Cyclospora

Aka: Cyclospora, Cyclosporiasis, Cyclospora cayetanensis

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