Intestinal apicomplexan parasitoses among a hospital-based population in Honduras, 2013-2019 / Parasitosis por Apicomplexa intestinales en población hospitalaria en Honduras, 2013-2019

Abstract | Introduction: Intestinal apicomplexa protozoa are a recognized cause of gastroenteritis. They are endemic in Honduras and their epidemiology varies in different population groups. Objective: To identify risk factors for cyclosporiasis, cryptosporidiosis, and cystoisosporiasis. Materials and methods: We conducted a case-control study in a hospital-based population. We performed the diagnosis using the modifed Ziehl-Neelsen staining technique and collected the information from laboratory records and clinical charts. Results: Cyclosporiasis was associated with diarrhea (OR=2.28; 95%CI: 1.10-4.89), weight loss (OR=12.7; 95%CI: 2.49-122.00), watery stools (OR=2.42; 95%CI: 1.26-4.65), and infection with another protozoan (OR=3.13; 95%CI: 1.66-5.95). Cryptosporidiosis was associated with HIV infection (OR=15.43; 95%CI: 3.34-71.22), diarrhea (OR=3.52; 95%CI: 1.40-9.40), lymphopenia (OR=6.16; 95%CI: 1.99-18.98), and green color stools (OR=3.00; 95%CI: 1.23-7.30). Cystoisosporiasis was associated with HIV infection (OR=11.20; 95%CI: 3.53-35.44), diarrhea (OR=7.30; 95%CI: 1.89-28.52), leukopenia (OR=4.28; 95%CI: 1.33-13.75), green color stools (OR=11.59; 95%CI: 1.16-558.60), and Charcot-Leyden crystals (OR=11.59; 95%CI: 1.16-558.60). Conclusions: In this hospital-based population from Honduras, HIV infection was a risk factor for cryptosporidiosis and cystoisosporiasis, but not for cyclosporiasis.

Resumen | Introducción. Los protozoos Apicomplexa intestinales son causa reconocida de gastroenteritis. Estas parasitosis son endémicas en Honduras y su epidemiologia varia según los grupos poblacionales. Objetivo. Identifcar los factores de riesgo para ciclosporiasis, criptosporidiosis y cistoisosporiasis. Materiales y métodos. Se hizo un estudio de casos y controles en población hospitalaria. El diagnóstico se hizo utilizando la coloración modifcada de Ziehl-Neelsen. La información se obtuvo del registro de laboratorio y las historias clínicas. Resultados. La ciclosporiasis se asoció con diarrea (OR=2,28; IC95% 1,10-4.89), pérdida de peso (OR=12,7; IC95% 2,49-122), heces líquidas (OR=2,42; IC95% 1,26-4,65), infección con otros protozoos (OR=3,13; IC95% 1,66-5,95). La criptosporidiosis se asoció con el HIV (OR=15,43; IC95% 3,34-71,22), la diarrea (OR=3,52; IC95% 1,40-9,40), la linfopenia (OR=6,16; IC 95% 1,99-18,98), las heces de color verde (OR=3,00; IC95% 1,23-7,30). La cistoisosporiasis se asoció con el HIV (OR=11,20; IC95% 3,53-35,44), la diarrea (OR=7,30; IC95% 1,89-28,52), la leucopenia (OR=4,28; IC95% 1,33-13,75), las heces de color verde (OR=11,59; IC95% 1,16- 558,60), y los cristales de Charcot-Leyden (OR=11,59; IC95% 1,16-558,60). Conclusiones. En este estudio de base hospitalaria en Honduras, el HIV fue un factor de riesgo para la criptosporidiosis y la cistoisosporiasis, pero no así para la ciclosporiasis.

