15 : Emerging Food- and Waterborne Protozoan Diseases

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

Emerging Food- and Waterborne Protozoan Diseases, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555815585/9781555813772_Chap15-1.gif /docserver/preview/fulltext/10.1128/9781555815585/9781555813772_Chap15-2.gif


This chapter describes the most relevant features of protozoan agents of foodborne diseases and waterborne diseases, specifically, and , which cause diarrheal illness in humans, and , which is associated with encephalitis, chorioretinitis, and abortion. In developing countries, human cryptosporidiosis and cyclosporiasis occur most frequently in children. While is common worldwide, endemic may be restricted to those communities that lack adequate water treatment (e.g., filtration) and sanitation (sewage treatment). Children can have multiple episodes of cryptosporidiosis and cyclosporiasis, implying that the acquired anti- or anti- immunity in children is short-lived or incomplete. Toxoplasmosis is one of the most common causes of primary chorioretinitis in children. In industrialized nations, the most effective treatment and prophylaxis for cryptosporidiosis in AIDS patients is the use of highly active antiretroviral therapy (HAART). Reports of food-related infections by are few, difficult to document, and probably greatly underreported, with individual cases and small-group outbreaks unlikely to be recognized. A small number of food-borne outbreaks of cryptosporidiosis have been reported. Genetic characterization of 25 isolates from market pigs identified three distinct strains based on RFLP assays at the SAG2 locus with no evidence of recombinants, implying that three distinct exposure events occurred during the lifespans of the pigs. Whether the risks are associated with improper water or sewage treatment, improper or inadequate food preparation or agricultural practices, or simply hygiene failures leading to person-to-person transmission, the efforts to control these opportunistic parasites will continue to be a challenge.

Citation: Arrowood M, Xiao L, Ortega Y, Fayer R. 2007. Emerging Food- and Waterborne Protozoan Diseases, p 283-308. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch15
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


