Cyclospora cayetanensis: diagnóstico de un coccidio poco frecuente en la Argentina / Cyclospora cayetanensis: diagnosis of a rare coccidium in Argentina

Resumen Cyclospora cayetanensis es un coccidio intestinal relacionado con brotes epidémicos debido al consumo de alimentos y agua contaminados con ooquistes esporulados. Predomina en regiones tropicales y subtropicales y puede causar síntomas gastrointestinales que son más graves en inmunocomprometidos, en los que puede causar infecciones extraintestinales. El diagnóstico se realiza por la observación microscópica de ooquistes que presentan un tamaño entre 8 y 10 micrones, refringentes y con glóbulos internos. Se confirma con coloración ácido resistente; los ooquistes se tiñen de color fucsia y tienen la capacidad de autofluorescer. En este informe se describe el diagnóstico de Cyclospora cayetanensis en un paciente inmunocomprometido, oriundo de Perú, que reside actualmente en un barrio vulnerable de la Ciudad de Buenos Aires. Este informe representaría el sexto caso diagnosticado en la Argentina.

Abstract Cyclospora cayetanensis is an intestinal coccidium related to epidemic outbreaks due to consumption of food and water contaminated with sporulated oocysts. It predominates in tropical and subtropical regions and may cause gastrointestinal symptoms which are more severe in immunocompromised patients, to whom it may cause extraintestinal infections. Diagnosis is made by the microscopic observation of oocysts between 8 and 10 microns in size, with refractile globules inside of them. This diagnosis is confirmed by acid-fast staining where oocysts are observed red-stained. With ultraviolet epifluorescence, they stand out as bright blue or green staining circles. The aim of this report is to communicate the diagnosis of C. cayetanensis in an immunocompromised patient, born in Peru, but currently living in a vulnerable neighbourhood of Buenos Aires city. To our knowledge, this would be the sixth case of C. cayetanensis diagnosed in Argentina.

Resumo Cyclospora cayetanensis é um coccídio intestinal relacionado com surtos epidêmicos devido ao consumo de alimentos e água contaminados com oocistos esporulados. Predomina nas regiões tropicais e subtropicais e pode provocar sintomas gastrointestinais mais graves em pacientes imunodeprimidos, nos quais pode causar infecções extraintestinais. O diagnóstico é feito através da observação microscópica de oocistos com tamanho entre 8 e 10 mícrons, refringentes e com glóbulos internos. O diagnóstico é confirmado com coloração ácido-resistente; os oocistos são tingidos de cor fúcsia e eles têm a capacidade de auto-fluorescer. Este relatório descreve o diagnóstico de Cyclospora cayetanensis em um paciente imunodeprimido, nativo do Peru, atualmente residindo em um bairro vulnerável da cidade de Buenos Aires. Este relatório representaria o sexto caso diagnosticado na Argentina.

Intestinal coccidian: an overview epidemiologic worldwide and Colombia / Coccidias Intestinales: Panorama epidemiológico mundial y en Colombia

Intestinal coccidia have been classified as protozoa of the Apicomplex phylum, with the presence of an intracellular behavior and adaptation to the habit of the intestinal mucosa, related to several parasites that can cause enteric infections in humans, generating especially complications in immunocompetent patients and opportunistic infections in immunosuppressed patients. Alterations such as HIV/AIDS, cancer and immunosuppression. Cryptosporidium spp., Cyclospora cayetanensis and Cystoisospora belli are frequently found in the species. Multiple cases have been reported in which their parasitic organisms are associated with varying degrees of infections in the host, generally characterized by gastrointestinal clinical manifestations that can be observed with diarrhea, vomiting, abdominal cramps, malaise and severe dehydration. Therefore, in this review a specific study of epidemiology has been conducted in relation to its distribution throughout the world and in Colombia, especially, global and national reports about the association of coccidia informed with HIV/AIDS. Proposed revision considering the needs of a consolidated study in parasitology, establishing clarifications from the transmission mechanisms, global and national epidemiological situation, impact at a clinical level related to immunocompetent and immunocompromised individuals, as well as a focus on public health in institutional government policies and scientific information based on the characterization of coccidia in the tropical region and Colombia.

