title: Management of a Cryptosporidium hominis outbreak in a day-care center.
abstract: BACKGROUND
  Cryptosporidium outbreaks in day-care centers (DCCs) occur commonly. However, controlling spread of infection in these settings is difficult, and data about effectiveness of different control strategies are sparse. In this study, a Cryptosporidium outbreak in a large DCC located in Brussels is described with evaluation of hygienic and therapeutic interventions.
  
  
  METHODS
  During a 3-week period, 43 of 130 children attending the DCC developed enteric symptoms. Stools from 122 children were examined for microbial pathogens. Of them, 38 (31%) were diagnosed with Cryptosporidium, 29 of them being symptomatic (76%) and 9 (24%) asymptomatic. Diagnosis was performed by microscopy, antigen tests, and real-time polymerase chain reaction. Strict infection control measures were implemented during the first week after the start of outbreak. After 4 weeks, 27/38 children (71%) were still symptomatic and Cryptosporidium positive. Because of persisting symptoms and fear of further spread of infection, all 27 children were treated with paromomycin. Two weeks later, 18 of 27 children were asymptomatic and were parasitologically negative. The remaining 9 children, still symptomatic and Cryptosporidium positive, were treated with nitazoxanide. Three weeks later, week 9 after the start of outbreak, all 38 children involved in the outbreak were asymptomatic and Cryptosporidium negative.
  
  
  CONCLUSIONS
  Our study underscores the need to rule out Cryptosporidium etiology in a diarrheal outbreak in a DCC. Rapid implementation of infection control measures can most likely halt the spread of infection. The role of nitazoxanide to limit duration of shedding of oocysts deserves more attention for its use in outbreaks.
authors.affiliation: Department of Microbiology, Saint-Pierre University Hospital and Jules Bordet Institute, Brussels, Belgium. olivier.vandenberg@ulb.ac.be
authors.forename: Olivier
authors.initials: O
authors.lastname: Vandenberg
authors.forename: Françoise
authors.initials: F
authors.lastname: Robberecht
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dauby
authors.forename: Catherine
authors.initials: C
authors.lastname: Moens
authors.forename: Hana
authors.initials: H
authors.lastname: Talabani
authors.forename: Eddy
authors.initials: E
authors.lastname: Dupont
authors.forename: Jean
authors.initials: J
authors.lastname: Menotti
authors.forename: Tom
authors.initials: T
authors.lastname: van Gool
authors.forename: Jack
authors.initials: J
authors.lastname: Levy
mesh_terms: D000818:Animals; D000977:Antiparasitic Agents / Q000627:therapeutic use*; D001530:Belgium; D002656:Child Day Care Centers; D002675:Child, Preschool; D003457:Cryptosporidiosis / Q000175:diagnosis / Q000188:drug therapy* / Q000469:parasitology / Q000517:prevention & control; D003458:Cryptosporidium / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D003967:Diarrhea / Q000175:diagnosis / Q000188:drug therapy* / Q000469:parasitology / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control*; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D006920:Hygiene; D007223:Infant; D017053:Infection Control / Q000379:methods; D008297:Male; D009574:Nitro Compounds; D010303:Paromomycin / Q000627:therapeutic use; D016133:Polymerase Chain Reaction; D013844:Thiazoles / Q000627:therapeutic use
chemical_list: D000977:Antiparasitic Agents; D009574:Nitro Compounds; D013844:Thiazoles; D010303:Paromomycin; C041747:nitazoxanide