1. Ali, M. S.,, L. A. Mahmoud,, B. E. Abaza, and, M. A. Ramadan. 2000. Intestinal spore-forming protozoa among patients suffering from chronic renal failure. J. Egypt. Soc. Parasitol. 30: 93100.
2. Alpert, G.,, L. M. Bell,, C. E. Kirkpatrick,, L. D. Budnick,, J. M. Campos,, H. M. Friedman, and, S. A. Plotkin. 1984. Cryptosporidiosis in a day-care center. N. Engl. J. Med. 311: 860861.
3. Amadi, B.,, M. Mwiya,, J. Musuku,, A. Watuka,, S. Sianongo,, A. Ayoub, and, P. Kelly. 2002. Effect of nitazoxanide on morbidity and mortality in Zambian children with cryptosporidiosis: a randomised controlled trial. Lancet 360: 13751380.
4. Anonymous. 1998. Cases in British Columbia prompt boil water alert. Cryptosporidium Capsule 3:3.
5. Anonymous. 1987. Cryptosporidiosis—New Mexico, 1986. Morb. Mortal. Wkly. Rep. 36: 561563.
6. Anonymous. 1990. Cryptosporidiosis in England and Wales—prevalence and clinical and epidemiological features. Public Health Laboratory Service Study. Br. Med. J. 300: 774777.
7. Anonymous. 1994. Cryptosporidium infections associated with swimming pools—Dane county, Wisconsin, 1993. Morb. Mortal. Wkly. Rep. 43: 561563.
8. Anonymous. 1998. Foodborne outbreak of cryptosporidiosis—Spokane, Washington, 1997. Morb. Mortal. Wkly. Rep. 47: 565567.
9. Anonymous. 1996. Foodborne outbreak of diarrheal illness associated with Cryptosporidium parvum—Minnesota, 1995. Morb. Mortal. Wkly. Rep. 45: 783784.
10. Anonymous. 1999. Increase in cases in New Zealand. Cryptosporidium Capsule 4: 1.
11. Anonymous. 1996. Kelowna outbreak spreads to neighboring areas in British Columbia. Cryptosporidium Capsule 1: 12.
12. Anonymous. 1997. Outbreak at a first nation community on Shoal Lake, Ontario, Canada. Cryptosporidium Capsule 2: 23.
13. Anonymous. 1999. Outbreak in NW England—water samples found positive. Cryptosporidium Capsule 4: 1.
14. Anonymous. 1998. Outbreak of cryptosporidiosis associated with a water sprinkler fountain—Minnesota, 1997. Morb. Mortal. Wkly. Rep. 47: 856860.
15. Anonymous. 1996. Outbreak of cryptosporidiosis at a day camp—Florida, July-August 1995. Morb. Mortal. Wkly. Rep. 45: 442444.
16. Anonymous. 2000. Outbreak of cryptosporidiosis in Lancashire. Commun. Dis. Rep. CDR Wkly. 10: 115.
17. Anonymous. 2000. Outbreak of cryptosporidiosis in Northern Ireland. Commun. Dis. Rep. CDR Wkly. 10: 323, 326.
18. Anonymous. 1997. Outbreak of cyclosporiasis—northern Virginia-Washington, D.C.-Baltimore, Maryland, metropolitan area, 1997. Morb. Mortal. Wkly. Rep. 46: 689691.
19. Anonymous. 1998. Outbreak of cyclosporiasis—Ontario, Canada, May 1998. Morb. Mortal. Wkly. Rep. 47: 806809.
20. Anonymous. 2004. Outbreak of cyclosporiasis associated with snow peas—Pennsylvania, 2004. Morb. Mortal. Wkly. Rep. 53: 876878.
21. Anonymous. 1998. Outbreaks in England and Wales: first half of 1997. Cryptosporidium Capsule 3: 4.
22. Anonymous. 1997. Outbreaks of Escherichia coli O157:H7 infection and cryptosporidiosis associated with drinking unpasteurized apple cider—Connecticut and New York, October 1996. Morb. Mortal. Wkly. Rep. 46: 48.
23. Anonymous. 2000, posting date. Population estimates. U.S. Census Bureau. [Online.] http://www.census.gov/popest/.
24. Anonymous. 2001. Protracted outbreaks of cryptosporidiosis associated with swimming pool use—Ohio and Nebraska, 2000. Morb. Mortal. Wkly. Rep. 50: 406410.
25. Anonymous. 1996. Report released on outbreak in Cranbrook, British Columbia. Cryptosporidium Capsule 2: 6.
26. Anonymous. 1998. Reported cases in England and Wales for 1997. Cryptosporidium Capsule 3: 6.
27. Anonymous. 1998. Reports released on 1992 and 1995 outbreaks in South Devon. Cryptosporidium Capsule 3: 78.
28. Anonymous. 1996. Update on outbreak in Collingwood, Ontario. Cryptosporidium Capsule 1: 4.
29. Anonymous. 1997. Update: outbreaks of cyclosporiasis—United States and Canada, 1997. Morb. Mortal. Wkly. Rep. 46: 521523.
30. Arendt, G.,, H. J. von Giesen,, H. Hefter,, E. Neuen-Jacob,, H. Roick, and, H. Jablonowski. 1999. Long-term course and outcome in AIDS patients with cerebral toxoplasmosis. Acta Neurol. Scand. 100: 178184.
31. Arrowood, M. J., 1997. Diagnosis, p. 4364. In R. Fayer (ed.), Cryptosporidium and Cryptosporidiosis. CRC Press, Boca Raton, Fla.
32. Ash, L. R., and, T. C. Orihel. 1987. Parasites: a guide to laboratory procedures and identification. American Society of Clinical Pathologists Press, Chicago. Ill.
33. Assadamongkol, K.,, M. Gracey,, D. Forbes, and, W. Varavithya. 1992. Cryptosporidium in 100 Australian children. Southeast Asian J. Trop. Med. Public Health 23: 132137.
34. Atherton, F.,, C. P. Newman, and, D. P. Casemore. 1995. An outbreak of waterborne cryptosporidiosis associated with a public water supply in the UK. Epidemiol. Infect. 115: 123131.
35. Ayala-Gaytan, J. J.,, C. Diaz-Olachea,, P. Riojas-Montalvo, and, C. Palacios-Martinez. 2004. Cyclosporidiosis: clinical and diagnostic characteristics of an epidemic outbreak. Rev. Gastroenterol. Mex. 69: 226229.
36. Bahia-Oliveira, L. M.,, J. L. Jones,, J. Azevedo-Silva,, C. C. Alves,, F. Orefice, and, D. G. Addiss. 2003. Highly endemic, waterborne toxoplasmosis in north Rio de Janeiro state, Brazil. Emerg. Infect. Dis. 9: 5562.
37. Baker, M.,, N. Russell,, C. Roseveare,, J. O’Hallahan,, S. Palmer, and, A. Bichan. 1998. Outbreak of cryptosporidiosis linked to Hutt Valley swimming pool. N. Z. Public Health Rep. 5: 4145.
38. Barer, M., and, A. Wright. 1990. A review: Cryptosporidium and water. Lett. Appl. Microbiol. 11: 271277.
39. Barwick, R. S.,, D. A. Levy,, G. F. Craun,, M. J. Beach, and, R. L. Calderon. 2000. Surveillance for waterborne-disease outbreaks—United States, 1997–1998. Morb. Mortal. Wkly. Rep. CDC Surveill. Summ. 49: 121.
40. Bell, A.,, R. Guasparini,, D. Meeds,, R. G. Mathias, and, J. D. Farley. 1993. A swimming pool-associated outbreak of cryptosporidiosis in British Columbia. Can. J. Public Health 84: 334337.
41. Benenson, M. W.,, E. T. Takafuji,, S. M. Lemon,, R. L. Greenup, and, A. J. Sulzer. 1982. Oocysttransmitted toxoplasmosis associated with ingestion of contaminated water. N. Engl. J. Med. 307: 666669.
42. Bern, C.,, B. Hernandez,, M. B. Lopez,, M. J. Arrowood,, A. M. De Merida, and, R. E. Klein. 2000. The contrasting epidemiology of Cyclospora and Cryptosporidium among outpatients in Guatemala. Am. J. Trop. Med. Hyg. 63: 231235.
43. Bern, C.,, Y. Ortega,, W. Checkley,, J. M. Roberts,, A. G. Lescano,, L. Cabrera,, M. Verastegui,, R. E. Black,, C. Sterling, and, R. H. Gilman. 2002. Epidemiologic differences between cyclosporiasis and cryptosporidiosis in Peruvian children. Emerg. Infect. Dis. 8: 581585.
