You might have heard of something called “cryptosporidiosis” recently, closely followed by warnings to stay away from your local swimming pool if you’ve had diarrhoea.

More than 700 cases of this gastrointestinal disease were reported in Queensland in January, which is 13 times more than in January last year. Just under 500 cases have been recorded in New South Wales this year to-date, while other states have similarly reported an increase in the number of cryptosporidiosis infections in recent months.

Cryptosporidiosis has been listed as a national notifiable disease in Australia since 2001.
But what exactly is it, and should we be worried?

What causes cryptosporidiosis, and who is affected?

Cryptosporidiosis is the disease caused by the parasite Cryptosporidium, of which there are two types that can make us sick. Cryptosporidum hominis only affects humans and is the major cause of recent outbreaks in Australia, while Cryptosporidium parvum can also affect animals.

The infection is spread by spores called oocysts in the stools of humans and animals. When ingested, these oocysts migrate and mature in the small bowel. They damage the small bowel lining and can lead to diarrhoea, nausea, vomiting, fever and abdominal discomfort.

Most people develop symptoms anywhere from one to 12 days after becoming infected. Usually these symptoms resolve within two weeks, but the illness may last longer and can be severe in those with a weakened immune system.

Children and the elderly tend to be the most commonly affected. Cryptosporidiosis is more prevalent in young children, particularly those under five, but the disease can affect people of any age.

So how do we catch it?

Most major outbreaks of cryptosporidiosis have been due to people drinking contaminated water. The largest recorded outbreak occurred in Milwaukee in 1993 where 403,000 people were believed to have been infected.

Cryptosporidium oocysts are very small in size and in Milwaukee they passed through the filtration system of one of the water treatment plants undetected, infecting the city’s water supply. As few as ten oocysts can cause infection, making it possible for contaminated drinking water to affect a very large number of people.

Four days after infection a person with cryptosporidiosis can shed up to ten billion oocysts into their stool a day, with the shedding persisting for about two weeks. This is why one infected person in a swimming pool can infect the entire pool in a single visit.

Cryptosporidium oocysts excreted in the faeces of infected humans and animals can also reach natural bodies of water such as beaches, rivers and lakes directly through sewer pipes or indirectly such as in manure transported with surface runoff after heavy rain.

One study which modelled Cryptosporidium concentrations in rivers around the world estimated there are anywhere from 100 to one million oocysts in a litre of river water.

In Australia, cryptosporidiosis outbreaks tend to occur during the late spring and early summer periods when there’s an increase in recreational water activities such as swimming in natural water holes, water catchments and public pools. We don’t know exactly why cases have seen such a surge this summer compared to other years, but we know Cryptosporidium is very infectious.

Oocysts have been found in foods such as fresh vegetables and seafood but these are not common sources of infection in Australia.

What about chlorine?

Contrary to popular belief, chlorine doesn’t kill off all infectious microbes in a swimming pool. Cryptosporidium oocysts are hardy, thick-walled and resistant to chlorine and acid. They are not destroyed by chlorine at the normal concentrations found in swimming pools.

We also know oocysts can be significantly protected from the effects of chlorine in swimming pools by faecal material, so the presence of even small amounts of faecal matter contaminated with Cryptosporidium in a swimming pool would necessitate closure and a thorough decontamination.

Young children and in particular children in nappies are known to increase the potential for disease transmission in recreational water. Proper nappy changing, frequent bathroom breaks and showering before swimming to remove faecal residue are helpful ways to reduce the risk.

Some sensible precautions

Other measures you can take to reduce yours and others’ risk of cryptosporidiosis include:

• avoid swimming in natural waters such as rivers and creeks during and for at least three days after heavy rain
• avoid swimming in beaches for at least one day after heavy rain
• avoid drinking untreated water such as water from rivers or springs. If you need to drink untreated water, boiling it first will kill the Cryptosporidium
• avoid swallowing water when swimming if you can
• if you’ve had diarrhoea, avoid swimming for at least two weeks after it has resolved
• avoid sharing towels or linen for at least two weeks after diarrhoea has resolved
• avoid sharing, touching or preparing food that other people may eat for at least 48 hours after diarrhoea has resolved
• wash your hands with soap and water after going to the bathroom or before preparing food (Cryptosporidium is not killed by alcohol gels and sanitisers).

Not all cases of diarrhoea are due to cryptosporidiosis. There are many other causes of infectious gastroenteritis and because the vast majority of the time recovery is uneventful you don’t need to see a doctor unless very unwell. If you do suspect you may have cryptosporidiosis you can ask your doctor to refer you for a stool test.

Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Each year, more and more Victorians become sick with a flesh-eating bacteria known as Buruli ulcer. Last year, 363 people presented with the infection, the highest number since 2004.

But it has been unclear exactly how it spreads, until now. New research shows mosquitoes are infected from biting possums that carry the bacteria. Mozzies spread it to humans through their bite.

What is Buruli ulcer?

Buruli ulcer, also known as Bairnsdale ulcer, is a skin infection caused by the bacterium Mycobacterium ulcerans.

It starts off like a small mosquito bite and over many months, slowly develops into an ulcer, with extensive destruction of the underlying tissue.

While often painless initially, the infection can become very serious. If left untreated, the ulcer can continue to enlarge. This is where it gets its “flesh-eating” name.

Thankfully, it’s treatable. A six to eight week course of specific antibiotics is an effective treatment, sometimes supported with surgery to remove the infected tissue.

Where can you catch it?

The World Health Organization considers Buruli ulcer a neglected tropical skin disease. Cases have been reported across 33 countries, primarily in west and central Africa.

However, since the early 2000s, Buruli ulcer has also been increasingly recorded in coastal Victoria, including suburbs around Melbourne and Geelong.

Scientists have long known Australian native possums were partly responsible for its spread, and suspected mosquitoes also played a role in the increase in cases. New research confirms this.

Our efforts to ‘beat Buruli’

Confirming the role of insects in outbreaks of an infectious disease is achieved by building up corroborating, independent evidence.

In this new research, published in Nature Microbiology, the team (including co-authors Tim Stinear, Stacey Lynch and Peter Mee) conducted extensive surveys across a 350 km² area of Victoria.

We collected mosquitoes and analysed the specimens to determine whether they were carrying the pathogen, and links to infected possums and people. It was like contact tracing for mosquitoes.

Molecular testing of the mosquito specimens showed that of the two most abundant mosquito species, only Aedes notoscriptus (a widespread species commonly known as the Australian backyard mosquito) was positive for Mycobacterium ulcerans.

We then used genomic tests to show the bacteria found on these mosquitoes matched the bacteria in possum poo and humans with Buruli ulcer.

We further analysed mosquito specimens that contained blood to show Aedes notoscriptus was feeding on both possums and humans.

To then link everything together, geospatial analysis revealed the areas where human Buruli ulcer cases occur overlap with areas where both mosquitoes and possums that harbour Mycobacterium ulcerans are active.

Stop its spread by stopping mozzies breeding

The mosquito in this study primarily responsible for the bacteria’s spread is Aedes notoscriptus, a mosquito that lays its eggs around water in containers in backyard habitats.

Controlling “backyard” mosquitoes is a critical part of reducing the risk of many global mosquito-borne disease, especially dengue and now Buruli ulcer.

You can reduce places where water collects after rainfall, such as potted plant saucers, blocked gutters and drains, unscreened rainwater tanks, and a wide range of plastic buckets and other containers. These should all be either emptied at least weekly or, better yet, thrown away or placed under cover.

There is a role for insecticides too. While residual insecticides applied to surfaces around the house and garden will reduce mosquito populations, they can also impact other, beneficial, insects. Judicious use of such sprays is recommended. But there are ecological safe insecticides that can be applied to water-filled containers (such as ornamental ponds, fountains, stormwater pits and so on).

Recent research also indicates new mosquito-control approaches that use mosquitoes themselves to spread insecticides may soon be available.

How to protect yourself from bites

The first line of defence will remain personal protection measures against mosquito bites.

Covering up with loose fitted long sleeved shirts, long pants, and covered shoes will provide physical protection from mosquitoes.

Applying topical insect repellent to all exposed areas of skin has been proven to provide safe and effective protection from mosquito bites. Repellents should include diethytolumide (DEET), picaridin or oil of lemon eucalyptus.

While the rise in Buruli ulcer is a significant health concern, so too are many other mosquito-borne diseases. The steps to avoid mosquito bites and exposure to Mycobacteriam ulcerans will also protect against viruses such as Ross River, Barmah Forest, Japanese encephalitis, and Murray Valley encephalitis.

Cameron Webb, Clinical Associate Professor and Principal Hospital Scientist, University of Sydney; Peter Mee, Adjunct Associate Lecturer, School of Applied Systems Biology, La Trobe University; Stacey Lynch, Team Leader- Mammalian infection disease research, CSIRO, and Tim Stinear, Professor of Microbiology, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.