Cyclospora - Information for Clinicians
Type of infection
Cyclospora cayetanensis is a protozoal parasite.
Sources of infection
- Cyclospora are found worldwide. Humans are the only known host; the role of animals is uncertain. Oocysts excreted in the stool of an infected person unsporulate in the environment and enter the food chain.
- Most infections occur in tropical and subtropical locations.
- Foodborne outbreaks have been linked to raspberries, basil, snow peas, and lettuce.
- Waterborne disease is thought to be important.
- Oocysts in water may not be killed by routine treatment with chlorine or iodine.
Usual symptoms
- Median incubation period is 7 days (range 2 to >14 days).
- Symptoms include watery diarrhea, anorexia, nausea, bloating, low grade fever, and increased gas.
- Fatigue and weight loss can be prominent.
Complications
- Malabsorption and Reiter's syndrome have been reported.
Duration of illness
- Symptoms can last a few days to more than a month. The course can be relapsing and remitting.
How is it treated?
- Because of the typical prolonged course, treatment is usually indicated.
- Trimethoprim sulfamethoxazole is the treatment of choice 5 mg/kg po or IV bid (trimethoprim component) up to 160 mg po bid for 7-10 days. Immunocompromised patients may require longer therapy.
- There is no clear alternative agent. Ciprofloxacin may have some activity.
Comments
- Rarely diagnosed on routine ova and parasite exam unless the microscopist is highly experienced as the organism does not stain with routine stains. Modified acid fast stains improve detection.
- Molecular assays may be more sensitive than microscopy.
- Travelers should take care to avoid food or water likely to be contaminated with human feces.