44. Bhattacharya, M. K.,, T. Teka,, A. S. Faruque, and, G. J. Fuchs. 1997. Cryptosporidium infection in children in urban Bangladesh. J. Trop. Pediatr. 43: 282286.
45. Bier, J. W., 1991. Isolation of parasites on fruits and vegetables. Southeast Asian J. Trop. Med. Public Health 22: 144145.
46. Blackburn, B. G.,, G. F. Craun,, J. S. Yoder,, V. Hill,, R. L. Calderon,, N. Chen,, S. H. Lee,, D. A. Levy, and, M. J. Beach. 2004. Surveillance for waterborne-disease outbreaks associated with drinking water—United States, 2001–2002. Morb. Mortal. Wkly. Rep. 53: 2345.
47. Boothroyd, J. C., and, M. E. Grigg. 2002. Population biology of Toxoplasma gondii and its relevance to human infection: do different strains cause different disease? Curr. Opin. Microbiol. 5: 438442.
48. Bowie, W. R.,, A. S. King,, D. H. Werker,, J. L. Isaac-Renton,, A. Bell,, S. B. Eng, and, S. A. Marion. 1997. Outbreak of toxoplasmosis associated with municipal drinking water. Lancet 350: 173177.
49. Bridgman, S. A.,, R. M. Robertson,, Q. Syed,, N. Speed,, N. Andrews, and, P. R. Hunter. 1995. Outbreak of cryptosporidiosis associated with a disinfected groundwater supply. Epidemiol. Infect. 115: 555566.
50. Brown, E. A.,, D. P. Casemore,, A. Gerken, and, I. F. Greatorex. 1989. Cryptosporidiosis in Great Yarmouth—the investigation of an outbreak. Public Health 103: 39.
51. Carpenter, C.,, R. Fayer,, J. Trout, and, M. J. Beach. 1999. Chlorine disinfection of recreational water for Cryptosporidium parvum. Emerg. Infect. Dis. 5: 579584.
52. Carr, A.,, D. Marriott,, A. Field,, E. Vasak, and, D. A. Cooper. 1998. Treatment of HIV-1-associated microsporidiosis and cryptosporidiosis with combination antiretroviral therapy. Lancet 351: 256261.
53. Carreno, R. A.,, D. S. Martin, and, J. R. Barta. 1999. Cryptosporidium is more closely related to the gregarines than to coccidia as shown by phylogenetic analysis of apicomplexan parasites inferred using small-subunit ribosomal RNA gene sequences. Parasitol. Res. 85: 899904.
54. Carter, R. J.,, F. Guido,, G. Jacquette, and, M. Rapoport. 1996. Outbreak of cyclosporiasis associated with drinking water. Abstr. 36th Intersci. Conf. Antimicrob. Agents Chemother.,abstr. K52. American Society for Microbiology, Washington, D.C.
55. Checkley, W.,, L. D. Epstein,, R. H. Gilman,, R. E. Black,, L. Cabrera, and, C. R. Sterling. 1998. Effects of Cryptosporidium parvum infection in Peruvian children: growth faltering and subsequent catch-up growth. Am. J. Epidemiol. 148: 497506.
56. Checkley, W.,, R. H. Gilman,, L. D. Epstein,, M. Suarez,, J. F. Diaz,, L. Cabrera,, R. E. Black, and, C. R. Sterling. 1997. Asymptomatic and symptomatic cryptosporidiosis: their acute effect on weight gain in Peruvian children. Am. J. Epidemiol. 145: 156163.
57. Chen, X. M., and, N. F. LaRusso. 2002. Cryptosporidiosis and the pathogenesis of AIDS-cholangiopathy. Semin. Liver Dis. 22: 277289.
58. Chieffi, P. P.,, Y. A. Sens,, M. A. Paschoalotti,, L. A. Miorin,, H. G. Silva, and, P. Jabur. 1998. Infection by Cryptosporidium parvum in renal patients submitted to renal transplant or hemodialysis. Rev. Soc. Bras. Med. Trop. 31: 333337.
59. Chmelik, V.,, O. Ditrich,, R. Trnovcova, and, J. Gutvirth. 1998. Clinical features of diarrhoea in children caused by Cryptosporidium parvum. Folia Parasitol. 45: 170172.
60. Clayton, F.,, T. Heller, and, D. P. Kotler. 1994. Variation in the enteric distribution of cryptosporidia in acquired immunodeficiency syndrome. Am. J. Clin. Pathol. 102: 420425.
61. Colford, J. M., Jr.,, I. B. Tager,, A. M. Hirozawa,, G. F. Lemp,, T. Aragon, and, C. Petersen. 1996. Cryptosporidiosis among patients infected with human immunodeficiency virus. Factors related to symptomatic infection and survival. Am. J. Epidemiol. 144: 807816.
62. Corliss, J. O., 1994. An interim utilitarian (’user-friendly’) hierarchical classification and characterization of the protists. Acta Protozool. 33: 151.
63. Current, W. L., and, P. H. Bick. 1989. Immunobiology of Cryptosporidium spp . Pathol. Immunopathol. Res. 8: 141160.
64. Current, W. L.,, N. C. Reese,, J. V. Ernst,, W. S. Bailey,, M. B. Heyman, and, W. M. Weinstein. 1983. Human cryptosporidiosis in immunocompetent and immunodeficient persons. Studies of an outbreak and experimental transmission. N. Engl. J. Med. 308: 12521257.
65. Dalle, F.,, P. Roz,, G. Dautin,, M. Di-Palma,, E. Kohli,, C. Sire-Bidault,, M. G. Fleischmann,, A. Gallay,, S. Carbonel,, F. Bon,, C. Tillier,, P. Beaudeau, and, A. Bonnin. 2003. Molecular characterization of isolates of waterborne Cryptosporidium spp. collected during an outbreak of gastroenteritis in South Burgundy, France. J. Clin. Microbiol. 41: 26902693.
66. D’Antonio, R. G.,, R. E. Winn,, J. P. Taylor,, T. L. Gustafson,, W. L. Current,, M. M. Rhodes,, G. W. Gary, and, R. A. Zajac. 1985. A waterborne outbreak of cryptosporidiosis in normal hosts. Ann. Intern. Med. 103: 886888.
67. Daoud, A. S.,, M. Zaki,, R. N. Pugh,, G. al-Mutairi,, F. al-Ali, and, Q. el-Saleh. 1990. Cryptosporidium gastroenteritis in immunocompetent children from Kuwait. Trop. Geogr. Med. 42: 113118.
68. Deodhar, L.,, J. K. Maniar, and, D. G. Saple. 2000. Cyclospora infection in acquired immunodeficiency syndrome. J. Assoc. Physicians India 48: 404406.
69. Dietz, V.,, D. Vugia,, R. Nelson,, J. Wicklund,, J. Nadle,, K. G. McCombs, and, S. Reddy. 2000. Active, multisite, laboratory-based surveillance for Cryptosporidium parvum. Am. J. Trop. Med. Hyg. 62: 368372.
70. Dietz, V. J., and, J. M. Roberts. 2000. National surveillance for infection with Cryptosporidium parvum, 1995–1998: what have we learned? Public Health Rep. 115: 358363.
71. Doumbo, O.,, J. F. Rossignol,, E. Pichard,, H. A. Traore,, T. M. Dembele,, M. Diakite,, F. Traore, and, D. A. Diallo. 1997. Nitazoxanide in the treatment of cryptosporidial diarrhea and other intestinal parasitic infections associated with acquired immunodeficiency syndrome in tropical Africa. Am. J. Trop. Med. Hyg. 56: 637639.
72. Dubey, J. P., 1994. Toxoplasmosis. J. Am. Vet. Med. Assoc. 205: 15931598.
73. Dubey, J. P., 2004. Toxoplasmosis—a waterborne zoonosis. Vet. Parasitol. 126: 5772.
74. Dubey, J. P., and, C. P. Beattie. 1988. Toxoplasmosis of Animals and Man. CRC Press, Boca Raton, Fla.
75. Dubey, J. P.,, D. H. Graham,, D. S. da Silva,, T. Lehmann, and, L. M. Bahia-Oliveira. 2003. Toxoplasma gondii isolates of free-ranging chickens from Rio de Janeiro, Brazil: mouse mortality, genotype, and oocyst shedding by cats. J. Parasitol. 89: 851853.
