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Boks, M., Lilja, M., Widerström, M., Karling, P., Lindam, A. & Sjöström, M. (2023). Persisting symptoms after Cryptosporidium hominis outbreak: a 10-year follow-up from Östersund, Sweden. Parasitology Research, 122(7), 1631-1639
Open this publication in new window or tab >>Persisting symptoms after Cryptosporidium hominis outbreak: a 10-year follow-up from Östersund, Sweden
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2023 (English)In: Parasitology Research, ISSN 0932-0113, E-ISSN 1432-1955, Vol. 122, no 7, p. 1631-1639Article in journal (Refereed) Published
Abstract [en]

In late 2010, an outbreak of Cryptosporidium hominis affected 27,000 inhabitants (45%) of Östersund, Sweden. Previous research shows that abdomen and joint symptoms commonly persist up to 5 years post-infection. It is unknown whether Cryptosporidium is associated with sequelae for a longer duration, how persisting symptoms present over time, and whether sequelae are associated with prolonged infection. In this prospective cohort study, a randomly selected cohort in Östersund was surveyed about cryptosporidiosis symptoms in 2011 (response rate 69.2%). A case was defined as a respondent reporting new diarrhoea episodes during the outbreak. Follow-up questionnaires were sent after 5 and 10 years. Logistic regressions were used to examine associations between case status and symptoms reported after 10 years, with results presented as adjusted odds ratios (aOR) with 95% confidence intervals. Consistency of symptoms and associations with case status and number of days with symptoms during outbreak were analysed using X 2 and Mann–Whitney U tests. The response rate after 10 years was 74% (n = 538). Case status was associated with reporting symptoms, with aOR of ~3 for abdominal symptoms and ~2 for joint symptoms. Cases were more likely to report consistent symptoms. Cases with consistent abdominal symptoms at follow-up reported 9.2 days with symptoms during the outbreak (SD 8.1), compared to 6.6 days (SD 6.1) for cases reporting varying or no symptoms (p = 0.003). We conclude that cryptosporidiosis was associated with an up to threefold risk for reporting symptoms 10 years post-infection. Consistent symptoms were associated with prolonged infection.

Place, publisher, year, edition, pages
Springer Nature, 2023
Keywords
Cryptosporidium, Diarrhoea, Disease outbreaks, PI-IBS, Post-infectious symptoms, Sequelae
National Category
Infectious Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-209290 (URN)10.1007/s00436-023-07866-8 (DOI)000990476700002 ()37199767 (PubMedID)2-s2.0-85159654199 (Scopus ID)
Funder
Region Jämtland Härjedalen, JLL-939404Region Jämtland Härjedalen, JLL-965542Region Jämtland Härjedalen, JLL-967794Region Jämtland Härjedalen, JLL-978075Region Jämtland Härjedalen, JLL-980156Visare Norr, 967799
Available from: 2023-06-08 Created: 2023-06-08 Last updated: 2023-12-05Bibliographically approved
Boks, M., Lilja, M., Widerström, M., Karling, P., Lindam, A., Eriksson, A. & Sjöström, M. (2022). Increased incidence of late-onset inflammatory bowel disease and microscopic colitis after a Cryptosporidium hominis outbreak. Scandinavian Journal of Gastroenterology, 57(12), 1443-1449
Open this publication in new window or tab >>Increased incidence of late-onset inflammatory bowel disease and microscopic colitis after a Cryptosporidium hominis outbreak
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2022 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 57, no 12, p. 1443-1449Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: In 2010, 27,000 inhabitants (45% of the population) of Östersund, Sweden, contracted clinical cryptosporidiosis after drinking water contaminated with Cryptosporidium hominis. After the outbreak, local physicians perceived that the incidence of inflammatory bowel disease (IBD), including ulcerative colitis (UC), Crohn's disease (CD), and IBD-unclassified, and microscopic colitis (MC) increased. This study assessed whether this perception was correct.

MATERIALS AND METHODS: This observational study included adult patients (≥18 years old) from the local health care region who were diagnosed with pathology-confirmed IBD or MC during 2006-2019. We collected and validated the diagnosis, date of diagnosis, age at diagnosis, and sex from the Swedish quality register SWIBREG and electronic patient records. Population data were collected from Statistics Sweden. The incidences for 2006-2010 (pre-outbreak) and 2011-2019 (post-outbreak) were evaluated by negative binomial regression analysis and presented as incidence rate ratios (IRRs). Data were analyzed for IBD, for UC and CD separately, and MC.

RESULTS: During the study period, we identified 410 patients with new onset IBD and 155 new cases of MC. Overall, we found a trend toward an increased incidence of IBD post-outbreak (IRR 1.39, confidence interval (CI) 0.99-1.94). In individuals ≥40 years old, the post-outbreak incidence significantly increased for IBD (IRR 1.69, CI 1.13-2.51) and CD (IRR 2.23, CI 1.08-4.62). Post-outbreak incidence of MC increased 6-fold in all age groups (IRR 6.43, CI 2.78-14.87).

CONCLUSIONS: The incidence of late-onset IBD and MC increased after the Cryptosporidium outbreak. Cryptosporidiosis may be an environmental risk factor for IBD and MC.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2022
Keywords
Crohn’s disease, Cryptosporidium, epidemiology, inflammatory bowel disease, microscopic colitis
National Category
Gastroenterology and Hepatology Health Care Service and Management, Health Policy and Services and Health Economy Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-199584 (URN)10.1080/00365521.2022.2094722 (DOI)000822350600001 ()35802626 (PubMedID)2-s2.0-85133721591 (Scopus ID)
Funder
Region Jämtland Härjedalen, JLL-939404Region Jämtland Härjedalen, JLL-965542Region Jämtland Härjedalen, JLL-564341
Available from: 2022-09-20 Created: 2022-09-20 Last updated: 2023-05-22Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1216-2440

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