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cyclosporiasis

Etiology: - Cyclospora Epidemiology: 1) recovered from patients in several countries, including USA 2) disease is more common in the summer 3) cause of traveler's diarrhea 4) can cause outbreaks of diarrhea in filtered & chlorinated water 5) 200 cases of cyclosporiasis in Iowa, Nebraska, Texas, & Wisconsin in 2013 [4] 6) outbreaks in Nebraska and Iowa 2013 linked to bagged salad & fresh cilantro grown in Mexico 7) 206 cases May 1-Aug 7 from 27 states 2017 [7,8] twice rate of 2016 (18 hospitalizations, no deaths) Pathology: 1) oocysts pass unsporulated 2) 1-2 weeks are required for sporulation 3) each mature oocyst contains 2 sporocysts, each with 2 sporozoites Clinical manifestations: 1) flu-like illness with nausea/vomiting, weight loss & explosive diarrhea - watery diarrhea, bloating, flatulence, crampy abdominal pain - nausea, anorexia, fever (occasional) 2) symptoms last 1-3 weeks Laboratory: 1) Cyclospora antigen in stool - diagnosis is made by recovery of oocysts in feces 2) oocysts in stool a) nonrefractile spheres measuring 8-10 um containing a cluster of refractile globules enclosed within a membrane b) with trichrome stains, appear clear, round & somewhat wrinkled c) stain with acid fast stains 1] auramine-O 2] modified Kinyoun method d) autofluoresce bright green to intense blue under UV-epifluorescence e) numerous stool specimens may be necessary because Cyclospora oocysts are sometimes shed at low levels & intermittently [8] 3) Cyclospora DNA Management: 1) Bactrim DS (TMP/SMX), 1 PO BID for 7 days 2) ciprofloxacin if sulfonamide allergy [3] 3) HIV patients may experience relapse & require long-term maintenance therapy

Related

Cyclospora Cyclospora cayetanensis

General

protozoan infection parasitic gastroenteritis

References

  1. Clinical Diagnosis & Management by Laboratory Methods, 19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia, PA. 1996, pg 1281
  2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1204
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018.
  4. FDA: Food. Posted July 22, 2013 FDA Investigates Multistate Outbreak of Cyclosporiasis http://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm361637.htm
  5. Physician's First Watch, August 1, 2013 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society (see CDC site) http://www.jwatch.org
  6. Centers for Disease Control and Prevention CDC) Parasites - Cyclosporiasis (Cyclospora Infection) Investigation of an Outbreak of Cyclosporiasis in the United States. Updated Oct 23, 2013 http://www.cdc.gov/parasites/cyclosporiasis/outbreaks/investigation-2013.html
  7. Frellick M Spike in Reported Cyclosporiasis Cases, CDC Warns. Medscape - Aug 07, 2017. http://www.medscape.com/viewarticle/883877
  8. Centers for Disease Control and Prevention (CDC) Increase in Reported cases of Cyclospora cayetanensis Infection, United States, Summer 2017. CDC Health Alert Network. August 7, 2017, https://emergency.cdc.gov/han/han00405.asp