Coccidiosis y amibiasis intestinal en niños de edad escolar de un distrito de Lambayeque, Perú / Intestinal coccidiosis and amebiasis in school age children of a district in Lambayeque, Peru

Objetivos: Determinar la prevalencia y los factores asociados a coccidiosis y amibiasis intestinal en niños de edad escolar del distrito de Chongoyape, Chiclayo, Perú. Material y métodos: Estudio transversal de tipo relacional entre noviembre del 2014 y enero del 2015 en 133 escolares. Para recolectar la información sociodemográfica y de saneamiento se usó un cuestionario estructurado. La detección de los parásitos se realizó en muestras seriadas de heces. Para los coccidios intestinales se realizó examen microscópico directo (EMD), técnica ácido resistente modificada (TARM) y ELISA coproantígenos para Cryptosporidium spp., mientras que para la amibiasis se usó EMD y ELISA coproantígenos para Entamoeba hystolitica. Resultados: El 6,8% (9/133) de la muestra presentó coccidiosis intestinal, 3,8% (5/133) con Cryptosporidium spp., y 3,0% (4/133) con Cyclospora cayetanensis. No se detectó Cystoisospora belli. El 4,5% (6/133) de la muestra presentó E. histolytica. El factor asociado en ambas parasitosis fue el consumo de agua insalubre (p=0,001 y p=0,026 respectivamente), mientras que el contacto con animales se asoció a la coccidiosis intestinal (p=0,013). Conclusiones: La coccidiosis y la amibiasis intestinal son frecuentes en niños de la población estudiada, evidenciando su importancia como problema de salud pública y la necesidad de un diagnóstico específico y rutinario en las instituciones de salud de la región. (AU)

Objectives: To determine the prevalence of and risk factors for intestinal coccidiosis and amebiasis in school-age children in the district of Chongoyape, Chiclayo, Peru. Methods: Cross-sectional study carried-out between November 2014 and January 2015 among 133 school-aged children. A structures questionnaire collected socio-demographic and sanitation information. Serial stool samples were required, which were processed under direct microscopy, modified acid-fast staining and ELISA to detect antigens of Cryptosporidium spp, while direct microscopy and ELISA were used to detect Entamoeba hystolitica. Results: 6.8% (9/133) of the samples were positive for coccidian parasites, 3.8% (5/133) were positive for Cryptosporidium and 3% (4/133) for Cyclospora cayetanensis, no Cystoisospora belli was identified. E. hystolitica was found in 4.5% (6/133) samples. Drinking non-potable water was a risk factor for getting both infections, while animal contact was associated with getting a coccidian parasite (p=0.013). Conclusions: Both coccidian and intestinal amebas are frequent protozoan infections in this population. These parasites are public health problem that require routine and specific diagnostic methods in the region. (AU)

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.

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.

Cyclospora cayetanensis: biología, distribución ambiental y transferencia: [revisión] / Cyclospora cayetanensis: biology, environmental distribution and transfer: [review]

Cyclospora cayetanensis es un protozoo apicomplexa que ha emergido como un patógeno importante causante de diarrea endémica y epidémica en el mundo. En los países industrializados, el parásito se ha reconocido como agente causal de diversas epidemias asociadas, principalmente, con alimentos importados de áreas endémicas. En los países en vías de desarrollo, la ciclosporosis humana está ampliamente distribuida y, en la población general, se han descrito tasas de infección que varían de 0 % a 41,6 %. Sin embargo, la epidemiologia, biología y ecología de C. cayetanensis permanecen poco conocidas. Su ciclo de vida no está totalmente caracterizado y parece requerir un huésped único, el humano, para completarse. El papel que los animales puedan desempeñar como reservorios naturales del parásito permanece sin determinar. Se tiene poca información sobre la distribución ambiental de C. cayetanensis y los vehículos de transmisión del ambiente a los humanos. El agua, los alimentos y los suelos contaminados pueden actuar como vehículos de diseminación del coccidio. Permanecen incertidumbres significativas sobre el parásito, que reflejan la necesidad de continuar los esfuerzos de investigación en diversas áreas, incluyendo su biología básica y distribución ambiental.