76. Dubey, J. P.,, J. C. Leighty,, V. C. Beal,, W. R. Anderson,, C. D. Andrews, and, P. Thulliez. 1991. National seroprevalence of Toxoplasma gondii in pigs. J. Parasitol. 77: 517521.
77. Dubey, J. P.,, D. S. Lindsay, and, C. A. Speer. 1998. Structures of Toxoplasma gondii tachyzoites, bradyzoites, and sporozoites and biology and development of tissue cysts. Clin. Microbiol. Rev. 11: 267299.
78. Dworkin, M. S.,, D. P. Goldman,, T. G. Wells,, J. M. Kobayashi, and, B. L. Herwaldt. 1996. Cryptosporidiosis in Washington State: an outbreak associated with well water. J. Infect. Dis. 174: 13721376.
79. Eberhard, M. L., and, M. J. Arrowood. 2002. Cyclospora spp. Curr. Opin. Infect. Dis. 15: 519522.
80. Eberhard, M. L.,, A. J. da Silva,, B. G. Lilley, and, N. J. Pieniazek. 1999. Morphologic and molecular characterization of new Cyclospora species from Ethiopian monkeys: C. cercopitheci sp.n., C. colobi sp.n., and C. papionis sp.n. Emerg. Infect. Dis. 5: 651658.
81. Eberhard, M. L.,, Y. R. Ortega,, D. E. Hanes,, E. K. Nace,, R. Q. Do,, M. G. Robl,, K. Y. Won,, C. Gavidia,, N. L. Sass,, K. Mansfield,, A. Gozalo,, J. Griffiths,, R. Gilman,, C. R. Sterling, and, M. J. Arrowood. 2000. Attempts to establish experimental Cyclospora cayetanensis infection in laboratory animals. J. Parasitol. 86: 577582.
82. Eberhard, M. L.,, N. J. Pieniazek, and, M. J. Arrowood. 1997. Laboratory diagnosis of Cyclospora infections. Arch. Pathol. Lab. Med. 121: 792797.
83. Fayer, R., 2004. Cryptosporidium: a water-borne zoonotic parasite. Vet. Parasitol. 126: 3756.
84. Fayer, R.,, J. P. Dubey, and, D. S. Lindsay. 2004. Zoonotic protozoa: from land to sea. Trends Parasitol. 20: 531536.
85. Fayer, R.,, U. Morgan, and, S. J. Upton. 2000. Epidemiology of Cryptosporidium: transmission, detection and identification. Int. J. Parasitol. 30: 13051322.
86. Fayer, R.,, M. Santin, and, L. Xiao. 2005. Cryptosporidium bovis n. sp. (Apicomplexa: Cryptosporidiidae) in cattle, Bos taurus. J. Parasitol. 91: 624629.
87. Flanigan, T.,, C. Whalen,, J. Turner,, R. Soave,, J. Toerner,, D. Havlir, and, D. Kotler. 1992. Cryptosporidium infection and CD4 counts. Ann. Intern. Med. 116: 840842.
88. Flanigan, T. R., and, R. Graham. 1990. Extended spectrum of symptoms in cryptosporidiosis. Am. J. Med. 89: 252.
89. French, A. L.,, L. M. Beaudet,, D. A. Benator,, C. S. Levy,, M. Kass, and, J. M. Orenstein. 1995. Cholecystectomy in patients with AIDS: clinicopathologic correlations in 107 cases. Clin. Infect. Dis. 21: 852858.
90. Fuentes, I.,, J. M. Rubio,, C. Ramirez, and, J. Alvar. 2001. Genotypic characterization of Toxoplasma gondii strains associated with human toxoplasmosis in Spain: direct analysis from clinical samples. J. Clin. Microbiol. 39: 15661570.
91. Furtado, C.,, G. K. Adak,, J. M. Stuart,, P. G. Wall,, H. S. Evans, and, D. P. Casemore. 1998. Outbreaks of waterborne infectious intestinal disease in England and Wales, 1992–5. Epidemiol. Infect. 121: 109119.
92. Garly, M. L.,, E. Petersen,, C. Pedersen,, J. D. Lundgren, and, J. Gerstoft. 1997. Toxoplasmosis in Danish AIDS patients. Scand. J. Infect. Dis. 29: 597600.
93. Gelletlie, R.,, J. Stuart,, N. Soltanpoor,, R. Amstrong, and, G. Nichols. 1997. Cryptosporidiosis associated with school milk. Lancet 350: 10051006.
94. Goh, S.,, M. Reacher,, D. P. Casemore,, N. Q. Verlander,, R. Chalmers,, M. Knowles,, J. Williams,, K. Osborn, and, S. Richards. 2004. Sporadic cryptosporidiosis, North Cumbria, England, 1996–2000. Emerg. Infect. Dis. 10: 10071015.
95. Goldstein, S. T.,, D. D. Juranek,, O. Ravenholt,, A. W. Hightower,, D. G. Martin,, J. L. Mesnik,, S. D. Griffiths,, A. J. Bryant,, R. R. Reich, and, B. L. Herwaldt. 1996. Cryptosporidiosis: an outbreak associated with drinking water despite state-of-the-art water treatment. Ann. Intern. Med. 124: 459468.
96. Goodgame, R. W.,, R. M. Genta,, A. C. White, and, C. L. Chappell. 1993. Intensity of infection in AIDS-associated cryptosporidiosis. J. Infect. Dis. 167: 704709.
97. Grime, J. S., 1987. Investigation of an outbreak of cryptosporidiosis in Hull. Community Med. 9: 310311.
98. Harper, C. M.,, N. A. Cowell,, B. C. Adams,, A. J. Langley, and, T. D. Wohlsen. 2002. Outbreak of Cryptosporidium linked to drinking unpasteurised milk. Commun. Dis. Intell. 26: 449450.
99. Harrison, S. L.,, R. Nelder,, L. Hayek,, I. F. Mackenzie,, D. P. Casemore, and, D. Dance. 2002. Managing a large outbreak of cryptosporidiosis: how to investigate and when to decide to lift a ‘boil water’ notice. Commun. Dis. Public Health 5: 230239.
100. Hashmey, R.,, N. H. Smith,, S. Cron,, E. A. Graviss,, C. L. Chappell, and, A. C. White, Jr., 1997. Cryptosporidiosis in Houston, Texas. A report of 95 cases. Medicine 76: 118139.
101. Hayes, E. B.,, T. D. Matte,, T. R. O’Brien,, T. W. McKinley,, G. S. Logdson,, J. B. Rose,, B. L. P. Ungar,, D. M. Word,, P. F. Pinsky,, M. L. Cummings,, M. A. Wilson,, E. G. Long,, W. S. Hurwitz, and, D. D. Juranek. 1989. Large community outbreak of cryptosporidiosis due to contamination of a filtered public water supply. N. Engl. J. Med. 320: 13721376.
102. Health and Social Services Committee of the Regional Municipality of York Ontario Canada. 2000. The 1999 outbreak of Cyclospora in York region 1. Regional Municipality of York, York, Canada.
103. Hellard, M. E.,, M. I. Sinclair,, C. K. Fairley,, R. M. Andrews,, M. Bailey,, J. Black,, S. C. Dharmage, and, M. D. Kirk. 2000. An outbreak of cryptosporidiosis in an urban swimming pool: why are such outbreaks difficult to detect? Aust. N. Z. J. Public Health 24: 272275.
104. Herwaldt, B. L., 2000. Cyclospora cayetanensis: a review, focusing on the outbreaks of cyclosporiasis in the 1990s. Clin. Infect. Dis. 31: 10401057.
105. Herwaldt, B. L., and, M. L. Ackers. 1997. An outbreak in 1996 of cyclosporiasis associated with imported raspberries. N. Engl. J. Med. 336: 15481556.
106. Herwaldt, B. L.,, M. J. Beach, et al. 1999. The return of Cyclospora in 1997: another outbreak of cyclosporiasis in North America associated with imported raspberries. Ann. Intern. Med. 130: 210220.
107. Hewitt, R. G.,, C. T. Yiannoutsos,, E. S. Higgs,, J. T. Carey,, P. J. Geiseler,, R. Soave,, R. Rosenberg,, G. J. Vazquez,, L. J. Wheat,, R. J. Fass,, Z. Antoninievic,, A. L. Walawander,, T. P. Flanigan,, J. F. Bender, et al. 2000. Paromomycin: no more effective than placebo for treatment of cryptosporidiosis in patients with advanced human immunodeficiency virus infection. Clin. Infect. Dis. 31: 10841092.
108. Heyworth, M. F., 1996. Parasitic diseases in immunocompromised hosts. Cryptosporidiosis, isosporiasis, and strongyloidiasis. Gastroenterol. Clin. N. Am. 25: 691707.