Los coccidios intestinales se han clasificado como protozoos del Apicomplexa phylum, con presencia de un comportamiento intracelular y adaptación al hábito de la mucosa intestinal, relacionado con varios parásitos que pueden causar infecciones entéricas en los humanos, generando especialmente complicaciones en pacientes inmunocompetentes e infecciones oportunistas en pacientes inmunodeprimidos. Alteraciones como el VIH/SIDA, cáncer e inmunosupresión con tratamientos farmacológicos. En las especies que se encuentran frecuentemente se encuentran Cryptosporidium spp., Cyclospora cayetanensis y Cystoisospora belli. Se han reportado múltiples casos en los que sus organismos parásitos se asocian a diversos grados de infecciones en el huésped, generalmente caracterizadas por manifestaciones clínicas gastrointestinales que pueden observarse con diarrea, vómitos, calambres abdominales, malestar general y deshidratación severa. Por lo tanto, en esta revisión se ha realizado un estudio específico de epidemiología con relación a su distribución en todo el mundo y en Colombia, especialmente, reportes a nivel global y nacional a cerca de la asociación de coccidios informados con el VIH/SIDA. Revisión propuesta con el objetivo de considerar las necesidades de un estudio consolidado a nivel del campo de la parasitología, evidenciando literatura actualizada, estableciendo información de los mecanismos de transmisión, situación epidemiológica global y nacional, impacto a nivel clínico relacionadas con individuos inmunocompetentes e inmunocomprometidos, así como un enfoque en salud pública en políticas gubernamentales institucionales y la información científica basada en la caracterización de coccidias en la región tropical y principalmente en Colombia.

Aspectos epidemiológicos de coccidiosis intestinales en comunidad rural de la Península de Paraguaná, estado Falcón, Venezuela / Epidemiological aspects of intestinal coccidiosis in a rural community of Paraguaná peninsula, Falcon state, Venezuela

Resumen Introducción: Las coccidiosis intestinales ocasionadas por Cryptosporidium, Cystoisospora belli y entre abril- junio de 2015, se realizó un estudio prospectivo, descriptivo y transversal para Cyclospora cayetanensis constituyen patologías parasitarias de alta relevancia en la Salud Pública. Objetivo: Determinar la prevalencia y parámetros epidemiológicos de coccidiosis intestinales en 188 habitantes de "El Hato", Estado Falcón, Venezuela. Metodología: Para la identificación de los probables factores de riesgos asociados a las coccidiosis intestinales se usó una ficha encuesta-epidemiológica. El diagnóstico parasitológico se realizó con el método directo y la coloración de Kinyoun. Resultados: La prevalencia global de parasitosis intestinales fue 64,36%, siendo Blastocystis spp. el taxón más frecuentemente observado (39,89%). La prevalencia de coccidios intestinales fue 37,23%, observándose prevalencias de 32,98% para Cyclospora cayetanensis, 26,60% para Cryptosporidium spp. y 3,19% para Cystoisospora belli. Con la aplicación del análisis de regresión logística múltiple se determinó como potenciales factores de riesgo independientes significativamente involucrados en la transmisión de las entero-coccidiosis: lavado inadecuado de manos [Odds Ratio (OR) = 1,89], el consumo de "comidas rápidas" (OR=1,26), empleo del agua más frecuentemente para aseo personal y lavado de vestimentas (OR=2,88), tener un nivel socio-económico bajo (nivel IV/V-Graffar) (OR=1,41), nivel de instrucción de la madre (primaria/secundaria) (OR=0,53), que se realice limpieza del hogar interdiario (OR=2,95), y que se posea animales (OR=2,06). Conclusiones: Los hallazgos de esta investigación muestran que las infecciones ocasionadas por los coccidios intestinales aun representan un problema de salud pública en las áreas rurales de Venezuela.

