Disease: Cyclospora Infection

    Cyclospora infection (cyclosporiasis) facts

    • Cyclospora is a small parasitic organism that is passed to humans when they ingest food contaminated with feces from an infected person.
    • It is most common in tropical countries, and imported foods such as lettuce have caused outbreaks in the United States. Travelers to tropical or subtropical countries are at risk, although the risk is relatively low.
    • Diarrhea is the most common symptom, often accompanied by cramping abdominal pain and fatigue. If left untreated, the diarrhea can last for several weeks.
    • The recommended treatment is a seven- to ten-day course of oral trimethoprim-sulfamethoxazole (Bactrim, Septra).
    • Complications are uncommon, but it is important for patients to drink lots of fluids to prevent dehydration.
    • Prevention efforts are focused on improving the safety of the food supply. Because Cyclospora requires a period of time outside the body to become infectious, the organism is not spread directly from person to person.

    What is Cyclospora infection?

    Infection occurs when humans inadvertently ingest Cyclospora, usually by eating food contaminated with very small amounts of feces (stool) from an infected person.

    What causes Cyclospora infection?

    Cyclospora cayetanensis is a parasite which passes between the outside environment and humans during its life cycle. It exists for long times in nature in a highly stable form called an oocyst. The oocyst for can resist extreme temperatures and is not killed by usual concentrations of formalin or chlorine. When temperatures warm, the oocyst matures in a process called sporulation, producing forms known as sporozoites. When the sporozoites are inadvertently ingested by a human, they begin to reproduce, eventually forming new oocysts that are excreted in feces, starting the cycle all over again.

    What are the risk factors for a Cyclospora infection?

    Cyclospora causes disease throughout the world, but it is much more common in tropical and subtropical climates. Outbreaks that occur in more temperate zones, such as in the United States, are often -- but not exclusively -- associated with food imported from warmer climates. The produce at risk is that which is exposed to ground contaminated with human feces or washed with contaminated water. Thus, lettuce, raspberries, basil, and snow peas have all been implicated in past outbreaks. In 2013, an outbreak occurred involving many states, including Texas, Iowa, and Nebraska. This outbreak affected hundreds of people and was at least partially caused by bagged lettuce grown in Mexico.

    Although travel to a tropical or subtropical country is a risk factor for Cyclospora infection, the risk is relatively low. The organism is not a major cause of travelers' diarrhea.

    What are the symptoms of Cyclospora infection?

    The most common complaint for people with illness due to Cyclospora is diarrhea, which can last four weeks or more. The diarrhea is typically watery in nature and is often accompanied by cramping and fatigue. The infected person generally has from five to 15 bowel movements per day. Other common problems are fevers, abdominal or belly pain, heartburn, nausea, increased gas, decreased appetite, and weight loss. Symptoms are more severe in people with compromised immune systems, such as patients with the acquired immunodeficiency syndrome (AIDS).

    How is Cyclospora infection diagnosed?

    The diagnosis of Cyclospora is made by examining stool samples. Using a light microscope, the stool is examined for oocysts. Occasionally, more than one sample must be used to find oocysts. These samples should usually be 24 to 48 hours apart because oocysts are sometimes shed intermittently in stool. To increase the ability to diagnose Cyclospora, special staining methods, polymerase chain reaction (PCR) tests, and stool specimen concentration techniques are used. Physicians should alert the laboratory if Cyclospora is suspected so that these methods can be used. Currently, there is no blood test that can detect Cyclospora.

    What is the treatment of Cyclospora infections?

    Cyclospora infection is self-limited, and mild or asymptomatic cases require no treatment. For those who require treatment, the best option is oral trimethoprim-sulfamethoxazole (TMP-SMX) (Bactrim, Septra) twice daily for seven to 10 days. For those who continue to have symptoms or have persistent oocysts on stool examination, another seven-day course is usually effective in clearing infection. For patients with a sulfa allergy, there are few good alternatives. There are reported cases where nitazoxanide (Alinia) twice daily was successful as an alternate therapy, although large-scale studies have not been done. One small study suggested that ciprofloxacin (Cipro, Cipro XR, Proquin XR) twice daily for seven days is an option in adults, but it has a higher failure rate compared to TMP-SMX and some have questioned its effectiveness. Because these medications are not approved for routine use during pregnancy, treatment of pregnant patients should be individualized and done in consultation with an obstetrician.

