Cyclosporiasis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Joseph Nasr, M.D.[2]; Kalsang Dolma, M.B.B.S.[3] Alejandro Lemor, M.D. [4]
Overview
Cyclosporiasis is an intestinal infection caused by the coccidian protozoan parasite Cyclospora cayetanensis. Infection occurs after ingestion of sporulated oocysts in food or water contaminated with feces. Symptoms typically begin approximately 1 week after exposure, although the incubation period may range from several days to 2 weeks or longer.[1][2]
The characteristic manifestation is prolonged or relapsing watery diarrhea. Other common manifestations include loss of appetite, weight loss, abdominal cramping, bloating, abdominal distension, flatulence, nausea, fatigue, headache, myalgia, and low-grade fever. Vomiting may occur but is less common.[2][3]
Clinical illness may be more severe or prolonged in infants, young children, elderly patients, and immunocompromised individuals, including patients with advanced HIV infection and organ transplant recipients.[2][4]
History
The clinical history should assess the timing and character of diarrhea, recent travel, food and water exposures, outbreak exposure, and conditions associated with immunosuppression.
- The incubation period averages approximately 1 week. Symptoms may begin from several days to 2 weeks or longer after ingestion of sporulated oocysts.[1][2]
- Watery diarrhea is the most common manifestation and may be frequent, severe, prolonged, or relapsing.[2][3]
- Patients should be asked about consumption of fresh produce, including leafy vegetables and herbs such as lettuce, basil, and cilantro. Other produce-associated outbreaks have involved raspberries, snow peas, and prepackaged salad mixtures.[1][5]
- The history should assess recent travel to tropical or subtropical regions where cyclosporiasis is endemic. However, many cases in non-endemic countries are associated with domestically acquired foodborne outbreaks and occur without international travel.[5]
- Without treatment, symptoms may persist for days to weeks, a month or longer, and occasionally months. Diarrhea and other symptoms may remit and relapse.[2][6]
- Severe, chronic, or relapsing disease is more likely in patients with advanced HIV infection or other substantial immunosuppression.[7]
Symptoms
Patients with cyclosporiasis may remain asymptomatic, especially individuals living in endemic areas. Previously unexposed travelers and individuals affected during foodborne outbreaks may develop more clinically apparent illness.[2]
Symptoms include:
- Watery diarrhea
- Abdominal cramping or abdominal pain
- Anorexia
- Weight loss
- Bloating or abdominal distension
- Flatulence
- Nausea
- Fatigue
- Headache
- Myalgia
- Vomiting
- Low-grade fever
Complications
Complications are uncommon but may occur with severe, prolonged, or inadequately treated illness.
- Dehydration and electrolyte imbalance
- Weight loss, malabsorption, and nutritional impairment due to prolonged small-intestinal disease[8]
- Biliary tract disease, including acalculous cholecystitis, predominantly reported in patients with advanced HIV infection[7][9]
- Rare reported extraintestinal manifestations, including reactive arthritis, inflammatory oligoarthritis, Guillain-Barré syndrome, ocular inflammation, and sterile urethritis[10][11][2]
Prognosis
Cyclosporiasis is generally not life-threatening, particularly in immunocompetent patients. Most patients recover without permanent sequelae; however, untreated illness may be prolonged and relapsing.[6][2]
The principal morbidity is related to persistent diarrhea, dehydration, electrolyte abnormalities, weight loss, malabsorption, and prolonged fatigue. Infants, elderly patients, and immunocompromised individuals are at increased risk of severe or prolonged disease.[2][4]
Patients with advanced HIV infection or other substantial immunosuppression may develop chronic, recurrent, or extraintestinal disease, including severe wasting, malabsorption, or biliary tract involvement.[7]
References
- ↑ 1.0 1.1 1.2 Herwaldt BL, Ackers ML (1997). "An outbreak in 1996 of cyclosporiasis associated with imported raspberries. The Cyclospora Working Group". N Engl J Med. 336 (22): 1548–1556. doi:10.1056/NEJM199705293362202. PMID 9164810.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 Giangaspero A, Gasser RB (2019). "Human cyclosporiasis". Lancet Infect Dis. 19 (7): e226–e236. doi:10.1016/S1473-3099(18)30789-8.
- ↑ 3.0 3.1 Fleming CA, Caron D, Gunn JE, Barry MA (1998). "A foodborne outbreak of Cyclospora cayetanensis at a wedding: clinical features and risk factors for illness". Arch Intern Med. 158 (10): 1121–1125. PMID 9605784.
- ↑ 4.0 4.1 Almeria S, Cinar HN, Dubey JP (2019). "Cyclospora cayetanensis and cyclosporiasis: an update". Microorganisms. 7 (9): 317. doi:10.3390/microorganisms7090317.
- ↑ 5.0 5.1 Casillas SM, Hall RL, Herwaldt BL (2019). "Cyclosporiasis surveillance—United States, 2011-2015". MMWR Surveill Summ. 68 (3): 1–16. doi:10.15585/mmwr.ss6803a1.
- ↑ 6.0 6.1 Centers for Disease Control and Prevention. "Clinical Overview of Cyclosporiasis". Retrieved July 10, 2026.
- ↑ 7.0 7.1 7.2 Sifuentes-Osornio J, Porras-Cortés G, Bendall RP, Morales-Villarreal F, Reyes-Terán G, Ruiz-Palacios GM (1995). "Cyclospora cayetanensis infection in patients with and without AIDS: biliary disease as another clinical manifestation". Clin Infect Dis. 21 (5): 1092–1097. doi:10.1093/clinids/21.5.1092. PMID 8589126.
- ↑ Ortega YR, Nagle R, Gilman RH, Watanabe J, Miyagui J, Quispe H; et al. (1997). "Pathologic and clinical findings in patients with cyclosporiasis and a description of intracellular parasite life-cycle stages". J Infect Dis. 176 (6): 1584–1589. PMID 9395371.
- ↑ de Górgolas M, Fortés J, Fernández Guerrero ML (2001). "Cyclospora cayetanensis cholecystitis in a patient with AIDS". Ann Intern Med. 134 (2): 166. PMID 11177324.
- ↑ Richardson RF, Remler BF, Katirji B, Murad MH (1998). "Guillain-Barré syndrome after Cyclospora infection". Muscle Nerve. 21 (5): 669–671. PMID 9572253.
- ↑ Connor BA, Johnson EJ, Soave R (2001). "Reiter syndrome following protracted symptoms of Cyclospora infection". Emerg Infect Dis. 7 (3): 453–454. doi:10.3201/eid0703.010317. PMC 2631790. PMID 11384527.