Abstract Introduction: Intestinal coccidioses caused by Cryptosporidium sp., Cystoisospora belli and Cyclospora cayetanensis are parasitic diseases of major clinical importance in Public Health. Objective: Between April to June 2015, a prospective, descriptive and cross-sectional survey was designed to determine the prevalence and epidemiological profiles of intestinal coccidioses in 188 inhabitants of "El Hato", Falcon State, Venezuela. Methods: Probable risk factors for intestinal coccidioses were identified by using epidemiological questionnaires. The diagnosis of coccidian infection was made by direct wet-mounting and Kinyoun staining. Results: The overall prevalence of intestinal parasitosis was 64.36%, and Blastocystis spp. was the most prevalent taxa (39.89%). Enterococcidioses prevalence was 37.23%, detecting prevalence values of 32.98% for Cyclospora cayetanensis, 26.60% for Cryptosporidium spp. and 3.19% for Cystoisospora belli. Multiple logistic regression analysis allowed us to determine as independent potential risk factors for transmission of these enterococciodioses: inappropriate hand washing [Odds Ratio (OR) = 1.89], fast food consumption (OR=1.26), major use of water for personal and clothes washing (OR=2.88), low socio-economic status (level IV/V-Graffar) (OR=1.41), mother's educational status (primary/secondary school) (OR=0.53), non-daily home cleaning (OR=2.95), and keeping domestic animals (OR=2.06). Conclusions: Findings of this study showed that infections caused by intestinal coccidian infections are still remains as a serious health problem in rural areas of Venezuela.

Development of Molecular Diagnosis Using Multiplex Real-Time PCR and T4 Phage Internal Control to Simultaneously Detect Cryptosporidium parvum, Giardia lamblia, and Cyclospora cayetanensis from Human Stool Samples

This study aimed to develop a new multiplex real-time PCR detection method for 3 species of waterborne protozoan parasites (Cryptosporidium parvum, Giardia lamblia, and Cyclospora cayetanensis) identified as major causes of traveler's diarrhea. Three target genes were specifically and simultaneously detected by the TaqMan probe method for multiple parasitic infection cases, including Cryptosporidium oocyst wall protein for C. parvum, glutamate dehydrogenase for G. lamblia, and internal transcribed spacer 1 for C. cayetanensis. Gene product 21 for bacteriophage T4 was used as an internal control DNA target for monitoring human stool DNA amplification. TaqMan probes were prepared using 4 fluorescent dyes, FAM™, HEX™, Cy5™, and CAL Fluor Red® 610 on C. parvum, G. lamblia, C. cayetanensis, and bacteriophage T4, respectively. We developed a novel primer-probe set for each parasite, a primer-probe cocktail (a mixture of primers and probes for the parasites and the internal control) for multiplex real-time PCR analysis, and a protocol for this detection method. Multiplex real-time PCR with the primer-probe cocktail successfully and specifically detected the target genes of C. parvum, G. lamblia, and C. cayetanensis in the mixed spiked human stool sample. The limit of detection for our assay was 2×10 copies for C. parvum and for C. cayetanensis, while it was 2×10³ copies for G. lamblia. We propose that the multiplex real-time PCR detection method developed here is a useful method for simultaneously diagnosing the most common causative protozoa in traveler's diarrhea.

Cyclospora cayetanensis infections among diarrheal outpatients in Shanghai: a retrospective case study / 医学前沿

Cyclospora cayetanensis is a foodborne and waterborne pathogen that causes endemic and epidemic human diarrhea worldwide. A few epidemiological studies regarding C. cayetanensis infections in China have been conducted. During 2013, a total of 291 stool specimens were collected from patients with diarrhea at a hospital in urban Shanghai. C. cayetanensis was not detected in any of the stool specimens by traditional microscopy, whereas five stool specimens (1.72%, 5/291) were positive by PCR. These positive cases confirmed by molecular technology were all in the adult group (mean age 27.8 years; 2.94%, 5/170) with watery diarrhea. Marked infection occurred in the rainy season of May and July. Sequence and phylogenetic analyses of the partial 18S rRNA genes of C. cayetanensis isolated showed intra-species diversity of this parasite. This study showed, for the first time, that C. cayetanensis is a pathogen in outpatients with diarrhea in Shanghai, albeit at a low level. However, the transmission dynamics of this parasite in these patients remain uncertain.

