Cyclosporiasis epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2] Ammu Susheela, M.D. [3] Alejandro Lemor, M.D. [4]
Overview
Cyclosporiasis occurs in many countries, but the disease seems to be most common in tropical and subtropical regions. In areas where cyclosporiasis has been studied, the risk for infection is seasonal. However, no consistent pattern with respect to environmental conditions such as temperature or rainfall has been identified.
Epidemiology
- Cyclosporiasis is an intestinal illness caused by consuming food or water contaminated with the Cyclospora parasites.
- The major symptom is watery diarrhea lasting a few days to a few months. Additional symptoms may include loss of appetite, fatigue, weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting and a low fever. Symptoms may come and go multiple times over a period of weeks
- People become infected with Cyclospora by ingesting sporulated oocysts, which are the infective form of the parasites. This most commonly occurs when food or water contaminated with feces is consumed. An infected person sheds unsporulated (immature, non-infective) Cyclospora oocysts in the feces. The oocysts are thought to require days to weeks in favorable environmental conditions to sporulate and become infective. Therefore, direct person-to-person transmission is unlikely, as is transmission via ingestion of newly contaminated food or water.
- Cyclosporiasis occurs in many countries, but it seems to be most common in tropical and subtropical regions. In areas where Cyclosporiasis has been studied, the risk for infection is seasonal. However, no consistent pattern has been identified regarding the time of year or the environmental conditions, such as temperature or rainfall.
- In the United States, foodborne outbreaks of Cyclosporiasis since the mid-1990s have been linked to various types of imported fresh produce, including raspberries, basil, snow peas, and mesclun lettuce; no commercially frozen or canned produce has been implicated. U.S. cases of infection also have occurred in persons who traveled to Cyclospora-endemic areas. To reduce the risk for infection, travelers should take precautions. Travelers also should be aware that treatment of water or food with chlorine or iodine is unlikely to kill Cyclospora oocysts.
- Oocytes of Cyclospora has been isolated from stools of children and adults. They are found mainly in the stool of residents and travelers from developing countries like North central and South America, South east Asia, Australia, Carribean, Europe and Indian sub-continent.
- Outbreaks have been reported from North and South America and Nepal. 1996 outbreak reported 1465 cases in Canada and USA during spring and summer and some occassions where Raspberries have been served.
- Sporadic cases have been reported from many countries, in immunocompetent people with no prior travel history.
- They are also common in people with HIV
Molecular Epidemiology
The polymorphic area of the genome has been studied extensively as a part of investigation in their role in epidemiology. 18S rRNA has been used to differentiate Cyclospora from other parasites. The high sequence variability found in people in United states without a prior history of travel suggest an endemic focus for Cyclospora in United States.[1]
Outbreak of Cyclosporiasis in the United States in 2014
- On August 26, 2014, CDC had been notified of 304 ill persons with confirmed Cyclospora infection in 2014
- 207 out of the 304 ill persons from the following states had no history of international travel within two weeks before onset of illness: Arkansas, California, Connecticut, Florida, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, Pennsylvania, New Jersey, New York (and New York City), Texas, Virginia, Wisconsin, and Washington.
- Among 183 persons with available information, 7 (4%) have reported being hospitalized. No deaths have been reported.
Age
- Among 204 persons with available information, patients with Cyclosporiasis range in age from 3 to 88 years, with a median age of 49 years.
Gender
- Among 204 persons with available information, 115 (56%) patients with Cyclosporiasis are female.
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Outbreak of Cyclosporiasis in the United States in 2013
- On June 28, 2013, CDC was notified of 2 laboratory-confirmed cases of Cyclospora infection in Iowa residents who had become ill in June and did not have a history of international travel during the 14 days before the onset of illness.
- Since that date, CDC has been collaborating with public health officials in multiple states and the US Food and Drug Administration (FDA) to investigate an outbreak of cyclosporiasis. As of July 18, 2013, CDC has been notified of more than 200 cases of Cyclospora infection in residents of multiple states, including Iowa, Nebraska, Texas, and Wisconsin.
- Illinois has also notified CDC of one case that may have been acquired out of state.
- Most of the illness onset dates have ranged from mid-June through early July.
- At least 8 persons reportedly have been hospitalized.
- No food items have been implicated to date, but public health authorities are pursuing all leads.
- Previous outbreak investigations have implicated various types of fresh produce. It is not yet clear whether the cases from all of the states are part of the same outbreak.
- No common events (e.g., social gatherings) have been identified among the case patients.
Age
- Age ranges from less than 1 year to 94 years, with a median age of 52 years.
Gender
- Fifty-eight percent (58%) of patients with Cyclosporiasis were female.
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