoate, mebendazole, thiabendazole, albendazole, praziquantel or niclosamide. For treatment of intestinal protozoa, ornidazole (or other benzimidazoles), diloxanide furoate and co-trimoxazole are drugs of first choice; at present spiramycin is recommended for treatment of cryptosporidiosis in AIDS patients. When infections or symptoms persist after treatment, re-infection or immunodeficiency should be considered.

Report on a 12-year-old boy with diffuse abdominal pains, vomiting and lasting diarrhoea. All the usual bacteriological examinations for Salmonella, Shigella and Campylobacter were negative. Routine search for intestinal parasites by the MIF method was also negative. Cryptosporidium oocysts were, exceptionally, detected in stool smears from the two samples stained by the modified Ziehl-Neelsen method.

Cryptosporidiosis species were demonstrated in stool of 1.9% of 1600 unselected patients with enteritis (practically evenly divided between children and adults). Further investigations revealed seven cases of enteritis among family members. In eight patients there was a double infection with Cryptosporidium plus another enteritis pathogen. The most frequent clinical symptoms were diarrhea, vomiting, cramp-like abdominal pain, fever and headache. The mean period of parasite excretion was 14 days. Spontaneous cure occurred in all patients. Since cryptosporidiosis is relatively common not only in those with lowered resistance but also those who are immune-competent, search for Cryptosporidium should be included in all tests for etiologically uncertain cases of enteritis.