Simultaneous Molecular Detection of Cryptosporidium and Cyclospora from Raw Vegetables in Korea

Cryptosporidium and Cyclospora are well-known coccidian protozoa that can cause waterborne and foodborne diarrheal illnesses. There have been a few reports regarding contamination in different vegetables with Cryptosporidium, but no data are available regarding the sources of Cyclospora infections in Korea. In the present study, we collected 6 kinds of vegetables (perilla leaves, winter-grown cabbages, chives, sprouts, blueberries, and cherry tomatoes) from July 2014 to June 2015, and investigated contamination by these 2 protozoa using multiplex quantitative real-time PCR. Among 404 vegetables, Cryptosporidium and Cyclospora were detected in 31 (7.7%) and 5 (1.2%) samples, respectively. In addition, Cryptosporidium was isolated from all 6 kinds of vegetables, whereas Cyclospora was detected in 4 kinds of vegetables (except perilla leaves and chives). Cryptosporidium (17.8%) and Cyclospora (2.9%) had the highest detection rates in chives and winter-grown cabbages, respectively. Cryptosporidium was detected all year long; however, Cyclospora was detected only from October to January. In 2 samples (sprout and blueberry), both Cryptosporidium and Cyclospora were detected. Further investigations using TaqI restriction enzyme fragmentation and nested PCR confirmed Cryptosporidium parvum and Cyclospora cayetanensis, respectively. In conclusion, we detected C. cayetanensis in vegetables for the first time in Korea. This suggests that screening should be employed to prevent these protozoal infections in Korea.

Primer reporte de Cyclospora cayetanensis en una comunidad indígena Kariña del municipio Sucre, estado Sucre, Venezuela / First report of Cyclospora cayetanensis in an indigenous Kariña A community in Sucre state, Venezuela

Cyclospora cayetanensis es un protozoario emergente, considerado un patógeno importante causante de diarrea endémica y epidémica en niños y adultos en todo el mundo. En el estado Sucre, son escasas las investigaciones dedicadas al diagnóstico de los coccidios intestinales y se desconocen los aspectos epidemiológicos asociados con estos parásitos. En este sentido, se realizó un estudio en la comunidad indígena Kariña de Piñantal, estado Sucre, Venezuela, con la finalidad de determinar la prevalencia de las enteroparasitosis haciendo énfasis en los coccidios intestinales. Para ello, se recolectaron 141 muestras fecales de individuos de ambos géneros con edades comprendidas entre 0 y 60 años. El diagnóstico parasitológico se realizó mediante el examen directo, técnica de filtración de formol al 5%, dicromato de potasio al 2,5%, coloración de Kinyoun y micrometría ocular. La prevalencia de enteroparasitosis fue de 82,98%, destacándose el cromista Blastocystis spp. (60,80%), Endolimax nana (24,70%) y Ascaris lumbricoides (25,53%). De los coccidios intestinales evaluados, sólo se encontró Cyclospora cayetanensis (10%), resultando los individuos menores de 20 años los más afectados (85,71%); esta alta prevalencia de C. cayetanensis refleja precarias condiciones de vida asociadas con insalubridad y falta de educación en la población indígena Kariña. De los individuos con ciclosporiosis, sólo el 36% presentó diarrea y el 64% restante resultaron portadores asintomáticos, lo que representa un riesgo epidemiológico que debe ser tomado en cuenta por los organismos sanitarios competentes para la implementación del diagnóstico de coccidios de forma rutinaria, contribuyendo así a la prevención de brotes.

Cyclospora cayetanensis is an emerging protozoan pathogen considered as a major cause of endemic and epidemic diarrhea in children and adults worldwide. In Sucre state, Venezuela, few investigations have focused on the diagnosis of intestinal coccidia, and the epidemiological aspects associated with these intestinal parasites are unknown. The prevalence of enteroparasitosis, in particular intestinal coccidian, was studied in an indigenous Kariña community in Piñantal, Sucre state, Venezuela. A total of 141 fecal specimens were collected from individuals of both sexes, aged between 0 and 60 years. Parasitological diagnosis was done by direct examination, filtration technique with 5% formalin, 2.5% potassium dichromate, Kinyoun stain and ocular micrometry. The total prevalence of intestinal parasites was 82.98% with the chromista Blastocystis spp. (60.8%), Endolimax nana (24.7%) and Ascaris lumbricoides (25.53%), being the most abundant species. Of the evaluated intestinal coccidia, only Cyclospora cayetanensis (10%) was found, with individuals under 20 years old being the most affected (85.71%). The high prevalence of C. cayetanensis reflects inadequate living conditions associated with poor health and a lack of education among the indigenous Kariña population. Of the individuals infected with Cyclosporiosis, only 36% had diarrhea and the remaining 64% were asymptomatic carriers, these latter representing an epidemiological risk. This should be taken into account by the competent health authorities and the diagnosis of coccidia conducted routinely in order to reduce outbreaks.

