j u .t o u t ▼ o c to b o r 2 1 . 1 9 9 4 ▼ 19
M icrogam étocyte
ealth officials say a parasite often
8
found in drinking water may prove
harmful to people with suppressed
immune systems. The parasite,
O
>
Cryptosporidium parvum, causes the
CD
disease cryptosporidiosis, of which the symptoms
include diarrhea and vomiting. Once infected,
immunocompromised citizens, such as cancer che
motherapy patients or those with HI V/A1DS, are at
risk for severe illness.
“We do know of cases of people coming down
with cryptosporidiosis in the Portland area, but it’s
very difficult to trace the source of that contamina
tion,” says Susan Stoltenberg, executive director
A parasite often found in drinking water may pose
of the Cascade AIDS Project, Oregon’s largest
HIV/AIDS service organization.
a threat to those with weakened immune systems
According to health officials, cryptosporidiosis
is spread by putting something in the mouth that
has been contaminated with the feces of an in
by Inga Sorensen
fected person or animal. In this way, people swal
low the parasite, which is too small to be seen with
the naked eye. A person can become infected by
50 people died, includ
those sam ples we
drinking contaminated water or eating raw or
ing several people with
have found Crypto
undercooked food contam inated with
AIDS.
sporidium in the
Cryptosporidium oocysts (an egg-like form of the
Since that outbreak,
w ater,” says Mark
parasite that is in the infectious stage); direct
there has been increased
Knudson, a Portland
contact with the feces of infected humans or ani
concern about the
waterquality manager.
mals; or hand-to-mouth transfer of oocysts from
nation’s water supplies,
“The measurements
surfaces that may have become contaminated with
but there remain no gov
range from .5 to 5.3
microscopic amounts of the feces of an infected
ernmental guidelines
oocysts per hundred
person or animal.
mandating that water be
lite rs o f w a te r .”
Those most at risk for cryptosporidiosis in
tested for the parasite.
Knudson cautions the
clude child care workers; diaper-aged children
“This is a relatively
figures mean little, due
who attend day-care centers; persons exposed to
new disease, and it is a
to an uncertainty in
human feces through sexual contact; and caregivers
significant disease,” says
testing methods (for
who might come in direct contact with feces while
Dr. William Keene, a
example, algae may
caring fora person infected with cryptosporidiosis.
communicable disease
look li ke an oocy st) and
Symptoms include diarrhea, headache, abdomi
epidemiologist for the
because testing and
nal cramps, nausea, vomiting and low-grade fever
Oregon Health Division.
stu d y o f C ry p to
which may lead to weight loss and dehydration. In
Keene has been follow
sporidium has not oc
otherwise healthy people, these symptoms usually
ing Cryptosporidium
curred on a widespread
last one to two weeks, but for immunocompromised
outbreaks since 1986.
level.
people the infection may persist and become life-
“There are already lots of government standards
For comparison’s sake, however, New York
threatening.
regarding the testing of the public water supply,
City’s water supply has measured 17 oocysts per
According to Stoltenberg, CAP received sev
but none deal specifically with crypto. That’s chang
hundred liters of water. “And I guess we can take
eral concerned phone calls following an airing of
ing, however. The EPA [federal Environmental
some comfort in the fact that during the Milwaukee
NBC’s Dateline, a weekly newsmagazine that
Protection Agency) is in the process of developing
outbreak levels were at 100 oocysts per hundred
recently featured a segment on the potential dan
guidelines that are specific to crypto.”
liters,” Knudson says, adding, “Most outbreaks
gers of Cryptosporidium.
The Portland Water Bureau has been voluntar
seem to occur when the measurement hits about 30
“It’s very understandable that the people we
ily testing for Cryptosporidium for eight years.
oocysts per hundred liters of water. Quite frankly,
service would want to know more about this be
Portland’s public water supply primarily comes
though, if you’ve got a depressed immune system,
cause of their depressed immune systems,” she
from the Bull Run Reservoir near Mount Hood.
it could take a lot less to affect you. It really varies
says.
According to health and water officials, livestock
from individual to individual.”
and people are kept away from the reservoir in
According to Knudson, Bull Run water is treated
et health officials say there is little informa
order to decrease the risk of contamination. Live
with chlorine before the public is allowed to drink
tion available about the parasite as it relates
stock in particular may pose a threat because
it. Cryptosporidium is not responsive to chlorine,
to human infection. In fact, as late as 1976,
parasite-infected feces may wash into the water
though it can be filtered. Bull Run water does not
the parasite was not known to cause disease in
supply during heavy rains. While many wild ani
undergo a filtering process, and Knudson says it
mals are infected, their importance as a source of
humans. Until 1993, when more than 400,000
would cost roughly $120 million to put such a
human infection is not clear. Officials say surface
people in Milwaukee, Wis., became ill with diar
system in place.
rhea after drinking water contaminated with the
water supplies are more prone to contamination
So what exactly can someone do to try to avoid
than ground water supplies.
parasite, few people had heard of Cryptosporidium.
infection? Some suggest installing a home water
“Since 1986 we’ve taken 68 samples. In 19 of
According to Milwaukee health officials, nearly
filtering system. “There is a standard for home
H
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Watch what you drink
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B uddhist A pproach to L iving W ith HIV
Free Workshop
filtering systems known as NSFCyst Removal that
ensures that crypto will be filtered out,” explains
Tom Richardson, coordinator of the Oregon AIDS
Hotline. Richardson is currently gathering infor
mation about the costs and availability of such
systems.
"You could also bring your tap water to a full
boil before drinking it—that will kill the parasite,
but it may be a very inconvenient way to handle the
situation,” he admits.
Some may think bottled water is safer to drink,
but, says Knudson, "That water may or may not
contain oocysts. There arc no regulations saying
bottled water has to be tested.” He further cautions
that home filtering systems often require diligent
maintenance in order to be effective.
“You can install the best system, but if you
forget to change your filters, then you’ve defeated
the purpose,” he says. “What I tell people is that if
they have a suppressed immune system, they should
consult with their physician about the best way to
avoid contamination.”
These are the most often mentioned steps one
can take to avoid infection: don’t drink untreated
surface water, including private water supplies or
water from streams or lakes; bring water to a full,
rolling boil before ingesting it; purchase and prop
erly maintain an appropriate home water filter
system; avoid fecal-oral modes of transmission.
Richardson says that although cases of
cryptosporidiosis may be brought on by the water
borne parasite, gay men may be picking it up in
other ways.
“Cryptosporidium in the water may be a prob
lem for the general public, but we also have to be
aware that in cases involving gay men, the infec
tion is brought on by unsafe anal-oral sexual prac
tices,” he says. “We need to be aware of the threat,
and we certainly address this in our safer-sex
educational materials.”
According to Keene, the state will soon make
cryptosporidiosis reportable, meaning that when a
health care provider diagnoses cryptosporidiosis
in a patient, the information will be forwarded to
state health officials. The purpose of the reporting
is to help pinpoint the source of infection in order
to prevent further transmission. State health offi
cials admit cry p to sp o rid io sis is “grossly
underdiagnosed” in part because the parasite is
rarely identified on a routine stool exam.
"Crypto will soon become reportable, and when
it does we will launch an educational campaign to
better inform other health care providers and the
public about its dangers and ways to avoid it,” says
Keene. Knudson adds the Portland Water Bureau
will soon make a Cryptosporidium consumer packet
available to the public.
“The fact of the matter is, there is no treatment
for cryptosporidiosis, and people are dying from
it,” says Knudson. “We’re concerned and will do
what we can to inform the public about the prob
lem.”
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