Cyclosporiasis

Cyclosporiasis

Cyclosporiasis is an infection by a parasite called Cyclospora cayetensis which may bring no symptoms at all or may cause watery diarrhea and other symptoms that may require treatment as untreated cases may go into relapses. ^[1]

Epidemiology

Endemic sites determined are Haiti, Nepal, and Peru. Mortality is rare except for patients who are immunocompromised. Both genders are equally affected. In developing countries where the infection is endemic, most of the patients belong to the pediatric group. ^[2]

Causes

The parasite Cyclospora cayetensis is a microscopic round-to-ovoid organism that usually infects the small intestine. People frequently acquire the infection through accidental ingestion of contaminated food or water. ^[3] Direct person-to-person transmission is deemed impossible as the oocysts are not infectious when expelled from the body. Travel to endemic areas is considered a risk factor. ^[2]

Signs and Symptoms

The usual time between being infected and manifesting the symptoms is one week. The organism frequently affects the small intestine. The result is watery diarrhea with numerous, at times explosive, bowel movements. It is often malodorous and associated with other symptoms like abdominal pain, low grade fever, muscle ache, fatigue, bloating, nausea and vomiting. The diarrhea may last for days up to months and sometimes even longer. Symptoms may subside then relapse. People with weak immune system may have a prolonged course. ^{[2] [3]}

Diagnosis

The patient’s history is important to identify possible risk factors such as a recent travel to an endemic area or consumption of contaminated food or water. Physical examination may show signs of dehydration. A stool exam is needed to make a diagnosis of the infection. ^[4]

Treatment

The infection may go away spontaneously in a span of days up to two weeks. Supportive care is needed such as fluid and electrolyte replenishment to avoid dehydration. When diarrhea persists for 3 weeks and more, oral rehydration therapy or parenteral rehydration therapy may be required. The drug of choice is Trimethoprim-sulfamethoxazole (TMP-SMZ). To avoid the illness, people should avoid untreated water and unpeeled fruits and vegetables especially when travelling. Full recovery is expected for people with normally functioning immune system. Adequate treatment may sufficiently prevent relapses in immunocompromised patients.  ^[2]

References:

1.      http://www.rightdiagnosis.com/c/cyclosporiasis/

2.      http://emedicine.medscape.com/article/996978-overview#a0199

3.      http://www.cdc.gov/parasites/cyclosporiasis/gen_info/faqs.html

4.      http://www.health.ny.gov/diseases/communicable/cyclosporiasis/fact_sheet.htm

Public Discussion