Multiplex-Touchdown PCR to Simultaneously Detect Cryptosporidium parvum, Giardia lamblia, and Cyclospora cayetanensis, the Major Causes of Traveler's Diarrhea

This study aimed to develop a multiplex-touchdown PCR method to simultaneously detect 3 species of protozoan parasites, i.e., Cryptosporidium parvum, Giardia lamblia, and Cyclospora cayetanensis, the major causes of traveler’s diarrhea and are resistant to standard antimicrobial treatments. The target genes included the Cryptosporidium oocyst wall protein for C. parvum, Glutamate dehydrogenase for G. lamblia, and 18S ribosomal RNA (18S rRNA) for C. cayetanensis. The sizes of the amplified fragments were 555, 188, and 400 bps, respectively. The multiplex-touchdown PCR protocol using a primer mixture simultaneously detected protozoa in human stools, and the amplified gene was detected in >1×10³ oocysts for C. parvum, >1×10⁴ cysts for G. lamblia, and >1 copy of the 18S rRNA gene for C. cayetanensis. Taken together, our protocol convincingly demonstrated the ability to simultaneously detect C. parvum, G. lamblia, and C. cayetanenesis in stool samples.

<i>Cyclospora</i> Infection among School Children in Kathmandu, Nepal: Prevalence and Associated Risk Factors

Background: The intestinal coccidian protozoa <i>Cyclospora cayetanensis</i> has emerged as an important cause of parasitic diarrhea among children living in developing countries. This study aimed to determine the prevalence of <i>Cyclospora</i> among the school children of Kathmandu with reference to various associated risk factors.Methodology: A total of five hundred and seven stool samples from students between the age of 3–14 years, studying in 13 different schools in Kathmandu were collected during the study period (May–November, 2014) and processed at the Public Health Research Laboratory, Institute of Medicine, Kathmandu, Nepal. A modified acid fast staining technique (Kinyoun’s method) was used to detect oocyst of <i>Cyclospora</i> from the formal-ether concentrated stool samples.Results: <i>Cyclospora</i> was detected in 3.94% (20/507) of the stool samples examined. The prevalence was found to be highest among the students in the 3–5 year age group i.e. 10.15% (13/128), peaking during the rainy season (June–August). The detection rate was found to be significantly higher (p < 0.05) among children presenting with diarrheal symptoms, household keeping livestock and consumers of raw vegetables/fruits, showing a prevalence of 10.57% (11/104), 10.11% (9/89) and 7.25% (14/193) respectively.Conclusion: Consumption of untreated drinking water, fresh produce (raw fruits/vegetables) without proper washing and the presence of livestock at home were found to be predisposing factors for higher susceptibility of infection due to <i>Cyclospora</i>. This finding confirms the existence of a public-health issue with potentially serious consequences whereby children can be infected through exposure to oocysts in contaminated food and water and get ill as a result.

Cyclospora cayetanensis: Un coccidio emergente / Cyclospora cayetanensis: An emerging coccidian / Cyclospora cayetanensis: Um coccídio emergente

Cyclospora cayetanensis es un protozoo coccidio con diversa prevalencia a nivel mundial que causa cuadros con diarrea acuosa y voluminosa tanto en pacientes inmunocompetentes como inmunocomprometidos. En estos últimos, además de producir cuadros entéricos más severos, puede cursar con compromisos biliares. Su distribución es cosmopolita, jugando un rol importante en su transmisión, el suelo, el agua y los alimentos contaminados, especialmente las verduras ingeridas crudas. El hombre, único reservorio constatado hasta el presente, elimina con las heces ooquistes inmaduros, que evolucionan en el ambiente transformándose en ooquistes maduros infectivos. Como otros coccidios, presenta un ciclo evolutivo complejo con formas sexuada y asexuada de reproducción en un único hospedador. El diagnóstico se basa fundamentalmente en el hallazgo de ooquistes ácido alcohol resistentes variables en materia fecal. Se han desarrollado métodos moleculares para su detección tanto en muestras fecales como ambientales y de alimentos.

