Cyclosporiasis (patient information)
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Cyclosporiasis |
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Cyclosporiasis On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
Cyclosporiasis is an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis. People can become infected with Cyclospora by consuming food or water contaminated with the parasite. People living or traveling in countries where Cyclosporiasis is endemic may be at increased risk for infection. Safe food and water habits is one of the most effective way to prevent the disease.
What are the symptoms of Cyclosporiasis?
Cyclospora infects the small intestine. Some of the patients are asymptomatic while a few others develop symptoms. Symptoms if present appear after one week of ingesting contaminated food. If it is not treated infection or if the patient is immunocompromised, symptoms may last upto several weeks to a month or more. Symptoms may include some of the following.[1]
- Frequent bouts of explosive watery diarrhea ( Most common symptom)
- Diarrhea may be alternated with constipation in some of the cases
- Loss of appetite and weight
- Abdominal cramps, bloating increased gas
- Nausea
- Vomiting ( less common)
- Fatigue
- Low grade fever
- Body ache
- Headache
- Flu like symptoms
- Warning symptoms of dehydration
- Sunken eyes
- Dry mouth, tongue and skin
- Reduced production of tears
- Decreased urine output
What causes Cyclosporiasis?
Cyclospora cayetanensis has been only recently identified as a single-celled coccidian parasite. It has been linked in the United States from fecally-contaminated imported raspberries and was virtually unknown before about 1990, but has been on the rise since. The health risk associated with the disease is usually confined to adult foreigners visiting endemic regions and acquiring the infection which is why Cyclospora cayetanensis has been labeled as causing traveler's diarrhea. This species was placed in the Cyclospora genus because of the spherical shape of its sporocysts. The species name refers to the Cayetano Heredia University in Lima, Peru, where early epidemiological and taxonomic work was done.
Who is at highest risk?
People of all ages are at risk for infection. Persons living or traveling in tropical or subtropical regions may be at increased risk because cyclosporiasis is endemic in some developing countries. Foodborne outbreaks of cyclosporiasis in the United States and Canada have been linked to various types of imported fresh produce.
When to seek urgent medical care?
In case of endemic infection, people should seek medical care if watery diarrhea is noted.
Diagnosis
Health care providers should consider Cyclospora as a potential cause of prolonged diarrhea, particularly in patients with a history of recent travel to Cyclospora endemic areas. Testing for Cyclospora is not routinely done in most U.S. laboratories, even when stool is tested for parasites. Therefore, if indicated, health care providers should specifically request testing for Cyclospora. Cyclospora infection is diagnosed by examining stool specimens. Diagnosis can be difficult in part because even persons who are symptomatic might not shed enough oocysts in their stool to be readily detectable by laboratory examinations. Therefore, patients might need to submit several specimens collected on different days. Special techniques, such as acid-fast staining, are often used to make Cyclospora oocysts more visible under the microscope. In addition, Cyclospora oocysts are autofluorescent, meaning that when stool containing the parasites is viewed under an ultraviolet (UV) fluorescence microscope the parasite appears blue or green against a black background. Molecular diagnostic methods, such as polymerase chain reaction (PCR) analysis, are used to look for the parasite's DNA in the stool.[2]
Treatment options
Trimethoprim-sulfamethoxazole (TMP-SMX), or Bactrim, Septra, or Cotrim, is the treatment of choice. If allergic to Sulfa drugs, no other alternaive drug has yet been developed. The health care provider will be able to discuss other options for treatment. Most people who have healthy immune systems will recover without treatment. If not treated, the illness may last for a few days to a month or longer. Symptoms may seem to go away and then return one or more times (relapse). Antidiarrheal medicine may help reduce diarrhea, but a health care provider should be consulted before such medicine is taken. People who are in poor health or who have weakened immune systems may be at higher risk for severe or prolonged illness. If diarrhea is present it is recommended to drink plenty of fluids to prevent dehydration and take rest.
Where to find medical care for Cyclosporiasis?
Contact your primary care physician if symptoms are present, especially in the case of an epidemic infection.
What to expect (Outlook/Prognosis)?
The symptoms usually start within one week of ingestion of contaminated food and water. If left untreated, symptoms may persist for weeks and months. This infection is not life threatening and is rarely associated with complications. People living in endemic area might have asymptomatic infections.
Possible complications
Reported complications from Cyclospora infection are rare, but have included malabsorption and cholecystitis.
Prevention
The main preventive measure against Cyclosporiasis is to avoid unclean water and food, mainly fruits and vegetables that are contaminated with feces. People who got infected earlier can get infected again with Cyclospora and there are currently no vaccines for prevention of Cyclospora. Practice safe food and water habits while traveling abroad especially to endemic regions as preventive measures.
Sources
http://www.cdc.gov/parasites/cyclosporiasis/