Timing of Symptoms and Oocyst Excretion in Human Cryptosporidiosis

To determine the timing of symptoms and oocyst excretion after the acquisition of cryptosporidium infection, we used a screening parasitologic stool examination to identify patients and then contacted them for the collection of retrospective histories and follow-up stool specimens. The study included 68 otherwise healthy patients with an identifiable source and time of infection. All 68 had diarrhea, 61 had abdominal pain, most also had other gastrointestinal symptoms, 33 had fever, and all recovered spontaneously. Among the 50 patients who submitted follow-up stool samples, more than 90 percent of the 610 symptomatic days and of the 136 oocyst-positive stools occurred between days 7 and 28 of infection, the mean incubation period was 7.2 days (range, 1 to 12), and the mean duration of illness was 12.2 days (range, 2 to 26). During the oocyst-excretion period cryptosporidium was detected in 90 percent of Ziehl-Neelsen-stained fecal concentrates. The end of oocyst excretion could be accurately determined in 26 patients; 19 (73 percent) had positive stools after the cessation of symptoms for a mean period of 6.9 days (range, 1 to 15). Fourteen patients were studied for two or more months, and in three of them asymptomatic episodes of oocyst excretion were detected up to two months after clinical recovery. We conclude that many cases of symptomatic cryptosporidiosis occur among immunocompetent patients, some of whom may excrete oocysts even when they have become asymptomatic. Conversely, infected symptomatic patients may occasionally have intermittently negative stools.