Cryptosporidiosis and Inflammatory Bowel Disease (Experience from the Milwaukee Outbreak)

Abstract

The 1993 Milwaukee Cryptosporidium outbreakposed several questions regarding appropriate managementand prognosis of inflammatory bowel disease patientsacutely infected with this organism. We prospectively identified and monitored 12 patients withstable ulcerative colitis or Crohn's disease whosuffered abrupt clinical decompensation during theoutbreak. All recovered to baseline at ≤60 days. Inpatients receiving immunosuppressive therapy, meanduration of symptoms was no longer than in patientswithout it. Antibiotics did not clearly reduce durationof illness. Two additional patients without a history of intestinal disease presented with ileitisand colitis, respectively, initially suggesting Crohn'sdisease. Both recovered completely without specifictherapy. We conclude that cryptosporidiosis may present as an acute relapse of inflammatory boweldisease and responds to standard therapy; antibioticsconfer no obvious benefit. Immunosuppressive therapydoes not predispose to chronic or severe illness inthese patients. Cryptosporidiosis may present withacute findings initially mimicking Crohn'sdisease.