CRYPTOSPORIDIOSIS AND INFLAMMATORY BOWEL-DISEASE - EXPERIENCE FROM THE MILWAUKEE OUTBREAK

The 1993 Milwaukee Cryptosporidium outbreak posed several questions re garding appropriate management and prognosis of inflammatory bowel dis ease patients acutely infected with this organism. We prospectively id entified and monitored 12 patients with stable ulcerative colitis or C rohn's disease who suffered abrupt clinical decompensation during the outbreak. All recovered to baseline at less than or equal to 60 days. In patients receiving immunosuppressive therapy, mean duration of symp toms was no longer than in patients without it. Antibiotics did not cl early reduce duration of illness. Two additional patients without a hi story of intestinal disease presented with ileitis and colitis, respec tively, initially suggesting Crohn's disease. Both recovered completel y without specific therapy. We conclude that cryptosporidiosis may pre sent as an acute relapse of inflammatory bowel disease and responds to standard therapy; antibiotics confer no obvious benefit. Immunosuppre ssive therapy does not predispose to chronic or severe illness in thes e patients. Cryptosporidiosis may present with acute findings initiall y mimicking Crohn's disease.