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Home , Cyclosporiasis

CYCLOSPORIASIS FACT SHEET

Agent: cayetanensis is a coccidian presence of the parasite. For intestinal parasite parasite. testing, three consecutive day’s samples are needed due to the shedding pattern of the Brief Description: Cyclospora infections are charac- organisms. terized by watery , with frequent, sometimes explosive, stools. Other symptoms include loss of Diagnostic Testing: appetite, substantial weight loss, bloating, increased 1. Specimen Needed: Feces flatus, stomach cramps, nausea, fatigue, low-grade 2. Outfit: IP & PVA outfit fever and vomiting. Diarrhea may last 9-43 days in 3. Lab Form: #3414 otherwise healthy persons, but it may continue for 4. Lab Test Performed: Identification of months in immunocompromised persons. Asymp- Cyclospora tomatic and relapsing infections occur. Most reported 5. Laboratory: Parasitology, Georgia Public cases have occurred during spring and summer. Health Laboratory

Reservoir: Humans. It is unknown whether animals Comment: It is important that it be specified can be infected and pass infection to people. on the laboratory request that testing for Cyclospora is desired. Identification of this Mode of Transmission: Cyclospora may be trans- parasite in stool requires special laboratory mitted by ingestion of water or contaminated tests that are not done routinely. A single with oocysts. Infected persons excrete the oocyst negative stool specimen does not rule out the stage of Cyclospora in their stool. Oocysts are not diagnosis; three or more specimens may be infectious when first excreted and may require days to required. Stool specimens should also be weeks to become infectious. Thus, direct person-to- checked for other microbes that can cause a person transmission is unlikely. Outbreaks linked to similar illness. contaminated water and various types of fresh pro- duce have been reported. Food vehicles have in- Case Classification: cluded raspberries imported from Guatemala, basil, • Probable: A clinically compatible case that and lettuce. is epidemiologically linked to a confirmed case Incubation period: Median is about 1 week. • Confirmed: A case that is laboratory con- firmed Laboratory Criteria for Diagnosis: The diameter of Cyclospora oocysts is 8–10 :m, NOTE: For outbreaks associated with an event approximately twice that of Cryptosporidium (involving a confirmed case), a probable case parvum. Cyclospora oocysts can be identified in of cyclosporiasis may be defined as onset of stool by examination of wet mounts under phase illness from 1 to 14 days after the event and: microscopy, use of modified acid-fast stains, or a. A stool specimen with Cyclospora oocysts demonstration of autofluorescence with ultraviolet and at least one gastrointestinal symptom epifluorescence microscopy. These procedures are (i.e., loose or watery stools, nausea, vomit- not routine for most clinical laboratories. The Geor- ing, stomach cramps, gas/bloating, loss of gia Public Health Laboratory can confirm the diagno- appetite, or unintentional weight loss) or sis using a modified Kinyoun acid-fast stain and constitutional symptom (i.e., fever, chills, epifluorescence. Polymerase chain reaction (PCR) muscle aches, joint aches, generalized body may also be used if other methods cannot confirm the aches, headaches, or fatigue), or 27 b. Three or more loose stools in a 24-hour period the Epidemiology Branch as soon as possible. and at least one other GI symptom or constitu- tional symptom, or Reported Cases of Cyclosporiasis in Geor- c. A total of 4 or more GI symptoms. gia, 1993-2000

Period of Communicability: Year Number of Cases Although Cyclospora is transmitted by the fecal-oral 1993 0 route, direct person-to-person transmission is unlikely 1994 0 because Cyclospora oocysts are not infectious at the 1995 0 time of excretion. 1996 0 1997 0 Treatment: Trimethoprim/sulfamethoxazole (TMP/ 1998 0 SMX), or Bactrim, Septra, or Cotrim is effective. 1999 10 Patients with immunosuppression may require higher 2000 11 doses and long-term maintenance treatment. No alternative treatment regimen has been identified for References: patients who do not respond to or are intolerant of 1. Centers for Disease Control and Prevention. TMP/SMX. Case Definitions for Infectious Conditions under Public Health Surveillance. MMWR Investigation and Follow-Up: Ensure that ill per- 1997;46(No. RR-10):1-55. sons are aware of the Cyclospora diagnosis as soon 2. Centers for Disease Control and Prevention. as it is confirmed, so that their physicians can provide Outbreak of Cyclosporiasis — Northern appropriate treatment. Notify CDC when an outbreak Virginia-Washington, DC- Baltimore, is suspected, as it is possible that related outbreaks Maryland, Metropolitan Area, 1997. are occurring simultaneously in other states. Investi- MMWR 1997;46(30):689-691. gate cases to determine the possible source of infec- 3. Centers for Disease Control and Prevention. tion. Take note of seasonal produce originating from Outbreaks of Pseudo-Infection with a domestic or international location. Initiate Cyclospora and Cryptosporidium – Florida traceback on implicated food vehicle(s) through the and New York City, 1995. MMWR Food and Drug Administration (FDA). 1997;46(16):354-358. 4. Chin J, ed. Cyclosporiasis. In: Control of Reporting: Report single confirmed cases WITHIN Communicable Diseases Manual. 17th ed. 7 DAYS electronically through the State Electronic Washington, DC: American Public Health Notifiable Disease Surveillance System (SENDSS) at Association, 2000: 137-138. http://sendss.state.ga.us, or complete and mail a GA 5. Herwaldt BL. : A Notifiable Disease Report Form (#3095). IMMEDI- Review, Focusing on the Outbreaks of ATELY report any cluster of cyclosporiasis by Cyclosporiasis in the 1990s. Clinical telephone to the local health department, District Infectious Diseases 2000;31(4):1040-1057. Health Office, or the Epidemiology Branch at 404- 657-2588. If calling after hours, report cases to the Links: Epidemiology Branch answering service at 770-578- • CDC Cyclosporiasis Fact Sheet http:// 4104. If applicable, complete CDC form 52.13, www.cdc.gov/ncidod/dpd/parasites/ “Investigation of a Foodborne Outbreak,” and fax to cyclospora/default.htm 28