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In the present study, we analyzed genetic variation in Cryptosporidium species from humans (n = 62) with clinical cryptosporidiosis in South Australia. Sequence variation was assessed in regions within the small subunit of nuclear rRNA (p-SSU), the 70-kDa heat shock protein (p-hsp70), and the 60-kDa glycoprotein (p-gp60) genes by employing single-strand conformation polymorphism analysis and sequencing. Based on the analyses of p-SSU and p-hsp70, Cryptosporidium hominis (n = 38) and Cryptosporidium parvum (n = 24) were identified. The analysis of p-gp60 revealed eight distinct subgenotypes, classified as C. hominis IaA17R1 (n = 3), IbA9G3R2 (n = 14), IbA10G2R2 (n = 20), and IfA12G1R1 (n = 1), as well as C. parvum IIaA18G3R1 (n = 15), IIaA20G3R1 (n = 6), IIaA22G4R1 (n = 2), and IIcA5G3R2 (n = 1). Subgenotypes IaA17R1 and IIaA22G4R1 are new. Of the six other subgenotypes, IbA10G2R2, IIaA18G3R1, IIaA20G3R1, and IIcA5G3R2 were reported previously from the state of Victoria. This is the fourth record in Australia of C. parvum subgenotype IIaA18G3R1 from humans, which, to date, has been isolated only from cattle in other countries. This subgenotype might be a significant contributor to sporadic human cryptosporidiosis and may indicate a greater zoonotic contribution to the infection of humans in the area of study. Comparative analyses revealed, for the first time, the differences in the genetic makeup of Cryptosporidium populations between two relatively close, major metropolitan cities.

This study assessed whether serological responses to Cryptosporidium antigens are associated with a reduced risk of diarrheal illness in cases of infection with human immunodeficiency virus (HIV). The association between serological responses to the Cryptosporidium 15/17-kDa and 27-kDa antigen groups and reported diarrheal illness was examined by use of data from a previously published study of cases of HIV infection. In immunosuppressed individuals, a strong serological response to the 27-kDa antigen group was associated with a reduced risk of diarrhea without weight loss. This finding suggests that acquired protective immunity to cryptosporidiosis may be important in controlling the burden of cryptosporidiosis in immunosuppressed individuals.

Few studies have assessed risk factors for sporadic cryptosporidiosis in industrialized countries, even though it may be numerically more common than outbreaks of disease. We carried out case-control studies assessing risk factors for sporadic disease in Melbourne and Adelaide, which have water supplies from different ends of the raw water spectrum. In addition to examining drinking water, we assessed several other exposures. 201 cases and 795 controls were recruited for Melbourne and 134 cases and 536 controls were recruited for Adelaide. Risk factors were similar for the two cities, with swimming in public pools and contact with a person with diarrhoea being most important. The consumption of plain tap water was not found to be associated with disease. This study emphasizes the need for regular public health messages to the public and swimming pool managers in an attempt to prevent sporadic cryptosporidiosis, as well as outbreaks of disease.

Objective: To describe an outbreak of Cryptosporidium gastroenteritis in a swimming pool in Melbourne in early 1998 that was not detected through routine surveillance, and discuss difficulties in identifying such outbreaks., Methods: The Water Quality Study (WQS) was a large community-based study of gastroenteritis. Following suspicion of an outbreak of cryptosporidiosis within the study group, due to pool "X", a nested case control study was performed. Each case of Cryptosporidium gastroenteritis was matched with six controls and data from weekly Health Diaries from the WQS were reviewed. The Department of Human Services also instigated active surveillance among patrons at pool "X" using a systematic sample of 50 people from the pool's swim-school enrollment list., Results: There were seven cases of Cryptosporidium gastroenteritis in the case control study. Five cases and eight controls swam at pool "X" during the outbreak period. The adjusted odds of developing cryptosporidial diarrhoea if an individual swam at pool "X" was 34.5 (CI 2.3-2548). DHS identified another 11 laboratory confirmed cases associated with pool "X" as well as cases not linked to pool "X". 125 cases were identified throughout Melbourne with the suspected involvement of seven swimming pools., Conclusions: Despite a high odds ratio of developing cryptosporidiosis this outbreak was not detected by routine surveillance methods. Current outbreak detection methods lack sensitivity, specificity or timeliness., Implications: Improved surveillance systems are required if outbreaks of gastroenteritis are to be detected early so an intervention can be instigated to reduce the amount of subsequent illness.

A cross-sectional serosurvey for markers of prior Cryptosporidium infection was conducted among homosexual or bisexual males infected with human immunodeficiency virus (HIV); of 262 individuals approached, 236 (90%) agreed to participate. Serological response to two Cryptosporidium antigens was measured using a Western blot assay. The intensity or detection of serological responses to two Cryptosporidium antigens was not associated with CD4 cell counts or tap water consumption. A number of sexual practices were related to increased serological response for only the 27-kDa marker, including having had sex within the past 2 years, having anal sex and having had a larger number of sex partners during the past 2 years. Attending a spa or sauna was related to serological response to both the 27-kDa and 17-kDa markers. Based on these results, activities related to sexual activity appear to be a significant risk factors for prior Cryptosporidium infection.