Cyclospora cayetanensis is a coccidian protozoon with several prevalence worldwide that causes watery and voluminous diarrhea conditions both in immunocompetent and immunocompromised patients. In the latter, apart from originating more severe enteric diseases, it can occur with billiary involvement. Its distribution is cosmopolitan, with soil, water and contaminated food, especially consumption of raw vegetables, playing an important role in its transmission. Man, the only reservoir recorded so far, eliminates immature oocytes in feces, which evolve in the environment becoming infective- mature oocytes. Like other coccidians, it presents a complex evolutionary cycle with sexed and unsexed forms of reproduction in a single host. Diagnosis is mainly based on findings of variable acid-alcohol resistant variables in feces. Molecular methods have been developed for its detection in fecal samples and in environmental and food samples as well.

Cyclospora cayetanensis é um protozoo coccídio com diversa prevalência em nível mundial que causa quadros com diarreia aquosa e volumosa tanto em pacientes imunocompetentes como imunocomprometidos. Nestes últimos, além de produzir quadros entéricos mais severos, pode cursar com compromissos biliares. Sua distribuição é cosmopolita, tendo um papel importante na sua transmissão o solo, a água e os alimentos contaminados, especialmente as verduras ingeridas cruas. O homem, único reservatório constatado até o presente, elimina com as fezes oocistos imaturos, que evoluem no ambiente transformando-se em oocistos maduros infectivos. Como outros coccídios apresenta um ciclo evolutivo complexo com formas sexuada e assexuada de reprodução num único hospedeiro. O diagnóstico se baseia fundamentalmente no achado de oocistos ácido-álcool resistentes variáveis em matéria fecal. Foram desenvolvidos métodos moleculares para sua detecção tanto em amostras fecais quanto ambientais e de alimentos.

Reporte de cinco casos de cyclosporiosis en un centro penitenciario en Venezuela / Cyclosporiosis five cases report in Venezuelan penitentiery center

Cyclospora cayetanensis, es un protozoario intestinal humano, productor de diarrea en individuos inmunocompetentes e inmunocomprometidos. La transmisión ocurre por ingestión de ooquistes que han esporulado en el ambiente. La transmisión del parásito ocurre a través de un vehículo ambiental. En los países en vías de desarrollo, la ciclosporiosis se ha relacionado con el agua y los alimentos contaminados, contacto con la tierra o animales, y variables asociadas con bajas condiciones socioeconómicas. En junio de 2004 se realizó un estudio parasitológico en un centro pe nitenciario en Venezuela, donde se presentaron varios casos con diarrea. A 7 personas del sexo masculino, con edades entre 19-39 años y con diarrea de 2 a 10 días de du ración, se les realizó examen de heces con S.S. 0,85%, lugol, Quesel, Sudán III, ziehl Neelsen, Micrometría y Esporulación en K2Cr2O4 2,5%. Se encontró ooquistes de C. cayetanensis en 5 (71, 42%) y huevos de Ancylos tomídeos en 1 (14,3%). El número de casos, en los cuales se observó C. cayetanensis, en individuos con diarrea, en este centro penitenciario en Venezuela, resulta muy llamativo en virtud de ser este un microorganismo de baja prevalencia a escala mundial y nacional. No obstante, las condiciones de hacinamiento y probablemente medidas higiénicas inadecuadas, tanto en las áreas físicas como en la conservación y manipulación del agua y alimentos, favorecen la transmisión de parásitos que ocasionan diarrea. Lo cual demuestra, la necesidad de establecer medidas de control y educación sanitaria a los manipuladores de alimentos, para evitar la transmisión y aparición de diarrea por diversos agentes infecciosos entre estas poblaciones.