109. Hijjawi, N. S.,, B. P. Meloni,, U. M. Ryan,, M. E. Olson, and, R. C. Thompson. 2002. Successful in vitro cultivation of Cryptosporidium andersonii: evidence for the existence of novel extracellular stages in the life cycle and implications for the classification of Cryptosporidium. Int. J. Parasitol. 32: 17191726.
110. Hlavsa, M. C.,, J. C. Watson, and, M. J. Beach. 2005. Cryptosporidiosis surveillance—United States 1999–2002. Morb. Mortal. Wkly. Rep. 54: 18.
111. Hlavsa, M. C.,, J. C. Watson, and, M. J. Beach. 2005. Giardiasis surveillance—United States, 1998–2002. Morb. Mortal. Wkly. Rep. 54: 916.
112. Ho, A. Y.,, A. S. Lopez,, M. G. Eberhart,, R. Levenson,, B. S. Finkel,, A. J. da Silva,, J. M. Roberts,, P. A. Orlandi,, C. C. Johnson, and, B. L. Herwaldt. 2002. Outbreak of cyclosporiasis associated with imported raspberries, Philadelphia, Pennsylvania, 2000. Emerg. Infect. Dis. 8: 783788.
113. Hoang, L. M.,, M. Fyfe,, C. Ong,, J. Harb,, S. Champagne,, B. Dixon, and, J. Isaac-Renton. 2005. Outbreak of cyclosporiasis in British Columbia associated with imported Thai basil. Epidemiol. Infect. 133: 2327.
114. Hoepelman, A. I., 1996. Current therapeutic approaches to cryptosporidiosis in immunocompromised patients. J. Antimicrob. Chemother. 37: 871880.
115. Hommer, V.,, J. Eichholz, and, F. Petry. 2003. Effect of antiretroviral protease inhibitors alone, and in combination with paromomycin, on the excystation, invasion and in vitro development of Cryptosporidium parvum. J. Antimicrob. Chemother. 52: 359364.
116. Howe, A. D.,, S. Forster,, S. Morton,, R. Marshall,, K. S. Osborn,, P. Wright, and, P. R. Hunter. 2002. Cryptosporidium oocysts in a water supply associated with a cryptosporidiosis outbreak. Emerg. Infect. Dis. 8: 619624.
117. Howe, D. K., and, L. D. Sibley. 1995. Toxoplasma gondii comprises three clonal lineages: correlation of parasite genotype with human disease. J. Infect. Dis. 172: 15611566.
118. Huang, P.,, J. T. Weber,, D. M. Sosin,, P. M. Griffin,, E. G. Long,, J. J. Murphy,, F. Kocka,, C. Peters, and, C. Kallick. 1995. The first reported outbreak of diarrheal illness associated with Cyclospora in the United States. Ann. Intern. Med. 123: 409414.
119. Hunt, D. A.,, S. Sebugwawo,, S. G. Edmondson, and, D. P. Casemore. 1994. Cryptosporidiosis associated with a swimming pool complex. Commun. Dis. Rep. CDR Rev. 4: R20R22.
120. Hunter, P. R., and, G. Nichols. 2002. Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients. Clin. Microbiol. Rev. 15: 145154.
121. Hunter, P. R., and, C. Quigley. 1998. Investigation of an outbreak of cryptosporidiosis associated with treated surface water finds limits to the value of case control studies. Commun. Dis. Public Health 1: 234238.
122. Isaac-Renton, J.,, W. R. Bowie,, A. King,, G. S. Irwin,, C. S. Ong,, C. P. Fung,, M. O. Shokeir, and, J. P. Dubey. 1998. Detection of Toxoplasma gondii oocysts in drinking water. Appl. Environ. Microbiol. 64: 22782280.
123. Janoff, E. N.,, P. S. Mead,, J. R. Mead,, P. Echeverria,, L. Bodhidatta,, M. Bhaibulaya,, C. R. Sterling, and, D. N. Taylor. 1990. Endemic Cryptosporidium and Giardia lamblia infections in a Thai orphanage. Am. J. Trop. Med. Hyg. 43: 248256.
124. Jelinek, T.,, M. Lotze,, S. Eichenlaub,, T. Loscher, and, H. D. Nothdurft. 1997. Prevalence of infection with Cryptosporidium parvum and Cyclospora cayetanensis among international travellers. Gut 41: 801804.
125. Joce, R. E.,, J. Bruce,, D. Kiely,, N. D. Noah,, W. B. Dempster,, R. Stalker,, P. Gumsley,, P. A. Chapman,, P. Norman,, J. Watkins,, H. V. Smith,, T. J. Price, and, D. Watts. 1991. An outbreak of cryptosporidiosis associated with a swimming pool. Epidemiol. Infect. 107: 497508.
126. Johnson, D. C.,, K. A. Reynolds,, C. P. Gerba,, I. L. Pepper, and, J. B. Rose. 1995. Detection of Giardia and Cryptosporidium in marine waters. Water Sci. Technol. 31: 439442.
127. Jokipii, L., and, A. M. Jokipii. 1986. Timing of symptoms and oocyst excretion in human cryptosporidiosis. N. Engl. J. Med. 315: 16431647.
128. Jones, J.,, A. Lopez, and, M. Wilson. 2003. Congenital toxoplasmosis. Am. Fam. Physician 67: 21312138.
129. Joseph, C.,, G. Hamilton,, M. O’Connor,, S. Nicholas,, R. Marshall,, R. Stanwell-Smith,, R. Sims,, E. Ndawula,, D. Casemore,, P. Gallagher, and, P. Harnett. 1991. Cryptosporidiosis in the Isle of Thanet; an outbreak associated with local drinking water. Epidemiol. Infect. 107: 509519.
130. Kelly, P.,, F. A. Makumbi,, S. Carnaby,, A. E. Simjee, and, M. J. Farthing. 1998. Variable distribution of Cryptosporidium parvum in the intestine of AIDS patients revealed by polymerase chain reaction. Eur. J. Gastroenterol. Hepatol. 10: 855858.
131. Koumans, E. H.,, D. J. Katz,, J. M. Malecki,, S. Kumar,, S. P. Wahlquist,, M. J. Arrowood,, A. W. High-tower, and, B. L. Herwaldt. 1998. An outbreak of cyclosporiasis in Florida in 1995: a harbinger of multi-state outbreaks in 1996 and 1997. Am. J. Trop. Med. Hyg. 59: 235242.
132. Kramer, M. H.,, B. L. Herwaldt,, G. F. Craun,, R. L. Calderon, and, D. D. Juranek. 1996. Surveillance for waterborne-disease outbreaks—United States, 1993–1994. Morb. Mortal. Wkly. Rep. 45: 133.
133. Kramer, M. H.,, F. E. Sorhage,, S. T. Goldstein,, E. Dalley,, S. P. Wahlquist, and, B. L. Herwaldt. 1998. First reported outbreak in the United States of cryptosporidiosis associated with a recreational lake. Clin. Infect. Dis. 26: 2733.
134. Kuroki, T.,, Y. Watanabe,, Y. Asai,, S. Yamai,, T. Endo,, S. Uni,, I. Kimata, and, M. Iseki. 1996. An outbreak of waterborne cryptosporidiosis in Kanagawa, Japan. Kansenshogaku Zasshi 70: 132140.
135. Lacroix, C.,, M. Berthier,, G. Agius,, D. Bonneau,, B. Pallu, and, J. L. Jacquemin. 1987. Cryptosporidium oocysts in immunocompetent children: epidemiologic investigations in the day care centers of Poitiers, France. Eur. J. Epidemiol. 3: 381385.
136. Leander, B. S.,, R. E. Clopton, and, P. J. Keeling. 2003. Phylogeny of gregarines (Apicomplexa) as inferred from small-subunit rDNA and beta-tubulin. Int. J. Syst. Evol. Microbiol. 53: 345354.
137. Lee, S. H.,, D. A. Levy,, G. F. Craun,, M. J. Beach, and, R. L. Calderon. 2002. Surveillance for waterborne-disease outbreaks—United States, 1999–2000. Morb. Mortal. Wkly. Rep. 51: 147.
138. Lehmann, T.,, C. R. Blackston,, S. F. Parmley,, J. S. Remington, and, J. P. Dubey. 2000. Strain typing of Toxoplasma gondii: comparison of antigen-coding and housekeeping genes. J. Parasitol. 86: 960971.
139. Lehmann, T.,, D. H. Graham,, E. Dahl,, C. Sreekumar,, F. Launer,, J. L. Corn,, H. R. Gamble, and, J. P. Dubey. 2003. Transmission dynamics of Toxoplasma gondii on a pig farm. Infect. Genet. Evol. 3: 135141.