    What causes Cyclospora infection?

    Cyclospora cayetanensis is a parasite which passes between the outside environment and humans during its life cycle. It exists for long times in nature in a highly stable form called an oocyst. The oocyst for can resist extreme temperatures and is not killed by usual concentrations of formalin or chlorine. When temperatures warm, the oocyst matures in a process called sporulation, producing forms known as sporozoites. When the sporozoites are inadvertently ingested by a human, they begin to reproduce, eventually forming new oocysts that are excreted in feces, starting the cycle all over again.

    What are the risk factors for a Cyclospora infection?

    Cyclospora causes disease throughout the world, but it is much more common in tropical and subtropical climates. Outbreaks that occur in more temperate zones, such as in the United States, are often -- but not exclusively -- associated with food imported from warmer climates. The produce at risk is that which is exposed to ground contaminated with human feces or washed with contaminated water. Thus, lettuce, raspberries, basil, and snow peas have all been implicated in past outbreaks. In 2013, an outbreak occurred involving many states, including Texas, Iowa, and Nebraska. This outbreak affected hundreds of people and was at least partially caused by bagged lettuce grown in Mexico.

    Although travel to a tropical or subtropical country is a risk factor for Cyclospora infection, the risk is relatively low. The organism is not a major cause of travelers' diarrhea.

    What are the symptoms of Cyclospora infection?

    The most common complaint for people with illness due to Cyclospora is diarrhea, which can last four weeks or more. The diarrhea is typically watery in nature and is often accompanied by cramping and fatigue. The infected person generally has from five to 15 bowel movements per day. Other common problems are fevers, abdominal or belly pain, heartburn, nausea, increased gas, decreased appetite, and weight loss. Symptoms are more severe in people with compromised immune systems, such as patients with the acquired immunodeficiency syndrome (AIDS).

    How is Cyclospora infection diagnosed?

    The diagnosis of Cyclospora is made by examining stool samples. Using a light microscope, the stool is examined for oocysts. Occasionally, more than one sample must be used to find oocysts. These samples should usually be 24 to 48 hours apart because oocysts are sometimes shed intermittently in stool. To increase the ability to diagnose Cyclospora, special staining methods, polymerase chain reaction (PCR) tests, and stool specimen concentration techniques are used. Physicians should alert the laboratory if Cyclospora is suspected so that these methods can be used. Currently, there is no blood test that can detect Cyclospora.

    What is the treatment of Cyclospora infections?

    Cyclospora infection is self-limited, and mild or asymptomatic cases require no treatment. For those who require treatment, the best option is oral trimethoprim-sulfamethoxazole (TMP-SMX) (Bactrim, Septra) twice daily for seven to 10 days. For those who continue to have symptoms or have persistent oocysts on stool examination, another seven-day course is usually effective in clearing infection. For patients with a sulfa allergy, there are few good alternatives. There are reported cases where nitazoxanide (Alinia) twice daily was successful as an alternate therapy, although large-scale studies have not been done. One small study suggested that ciprofloxacin (Cipro, Cipro XR, Proquin XR) twice daily for seven days is an option in adults, but it has a higher failure rate compared to TMP-SMX and some have questioned its effectiveness. Because these medications are not approved for routine use during pregnancy, treatment of pregnant patients should be individualized and done in consultation with an obstetrician.

    Source: http://www.rxlist.com

    The diagnosis of Cyclospora is made by examining stool samples. Using a light microscope, the stool is examined for oocysts. Occasionally, more than one sample must be used to find oocysts. These samples should usually be 24 to 48 hours apart because oocysts are sometimes shed intermittently in stool. To increase the ability to diagnose Cyclospora, special staining methods, polymerase chain reaction (PCR) tests, and stool specimen concentration techniques are used. Physicians should alert the laboratory if Cyclospora is suspected so that these methods can be used. Currently, there is no blood test that can detect Cyclospora.

    Source: http://www.rxlist.com

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