Cicirello H G, Kehl K S, Addiss D G, Chusid M J, Glass R I, Davis J P, Havens P L
National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Epidemiol Infect. 1997 Aug;119(1):53-60. doi: 10.1017/s0950268897007589.
During the spring of 1993 an estimated 403000 residents of the greater Milwaukee, Wisconsin area experienced gastrointestinal illness due to infection with the parasite Cryptosporidium parvum following contamination of the city's water supply. To define the clinical, laboratory and epidemiologic features of outbreak-associated cryptosporidiosis in children, medical and laboratory records for all children submitting stool samples to the microbiology laboratory of the Children's Hospital of Wisconsin between 7 April and 13 May 1993 were reviewed retrospectively. Interviews with parents were also conducted to obtain additional clinical history. Cryptosporidium, as the sole pathogen, was identified in stools from 49 (23%) of the 209 children enrolled in the study. Children with laboratory-confirmed cryptosporidiosis were more likely to live in areas of Milwaukee supplied with contaminated water (RR = 1.92, CI = 1.19-3.09), to be tested later in their illness (P < 0.05), to have submitted more than one stool specimen (P = 0.01), to have an underlying disease that altered their immune status (RR = 2.78, CI = 1.60-4.84), and to be older than 1 year of age (RR = 2.02, CI = 1.13-3.60). Clinical illness in these patients was more prolonged and associated with weight loss and abdominal cramps compared with Cryptosporidium-negative children. In the context of this massive waterborne outbreak relatively few children had documented infection with Cryptosporidium. If many children who tested negative for the parasite were truly infected, as the epidemiologic data suggest, existing laboratory tests for Cryptosporidium were insensitive, particularly early in the course of illness.
1993年春季，威斯康星州大密尔沃基地区估计有40.3万居民因城市供水受微小隐孢子虫污染而感染，出现胃肠道疾病。为确定儿童暴发性隐孢子虫病的临床、实验室和流行病学特征，我们回顾性分析了1993年4月7日至5月13日期间向威斯康星儿童医院微生物实验室提交粪便样本的所有儿童的医学和实验室记录。我们还对患儿家长进行了访谈，以获取更多临床病史。在纳入研究的209名儿童中，有49名（23%）粪便中检出隐孢子虫，为唯一病原体。实验室确诊为隐孢子虫病的儿童更有可能居住在密尔沃基市受污染水供应区域（相对危险度=1.92，可信区间=1.19-3.09），发病后较晚接受检测（P<0.05），提交多个粪便样本（P=0.01），有改变免疫状态的基础疾病（相对危险度=2.78，可信区间=1.60-4.84），且年龄大于1岁（相对危险度=2.02，可信区间=1.13-3.60）。与隐孢子虫检测阴性的儿童相比，这些患儿的临床疾病病程更长，且伴有体重减轻和腹部绞痛。在这次大规模水源性暴发中，记录感染隐孢子虫的儿童相对较少。正如流行病学数据所显示的，如果许多检测寄生虫呈阴性的儿童实际上真的感染了，那么现有的隐孢子虫实验室检测方法不敏感，尤其是在疾病早期。