140. Leland, D.,, J. McAnulty,, W. Keene, and, G. Stevens. 1993. A cryptosporidiosis outbreak in a filtered water supply. J. Am. Water Works Assoc. 85: 3437.
141. Lemmon, J. M.,, J. M. McAnulty, and, J. Bawden-Smith. 1996. Outbreak of cryptosporidiosis linked to an indoor swimming pool. Med. J. Aust. 165: 613616.
142. Levy, D. A.,, M. S. Bens,, G. F. Craun,, R. L. Calderon, and, B. L. Herwaldt. 1998. Surveillance for waterborne-disease outbreaks—United States, 1995–1996. Morb. Mortal. Wkly. Rep. 47: 134.
143. Lim, L. S.,, P. Varkey,, P. Giesen, and, L. Edmonson. 2004. Cryptosporidiosis outbreak in a recreational swimming pool in Minnesota. J. Environ. Health 67: 1620, 27, 28, 31, 32.
144. Lopez, A. S.,, D. R. Dodson,, M. J. Arrowood,, P. A. Orlandi, Jr.,, A. J. da Silva,, J. W. Bier,, S. D. Hanauer,, R. L. Kuster,, S. Oltman,, M. S. Baldwin,, K. Y. Won,, E. M. Nace,, M. L. Eberhard, and, B. L. Herwaldt. 2001. Outbreak of cyclosporiasis associated with basil in Missouri in 1999. Clin. Infect. Dis. 32: 10101017.
145. Louie, K.,, L. Gustafson,, M. Fyfe,, I. Gill,, L. MacDougall,, L. Tom,, Q. Wong, and, J. Isaac-Renton. 2004. An outbreak of Cryptosporidium parvum in a Surrey pool with detection in pool water sampling. Can. Commun. Dis. Rep. 30: 6166.
146. Lumadue, J. A.,, Y. C. Manabe,, R. D. Moore,, P. C. Belitsos,, C. L. Sears, and, D. P. Clark. 1998. A clinicopathologic analysis of AIDS-related cryptosporidiosis. AIDS 12: 24592466.
147. MacKenzie, W. R.,, N. J. Hoxie,, M. E. Proctor,, M. S. Gradus,, K. A. Blair,, D. E. Peterson,, J. J. Kazmierczak,, D. G. Addiss,, K. R. Fox,, J. B. Rose, et al. 1994. A massive outbreak in Milwaukee of Cryptosporidium infection transmitted through the public water supply. N. Engl. J. Med. 331: 161167.
148. MacKenzie, W. R.,, J. J. Kazmierczak, and, J. P. Davis. 1995. An outbreak of cryptosporidiosis associated with a resort swimming pool. Epidemiol. Infect. 115: 545553.
149. MacKenzie, W. R.,, W. L. Schell,, K. A. Blair,, D. G. Addiss,, D. E. Peterson,, N. J. Hoxie,, J. J. Kazmierczak, and, J. P. Davis. 1995. Massive outbreak of waterborne Cryptosporidium infection in Milwaukee, Wisconsin: recurrence of illness and risk of secondary transmission. Clin. Infect. Dis. 21: 5762.
150. Maggi, P.,, A. M. Larocca,, M. Quarto,, G. Serio,, O. Brandonisio,, G. Angarano, and, G. Pastore. 2000. Effect of antiretroviral therapy on cryptosporidiosis and microsporidiosis in patients infected with human immunodeficiency virus type 1. Eur. J. Clin. Microbiol. Infect. Dis. 19: 213217.
151. Maguire, H. C.,, E. Holmes,, J. Hollyer,, J. E. Strangeways,, P. Foster,, R. E. Holliman, and, R. Stanwell-Smith. 1995. An outbreak of cryptosporidiosis in south London: what value the P value? Epidemiol. Infect. 115: 279287.
152. Manabe, Y. C.,, D. P. Clark,, R. D. Moore,, J. A. Lumadue,, H. R. Dahlman,, P. C. Belitsos,, R. E. Chaisson, and, C. L. Sears. 1998. Cryptosporidiosis in patients with AIDS: correlates of disease and survival. Clin. Infect. Dis. 27: 536542.
153. Mansfield, L. S., and, A. A. Gajadhar. 2004. Cyclospora cayetanensis, a food- and waterborne coccidian parasite. Vet. Parasitol. 126: 7390.
154. Mata, L., 1986. Cryptosporidium and other protozoa in diarrheal disease in less developed countries. Pediatr. Infect. Dis. 5: S117S130.
155. Mathieu, E.,, D. A. Levy,, F. Veverka,, M. K. Parrish,, J. Sarisky,, N. Shapiro,, S. Johnston,, T. Handzel,, A. Hightower,, L. Xiao,, Y. M. Lee,, S. York,, M. Arrowood,, R. Lee, and, J. L. Jones. 2004. Epidemiologic and environmental investigation of a recreational water outbreak caused by two genotypes of Cryptosporidium parvum in Ohio in 2000. Am. J. Trop. Med. Hyg. 71: 582589.
156. McAnulty, J. M.,, D. W. Fleming, and, A. H. Gonzalez. 1994. A community-wide outbreak of cryptosporidiosis associated with swimming at a wave pool. JAMA 272: 15971600.
157. McGowan, I.,, A. S. Hawkins, and, I. V. Weller. 1993. The natural history of cryptosporidial diarrhoea in HIV-infected patients. AIDS 7: 349354.
158. McLauchlin, J.,, C. F. Amar,, S. Pedraza-Diaz,, G. Mieli-Vergani,, N. Hadzic, and, E. G. Davies. 2003. Polymerase chain reaction-based diagnosis of infection with Cryptosporidium in children with primary immunodeficiencies. Pediatr. Infect. Dis. J. 22: 329335.
159. Mele, R.,, M. A. Gomez Morales,, F. Tosini, and, E. Pozio. 2003. Indinavir reduces Cryptosporidium parvum infection in both in vitro and in vivo models. Int. J. Parasitol. 33: 757764.
160. Miao, Y. M.,, F. M. Awad-El-Kariem,, C. Franzen,, D. S. Ellis,, A. Muller,, H. M. Counihan,, P. J. Hayes, and, B. G. Gazzard. 2000. Eradication of cryptosporidia and microsporidia following successful antiretroviral therapy. J. Acquir. Immun. Defic. Syndr. 25: 124129.
161. Millard, P. S.,, K. F. Gensheimer,, D. G. Addiss,, D. M. Sosin,, G. A. Beckett,, A. Houck-Jankoski, and, A. Hudson. 1994. An outbreak of cryptosporidiosis from fresh-pressed apple cider. JAMA 272: 15921596.
162. Miron, D.,, J. Kenes, and, R. Dagan. 1991. Calves as a source of an outbreak of cryptosporidiosis among young children in an agricultural closed community. Pediatr. Infect. Dis. J. 10: 438441.
163. Molbak, K.,, M. Andersen,, P. Aaby,, N. Hojlyng,, M. Jakobsen,, M. Sodemann, and, A. P. da Silva. 1997. Cryptosporidium infection in infancy as a cause of malnutrition: a community study from Guinea-Bissau, West Africa. Am. J. Clin. Nutr. 65: 149152.
164. Monge, R., and, M. L. Arias. 1996. Presence of various pathogenic microorganisms in fresh vegetables in Costa Rica. Arch. Latinoam. Nutr. 46: 292294.
165. Montoya, J. G., and, O. Liesenfeld. 2004. Toxoplasmosis. Lancet 363: 19651976.
166. Moore, A. C.,, B. L. Herwaldt,, G. F. Craun,, R. L. Calderon,, A. K. Highsmith, and, D. D. Juranek. 1993. Surveillance for waterborne disease outbreaks—United States, 1991–1992. Morb. Mortal. Wkly. Rep. 42: 122.
167. Morgan-Ryan, U. M.,, A. Fall,, L. A. Ward,, N. Hijjawi,, I. Sulaiman,, R. Fayer,, R. C. Thompson,, M. Olson,, A. Lal, and, L. Xiao. 2002. Cryptosporidium hominis n. sp. (Apicomplexa: Cryptosporidiidae) from Homo sapiens. J. Eukaryot. Microbiol. 49: 433440.
168. Navin, T. R.,, R. Weber,, D. J. Vugia,, D. Rimland,, J. M. Roberts,, D. G. Addiss,, G. S. Visvesvara,, S. P. Wahlquist,, S. E. Hogan,, L. E. Gallagher,, D. D. Juranek,, D. A. Schwartz,, C. M. Wilcox,, J. M. Stewart,, S. E. Thompson III, and, R. T. Bryan. 1999. Declining CD4 + T-lymphocyte counts are associated with increased risk of enteric parasitosis and chronic diarrhea: results of a 3-year longitudinal study. J. AIDS Hum. Retrovir. 20: 154159.
