II. Pathophysiology
- Coccidian Parasite in Eimeriidae family
- Organism: Cyclospora cayetanensis
- Infects the Small Intestine in humans
- Transmission via Cyclospora oocyst ingestion
- Waterborne Illness
- Endemic to some tropical and subtropical regions
- Foodborne Illness
- Fresh produce (outbreaks in U.S. and Canada)
- Fecal-oral transmission is unlikely
- Oocysts sporulate (over days to weeks) outside a host before they are once again infective
- Waterborne Illness
- Incubation: 2-14 days (1 week on average)
III. Symptoms
IV. Labs
- Cyclospora PCR
-
Ova and Parasite (microscopy)
- Variable detection rates
- Modified acid fast stain or UV microscopy may improve Test Sensitivity
V. Management
- Trimethoprim-Sulfamethoxazole DS (Septra, Bactrim)
- Immunocompetent
- Dose: 1 DS tab twice daily for 7-10 days
- Immunodeficiency or HIV
- Initial: 1 DS tab four times daily for 3-4 weeks
- Suppression may be needed with 1 DS tab three times weekly
- Immunocompetent
- Other agents (variably effective)
- Ciprofloxacin 500 mg twice daily for 7 days
- Nitazoxanide
VI. Complications
- Reactive Arthritis (Reiter's Syndrome)
- Malabsorption
- Cholecystitis (HIV patients)
VII. Course
- Without treatment, may persist for months or follow a relapsing course
VIII. Resources
- CDC Cyclosporiasis
IX. References
- (2015) Sanford Guide to antimicrobials, accessed IOS app 5/11/2016
- Ortega (2010) Clin Microbiol Rev 23(1): 218-34 +PMID:20065331 [PubMed]