Cyclospora cayetanensis is a human intestinal protozoan, causing diarrhea in immunocompetent and immunocompromised individuals. Transmission occurs by ingestion of oocysts that have sporulated in the environment. In developing countries, ciclosporosis has been associated with contaminated food and water, contact with soil or animals and low socioeconomic conditions. In June 2004, a parasitological survey in a venezuelan prison in, where several diarrhea cases appeared. All seven (7) people were male, age ranging 19-39 year-old with diarrhea during between 2 and 10 days; they were evaluated by stool examination with ss 0,85%, iodine, quensel, sudan III, ziehl Neelsen stain/mi - crometry and sporulation in K2Cr2O4 2,5%. C. cayetanensis oocysts were found in 5 (71,42%) and hookworm eggs in one (14,3%). The number of diarrhea cases at this prison in Venezuela in which C. cayetanensis was observed, is very striking, knowing the premise for this microorganism to be global and regional low prevalent protozoan. However, overcrowding and poor hygienic measures, probably both, in the physical areas and in the storage and food/water handling, contribute to diarrhea-causing parasites transmission. This shows the need to implement control measures and health education for food handlers to prevent transmission and diarrhea outbreaks caused by infectious agents among this population.

Infection of Cyclospora cayetanensis in Diarrhoeal Children of Nepal.

Introduction: Cyclospora cayetanensis is a coccidian parasite that causes recurrent gastroenteritis among children living under poor sanitary condition and adults from industrialized countries who lived or traveled in endemic developing countries. Methods: A total of 1842 stool specimens from gastroenteritis patients were examined between March 2006 to February 2007 and collected various types of faecal specimens from human, animals and samples of water and green leafy vegetables. Results: Of 1842 stool specimens collected from different areas of Nepal, 146 (7.9 %) were found to be positive for Cyclospora cayetanensis. with the majority were from children 2-9 years of age. The highest rate of infections was found in the month of June; (31.6%). Cyclospora cayetanensis were found to be contaminated in green vegetables including leaves of basil, mint leaves, water sources and feces of domestic animals and these findings were presented in the paper. Conclusion: Cyclospora-like oocysts were detected in vegetables leaves, feces of domestic animals and water sources. The results suggest that water, vegetables and domestic animals are possible sources of infection in Nepal. The study also obtained more information on Cyclospora cayetanensis a coccidian parasite that infect humans especially children and causes prolonged diarrhea and life threatening infestation.

Infección por Cyclospora cayetanensis: Revisión a propósito de tres casos de diarrea del viajero / Cyclospora cayetanensis infection: Updated review a propos of three cases of traveler's diarrhea

Human infection by Cyclospora cayetanensis, namely cyclosporiasis, can cause a wide range of symptoms in immunocompetent patients, from mild to severe diarrhea. Immunocompromised patients can present with chronic diarrhea and it has been recognized as a cause of traveler's diarrhea. We report three patients who traveled from Chile to Peru, who presented upon returning with prolonged traveler's diarrhea. A literature review about cyclosporiasis is presented, with emphasis on the clinical, epidemiological, diagnostic and therapeutic aspects of this disease.

AIDS - associated parasitic diarrhoea.

Since the advent of human immunodeficiency virus infection, with its profound and progressive effect on the cellular immune system, a group of human opportunistic pathogens has come into prominence. Opportunistic parasitic infection can cause severe morbidity and mortality. Because many of these infections are treatable, an early and accurate diagnosis is important. This can be accomplished by a variety of methods such as direct demonstration of parasites and by serological tests to detect antigen and/or specific antibodies. However, antibody response may be poor in these patients and therefore immunodiagnostic tests have to be interpreted with caution. Cryptosporidium parvum , Isospora belli , Cyclospora cayetanensis , Microsporidia, Entamoeba histolytica and Strongyloides stercoralis are the commonly detected parasites. Detection of these parasites will help in proper management of these patients because drugs are available for most of these parasitic infections.