169. Neill, M. A.,, S. K. Rice,, N. V. Ahmad, and, T. P. Flanigan. 1996. Cryptosporidiosis: an unrecognized cause of diarrhea in elderly hospitalized patients. Clin. Infect. Dis. 22: 168170.
170. Newman, R. D.,, C. L. Sears,, S. R. Moore,, J. P. Nataro,, T. Wuhib,, D. A. Agnew,, R. L. Guerrant, and, A. A. Lima. 1999. Longitudinal study of Cryptosporidium infection in children in northeastern Brazil. J. Infect. Dis. 180: 167175.
171. Nimri, L. F., and, S. S. Hijazi. 1994. Cryptosporidium. A cause of gastroenteritis in preschool children in Jordan. J. Clin. Gastroenterol. 19: 288291.
172. Ortega, Y. R.,, R. H. Gilman, and, C. R. Sterling. 1994. A new coccidian parasite (Apicomplexa: Eimeriidae) from humans. J. Parasitol. 80: 625629.
173. Ortega, Y. R.,, R. Nagle,, R. H. Gilman,, J. Watanabe,, J. Miyagui,, H. Quispe,, P. Kanagusuku,, C. Roxas, and, C. R. Sterling. 1997. Pathologic and clinical findings in patients with cyclosporiasis and a description of intracellular parasite life-cycle stages. J. Infect. Dis. 176: 15841589.
174. Ortega, Y. R.,, C. R. Roxas,, R. H. Gilman,, N. J. Miller,, L. Cabrera,, C. Taquiri, and, C. R. Sterling. 1997. Isolation of Cryptosporidium parvum and Cyclospora cayetanensis from vegetables collected in markets of an endemic region in Peru. Am. J. Trop. Med. Hyg. 57: 683686.
175. Ortega, Y. R.,, R. R. Sheehy,, V. A. Cama,, K. K. Oishi, and, C. R. Sterling. 1991. Restriction fragment length polymorphism analysis of Cryptosporidium parvum isolates of bovine and human origin. J. Protozool. 38: S40S41.
176. Pape, J. W.,, R. I. Verdier,, M. Boncy,, J. Boncy, and, W. D. Johnson. 1994. Cyclospora infection in adults infected with HIV: clinical manifestations, treatment, and prophylaxis. Ann. Intern. Med. 121: 654657.
177. Passos, L. N.,, O. F. Araujo Filho, and, H. F. Andrade, Jr., 2000. Toxoplasma encephalitis in AIDS patients in Sao Paulo during 1988 and 1991. A comparative retrospective analysis. Rev. Inst. Med. Trop. São Paulo 42: 141145.
178. Patel, S.,, S. Pedraza-Diaz,, J. McLauchlin,, D. P. Casemore, et al. 1998. Molecular characterisation of Cryptosporidium parvum from two large suspected waterborne outbreaks. Commun. Dis. Public Health 1: 231233.
179. Peng, M. M.,, L. Xiao,, A. R. Freeman,, M. J. Arrowood,, A. A. Escalante,, A. C. Weltman,, C. S. Ong,, W. R. MacKenzie,, A. A. Lal, and, C. B. Beard. 1997. Genetic polymorphism among Cryptosporidium parvum isolates: evidence of two distinct human transmission cycles. Emerg. Infect. Dis. 3: 567573.
180. Pozio, E.,, G. Rezza,, A. Boschini,, P. Pezzotti,, A. Tamburrini,, P. Rossi,, M. Di Fine,, C. Smacchia,, A. Schiesari,, E. Gattei,, R. Zucconi, and, P. Ballarini. 1997. Clinical cryptosporidiosis and human immunodeficiency virus (HIV)-induced immunosuppression: findings from a longitudinal study of HIV-positive and HIV-negative former injection drug users. J. Infect. Dis. 176: 969975.
181. Puech, M. C.,, J. M. McAnulty,, M. Lesjak,, N. Shaw,, L. Heron, and, J. M. Watson. 2001. A statewide outbreak of cryptosporidiosis in New South Wales associated with swimming at public pools. Epidemiol. Infect. 126: 389396.
182. Quiroz, E. S.,, C. Bern,, J. R. MacArthur,, L. Xiao,, M. Fletcher,, M. J. Arrowood,, D. K. Shay,, M. E. Levy,, R. I. Glass, and, A. Lal. 2000. An outbreak of cryptosporidiosis linked to a food handler. J. Infect. Dis. 181: 695700.
183. Rabold, J. G.,, C. W. Hoge,, D. R. Shlim,, C. Kefford,, R. Rajah, and, P. Echeverria. 1994. Cyclospora outbreak associated with chlorinated drinking water. Lancet 344: 13601361.
184. Relman, D. A.,, T. M. Schmidt,, A. Gajadhar,, M. Sogin,, J. Cross,, K. Yoder,, O. Sethabutr, and, P. Echeverria. 1996. Molecular phylogenetic analysis of Cyclospora, the human intestinal pathogen, suggests that it is closely related to Eimeria species. J. Infect. Dis. 173: 440445.
185. Richardson, A. J.,, R. A. Frankenberg,, A. C. Buck,, J. B. Selkon,, J. S. Colbourne,, J. W. Parsons, and, R. T. Mayon-White. 1991. An outbreak of waterborne cryptosporidiosis in Swindon and Oxfordshire. Epidemiol. Infect. 107: 485495.
186. Robertson, B.,, M. I. Sinclair,, A. B. Forbes,, M. Veitch,, M. Kirk,, D. Cunliffe,, J. Willis, and, C. K. Fairley. 2002. Case-control studies of sporadic cryptosporidiosis in Melbourne and Adelaide, Australia. Epidemiol. Infect. 128: 419431.
187. Rose, J. B., and, M. LeChevallier. 1997. Waterborne cryptosporidiosis: incidence, outbreaks, and treatment strategies, p. 93110. In R. Fayer (ed.), Cryptosporidiumand cryptosporidiosis. CRC Press, Boca Raton, Fla.
188. Rossignol, J. F.,, A. Ayoub, and, M. S. Ayers. 2001. Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of Nitazoxanide. J. Infect. Dis. 184: 103106.
189. Rossignol, J. F.,, H. Hidalgo,, M. Feregrino,, F. Higuera,, W. H. Gomez,, J. L. Romero,, J. Padierna,, A. Geyne, and, M. S. Ayers. 1998. A double-’blind’ placebo-controlled study of nitazoxanide in the treatment of cryptosporidial diarrhoea in AIDS patients in Mexico. Trans. R. Soc. Trop. Med. Hyg. 92: 663666.
190. Roy, S. L.,, S. M. DeLong,, S. A. Stenzel,, B. Shiferaw,, J. M. Roberts,, A. Khalakdina,, R. Marcus,, S. D. Segler,, D. D. Shah,, S. Thomas,, D. J. Vugia,, S. M. Zansky,, V. Dietz, and, M. J. Beach. 2004. Risk factors for sporadic cryptosporidiosis among immunocompetent persons in the United States from 1999 to 2001. J. Clin. Microbiol. 42: 29442951.
191. Santin, M.,, J. M. Trout,, L. Xiao,, L. Zhou,, E. Greiner, and, R. Fayer. 2004. Prevalence and age related variation of Cryptosporidium species and genotypes in dairy calves. Vet. Parasitol. 122: 103117.
192. Sayers, G. M.,, M. C. Dillon,, E. Connolly,, L. Thornton,, E. Hyland,, E. Loughman,, M. A. O’Mahony, and, K. M. Butler. 1996. Cryptosporidiosis in children who visited an open farm. Commun. Dis. Rep. CDR Rev. 6: R140R144.
193. Sifuentes-Osornio, J.,, G. Porras-Cortés,, R. P. Bendall,, F. Morales-Villarreal,, G. Reyes-Terán, and, G. M. Ruiz-Palacios. 1995. Cyclospora cayetanensis infection in patients with and without AIDS: biliary disease as another clinical manifestation. Clin. Infect. Dis. 21: 10921097.
194. Smith, H. V.,, W. J. Patterson,, R. Hardie,, L. A. Greene,, C. Benton,, W. Tulloch,, R. A. Gilmour,, R. W. A. Girdwood,, J. C. M. Sharp, and, G. I. Forbes. 1989. An outbreak of waterborne cryptosporidiosis caused by post-treatment contamination. Epidemiol. Infect. 103: 703715.
195. Sorvillo, F. J.,, K. Fujioka,, B. Nahlen,, M. P. Tormey,, R. Kebabjian, and, L. Mascola. 1992. Swimming-associated cryptosporidiosis. Am. J. Public Health 82: 742744.
