Cyclosporiasis

Description

Cyclospora cayetanensis, previously known as cyanobacterium-like, coccidia-like, and cyclospora-like bodies, is a protozoan parasite that causes gastrointestinal infection.

Occurrence

Infection can be acquired worldwide by persons of all ages by ingestion of water or food contaminated with the parasite. Outbreaks in North America have been linked to various types of imported fresh produce. Usually the symptoms of infection begin about 1 week after the exposure.

Risk for Travellers

Travellers to developing countries can be at increased risk for this infection, and the risk can vary with the season. Which season is of greatest risk varies by country; for example, in Nepal, risk of infection is greater in the summer and the rainy season.

Clinical Presentation

Infection can be asymptomatic or manifested by such symptoms as watery diarrhoea, loss of appetite, substantial weight loss, bloating, increased gas, stomach cramps, nausea, vomiting, prolonged fatigue, muscle aches, and low-grade fever. Some travellers first notice influenzalike symptoms. If untreated, the illness can last for weeks to months, and the symptoms can come and go.

Prevention

No vaccine is available. Travellers to resource-poor countries should be advised to follow the precautions in the Risks from Food and Drink section. Direct, person-to-person transmission is unlikely because the parasite is not immediately infectious when excreted.

Treatment

The treatment of choice is trimethoprim-sulfamethoxazole. Travellers may also be advised to consult with an infectious disease specialist. Physicians may consult CDC about patients who are allergic to or intolerant of sulfa-containing medications. For more information, see the Division of Parasitic Diseases' website at http://www.cdc.gov/ncidod/dpd/parasites/cyclospora/factsht_cyclospora.htm and http://www.cdc.gov/ncidod/dpd/parasites/cyclospora/healthcare_cyclospora.htm.

Bibliography
  • Herwaldt BL. Cyclospora cayetanensis: a review, focusing on the outbreaks of cyclosporiasis in the 1990s. Clin Infect Dis 2000;31:1040-57.
  • Hoge CW, et al. Placebo-controlled trial of co-trimoxazole for Cyclospora infections among travellers and foreign residents in Nepal. Lancet 1995;345:691-3.
  • Ortega YR, Shlim DL, Ghimire M, et al. Cyclospora species - a new protozoan pathogen of humans. N Engl J Med 1993;328:1308-12.

-Barbara Herwaldt

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