Cyclospora cayetanensis: revisión de cuatro casos clínicos / Cyclospora cayetanensis: review of four clinical cases

Cyclospora cayetanensis es un protozoario coccidio que afecta el intestino delgado del ser humano. Es el agente causal de la ciclosporiasis, una enfermedad que se caracteriza por una diarrea profusa que conlleva a ausentismo laboral temporal y que en algunos casos, de acuerdo a su severidad y al estado inmune del paciente, puede llevar incluso a la muerte. A cyclospora cayetanensis se le ha considerado desde inicios de los años noventa como responsable de una serie de brotes diarreicos asociados con agua y alimentos, especialmente en los Estados Unidos y Canadá. En Costa Rica son pocos los casos reportados de estas parasitosis en el laboratorio clínico, y el parásito es considerado aún por muchos profesionales como un organismo exótico. En este trabajo se presentan cuatro casos clínicos de ciclosporiasis, atendidos en un período de 15 días en lña Clínica Dr. Marcial Fallas, en el cantón de Desamparados. Se hace una revisión de las características de Cyclospora cayetanensis y se insiste en la necesidad de considerar a este parásito como posible agente causal de diarreas de origen abrupto.

Cyclospora cayetanensis is a coccidian protozoan which attaches the small intestine of the human being. It is the etiological agent of cyclosporiasis, a disease characterized by profuse diarrhea that leads to temporary sick leave and in some cases, depending on the severity of the illness and the immunologic condition of the patient, may lead to death. Since the 90’s Cyclospora cayetanensis has been considered responsible for a series of diarrheic outbreaks related to food and water, especially in USA and Canada. In Costa Rica few cases of this parasitosis have been reported in the clinical laboratory, and this parasite is still considered by many healthcare professionals as an exotic organism. This work presents four clinical cases of cyclosporiasis detected throughout...

Diagnóstico laboratorial da Cycçospora cayetanensis / Laboratory diagnosis of Cyclospora cayetanensis

Cyclospora cayetanensis, coccidio protista é uma protozoário patogênico para o homem. A ciclosporose é caracterizada por moderada à severa fadiga, náuseas, anorexia, mialgia, perda de peso e intensa diarréia. Durante os últimos anos, a ciclosporose tem sido descrita em vários surtos de diarréia na América Central e América do Sul e no Caribe, Africa, Bangladesh, no sul e oeste da Ásia, Austrália, Inglaterra e Europa oriental. As rotas de transmissão ainda são desconhecidas, entretanto, provavelmente a principal é a fecal-oral, como também diretamente ou via água. O mais recente surto de ciclosporose nos Estados Unidos da América do Norte sugere a transmissão de Cycl cayetanensis pela ingestão de frutas frescas contaminadas e importadas da América Central. Devido às limitações do exame microscópico de preparações a fresco, vários métodos de coloração favorecem o diagnóstico de Cycl. cayetanensis. Os oocistos de Cyclospora são diagnosticados pela coloração de preparações fixadas e coradas pelos derivados de Ziehl-Neelsen pela safranina modificada, pela autofluorescência (ação da luz ultravioleta - UV) e pela utilização da reação em cadeia da polimerase (PCR). As variações da coloração de Ziehl Neelsen não são tão eficazes para essa espécie como para outros coccicios intestinais (Cryptosporidium parvum e Isospora belli). A Cycl cayetanensis exibe uma alta variabilidade de coloração e alguns coccidios intestinais não são visualizados. Entretanto, foram obtidas colorações uniformes dos oocistos desse organismo pela modificação do método da safranina pelo aquecimento no forno de microondas. Os oocistos não são esporulados quando excretados nas fezes. Cada oocisto esporulado contém dois esporocistos e cada esporocisto contém dois esporozoítos.

Prevalence Survey on Cyclospora cayetanensis and Cryptosporidium ssp. in Diarrhea Cases in Yunnan Province / 中国寄生虫学与寄生虫病杂志

Objective To investigate the prevalence and distribution characteristics of Cyclospora cayetanensis and Cryptosporidium ssp. infection in diarrhea cases of Yunnan Province. Methods To collect fresh faeces from diarrhea cases in 7 counties/cities, examine the specimens by direct smear with iodine staining and modified acid-fast staining. Results The infection rate of C. cayetanensis and Cryptosporidium ssp. was 3.97% and 5.29%, respectively. The infection rate of the two pathogenic coccidians was as high as 10.64% and 8.51% in preschool children. C. cayetanensis was found in 3 counties and Cryptosporidium in 6 counties. Conclusion Both C. cayetanensis and Cryptosporidium ssp. are prevalent in Yunnan Province with the latter distributed more widely, and the two pathogens are more prevalent in preschool children.