196. Stafford, R.,, G. Neville,, C. Towner, and, B. McCall. 2000. A community outbreak of Cryptosporidium infection associated with a swimming pool complex. Commun. Dis. Intell. 24: 236239.
197. Striepen, B.,, A. J. Pruijssers,, J. Huang,, C. Li,, M. J. Gubbels,, N. N. Umejiego,, L. Hedstrom, and, J. C. Kissinger. 2004. Gene transfer in the evolution of parasite nucleotide biosynthesis. Proc. Natl. Acad. Sci. USA 101: 31543159.
198. Sulaiman, I. M.,, P. R. Hira,, L. Zhou,, F. M. Al-Ali,, F. A. Al-Shelahi,, H. M. Shweiki,, J. Iqbal,, N. Khalid, and, L. Xiao. 2005. Unique endemicity of cryptosporidiosis in children in Kuwait. J. Clin. Microbiol. 43: 28052809.
199. Sundkvist, T.,, M. Dryden,, R. Gabb,, N. Soltanpoor,, D. Casemore, and, J. Stuart. 1997. Outbreak of cryptosporidiosis associated with a swimming pool in Andover. Commun. Dis. Rep. CDR Rev. 7: R190R192.
200. Tangermann, R. H.,, S. Gordon,, P. Wiesner, and, L. Kreckman. 1991. An outbreak of cryptosporidiosis in a day-care center in Georgia. Am. J. Epidemiol. 133: 471476.
201. Taylor, J. P.,, J. N. Perdue,, D. Dingley,, T. L. Gustafson,, M. Patterson, and, L. A. Reed. 1985. Cryptosporidiosis outbreak in a day-care center. Am. J. Dis. Child. 139: 10231025.
202. Teixidor, H. S.,, T. A. Godwin, and, E. A. Ramirez. 1991. Cryptosporidiosis of the biliary tract in AIDS. Radiology 180: 5156.
203. Thomson, M. A.,, J. W. Benson, and, P. A. Wright. 1987. Two year study of Cryptosporidium infection. Arch. Dis. Child. 62: 559563.
204. Thurston-Enriquez, J. A.,, P. Watt,, S. E. Dowd,, R. Enriquez,, I. L. Pepper, and, C. P. Gerba. 2002. Detection of protozoan parasites and microsporidia in irrigation waters used for crop production. J. Food Prot. 65: 378382.
205. Tumwine, J. K.,, A. Kekitiinwa,, N. Nabukeera,, D. E. Akiyoshi,, S. M. Rich,, G. Widmer,, X. Feng,, S. Tzipori. 2003. Cryptosporidium parvum in children with diarrhea in Mulago Hospital, Kampala, Uganda. Am. J. Trop. Med. Hyg. 68: 710715.
206. Turkcapar, N.,, S. Kutlay,, G. Nergizoglu,, T. Atli, and, N. Duman. 2002. Prevalence of Cryptosporidium infection in hemodialysis patients. Nephron 90: 344346.
207. Udgiri, N.,, M. Minz,, R. Kashyap,, M. Heer,, C. S. Gupta,, K. Mohandas,, R. W. Minz, and, N. Malla. 2004. Intestinal cryptosporidiasis in living related renal transplant recipients. Transplant Proc. 36: 21282129.
208. Vakil, N. B.,, S. M. Schwartz,, B. P. Buggy,, C. F. Brummitt,, M. Kherellah,, D. M. Letzer,, I. H. Gilson, and, P. G. Jones. 1996. Biliary cryptosporidiosis in HIV-infected people after the waterborne outbreak of cryptosporidiosis in Milwaukee. N. Engl. J. Med. 334: 1923.
209. Ventura, G.,, R. Cauda,, L. M. Larocca,, M. E. Riccioni,, M. Tumbarello, and, M. B. Lucia. 1997. Gastric cryptosporidiosis complicating HIV infection: case report and review of the literature. Eur. J. Gastroenterol. Hepatol. 9: 307310.
210. Vikoren, T.,, J. Tharaldsen,, B. Frederiksen, and, K. Handeland. 2003. Prevalence of Toxoplasma gondii antibodies in wild red deer, roe deer, moose and reindeer from Norway. Vet. Parasitol. 120: 159169.
211. Wilberschied, L., 1995. A swimming-pool-associated outbreak of cryptosporidiosis. Kans. Med. 96: 6768.
212. Willocks, L.,, A. Crampin,, L. Milne,, C. Seng,, M. Susman,, R. Gair,, M. Moulsdale,, S. Shafi,, R. Wall,, R. Wiggins,, N. Lightfoot, et al. 1998. A large outbreak of cryptosporidiosis associated with a public water supply from a deep chalk borehole. Commun. Dis. Public Health 1: 239243.
213. Wilson, M., and, J. B. McAuley. 1991. Laboratory diagnosis of toxoplasmosis. Clin. Lab. Med. 11: 923939.
214. Wittner, M.,, H. B. Tanowitz, and, L. M. Weiss. 1993. Parasitic infections in AIDS patients. Cryptosporidiosis, isoporiasis, microsporidiosis, cyclosporiasis. Infect. Dis. Clin. N. Am. 7: 569586.
215. Xiao, L.,, C. Bern,, J. Limor,, I. Sulaiman,, J. Roberts,, W. Checkley,, L. Cabrera,, R. H. Gilman, and, A. A. Lal. 2001. Identification of 5 types of Cryptosporidium parasites in children in Lima, Peru. J. Infect. Dis. 183: 492497.
216. Xiao, L.,, C. Bern,, I. M. Sulaiman, and, A. A. Lal. 2003. Molecular epidemiology of human cryptosporidiosis, p. 121146. In R. C. A. Thompson,, A. Armson, and, U. M. Ryan (ed.), Cryptosporidium: from Molecules to Disease. Elsevier, Amsterdam, The Netherlands.
217. Xiao, L.,, R. Fayer,, U. Ryan, and, S. J. Upton. 2004. Cryptosporidium taxonomy: recent advances and implications for public health. Clin. Microbiol. Rev. 17: 7297.
218. Xiao, L., and, U. M. Ryan. 2004. Cryptosporidiosis: an update in molecular epidemiology. Curr. Opin. Infect. Dis. 17: 483490.
219. Yamazaki, T.,, N. Sasaki,, S. Takahashi,, A. Satomi,, G. Hashikita,, F. Oki,, A. Itabashi,, K. Hirayama, and, E. Hori. 1997. Clinical features of Japanese children infected with Cryptosporidium parvum during a massive outbreak caused by contaminated water supply. Kansenshogaku Zasshi 71: 10311036.
220. Yoder, J. S.,, B. G. Blackburn,, G. F. Craun,, V. Hill,, D. A. Levy,, N. Chen,, S. H. Lee,, R. L. Calderon, and, M. J. Beach. 2004. Surveillance for waterborne-disease outbreaks associated with recreational water—United States, 2001–2002. Morb. Mortal. Wkly. Rep. 53: 122.
221. Zar, F. A.,, E. El-Bayoumi, and, M. M. Yungbluth. 2001. Histologic proof of acalculous cholecystitis due to Cyclospora cayetanensis. Clin. Infect. Dis. 33: e140e141.
222. Zu, S. X., and, R. L. Guerrant. 1993. Cryptosporidiosis. J. Trop. Pediatr. 39: 132136.


Generic image for table
Table 1.

Cryptosporidiosis: drinking-water outbreaks

Citation: Arrowood M, Xiao L, Ortega Y, Fayer R. 2007. Emerging Food- and Waterborne Protozoan Diseases, p 283-308. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch15
Generic image for table

Cryptosporidiosis: recreational-water outbreaks

Citation: Arrowood M, Xiao L, Ortega Y, Fayer R. 2007. Emerging Food- and Waterborne Protozoan Diseases, p 283-308. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch15
Generic image for table
Table 3.

Cryptosporidiosis: food-borne outbreaks

Citation: Arrowood M, Xiao L, Ortega Y, Fayer R. 2007. Emerging Food- and Waterborne Protozoan Diseases, p 283-308. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch15
Generic image for table
Table 4.

Cyclosporiasis: food-borne and waterborne outbreaks

Citation: Arrowood M, Xiao L, Ortega Y, Fayer R. 2007. Emerging Food- and Waterborne Protozoan Diseases, p 283-308. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch15

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error