Cyclospora cayetanensis is an apicomplexan protozoan that has emerged as an important pathogen causing endemic or epidemic diarrheal disease worldwide. In industrialized countries, the parasite has been recognized as the causative agent of several outbreaks of diarrheal illness mostly associated with produce imported from endemic areas. In developing countries, human cyclosporosis is widely distributed. Infection rates from 0% to 41.6% have been described in the general population. However, the epidemiology, biology, and ecology of C. cayetanensis are not fully understood. The life cycle is not completely characterized, although it appears to require a single human host to be accomplished. The role of animals as natural reservoirs of the parasite remains to be determined. Little information is available concerning the environmental distribution and vehicles of transmission of C. cayetanensis. Contaminated water, foods or soil can be vehicles of spread of the parasite. The significant uncertainties that remain in the knowledge of C. cayetanensis highlight the need for continuing research in several areas, including its basic biology and environmental distribution.

International Travel and Imported Parasitic Diseases / 한양의대학술지

International travel has become increasingly common as travelers of various purposes. It is estimated that there are 900 million international tourist arrivals alone each year. Unfortunately, some health impairments were reported in about 50% of short term travelers to the tropics or sub-tropics, usually due to infectious agents. In this paper, the author reviewed imported parasitic diseases in Korea from 1970 to 2009 with literature and data collected by Korea Centers for Disease Control and Prevention (KCDC). The author also reviewed warning points about parasitic disease in pregnant and immune deficit travelers. Most prevalent imported parasitic disease was malaria. About 30~70 travelers infected with malaria are returned home anually from abroad, mostly South East Asia and Africa. Subtype of malaria classified from 2003~2006 surveillance data showed Plasmodium falciparum infection in about 55% of patients identified. Over 20 cases of hydatid disease and cutaneous leishmaniasis cases were reported respectively. Visceral leishmaniasis (5 cases), babesiosis (7 cases), loiasis (3 cases), cutaneous myiasis (1 case), pentastomiasis (1 case), gnathostomiasis (4 cases, 41 people), angiostrongylosis (1 case, 10 people), heterophyiasis (2 cases), schistosomiasis (13 cases), cyclosporiasis (1 case), cutaneous larva migrans (4 cases), ancylostomiasis (1 case) and syngamosis (1 case) were reported. Prevention and surveillance plan of imported parasitic diseases is organized and conducted by KCDC since 2001. According to increasing travel to developing or under developed countries, retraining of doctor and technician, systematization of consulting system for diagnosis of parasitic disease, supply of medication, supplement of the personnel, and financial supports are needed.

Imported Parasitic Diseases in Korea

International migration of people has risen exponentially during the past two decades. Many people travel abroad for business purposes, sightseeing, volunteer activities, immigration, education, missonary work, etc., and are exposed to vector-borne and food or water-borne parasitic diseases, especially when they are traveling to the tropical and sub-tropical areas. Recently, imported parasitic diseases have also increased in Korea due to frequent traveling by the local residents or entry of foreign workers to the country. According to the statistics from 1970 to 2008, malaria (727 cases) was the most frequently imported parasitic disease in Korea followed by gnathostomiasis (42 cases) and hydatidosis (31 cases). From 1970 to 2010, cases of ancylostomiasis (1 case), angiostrongylosis (15 cases), babesiosis (8 cases), cutaneous larva migrans (8 cases), cutaneous myiasis (2 cases), cyclosporiasis (1 case), heterophyiasis (2 cases), leishmaniasis (28 cases), loiasis (3 cases), pentastomiasis (1 case), schistosomiasis (13 cases), and syngamosis (1 case) have also been reported. Travelers to Sub-Saharan Africa, Southeast Asia, and Central and South America should be on alert against malaria and other tropical diseases. National surveillance for imported diseases started in 2001 by Korea Centers for Disease Control and Prevention (KCDC). This article reviews imported parasitic diseases in Korea with review of literature.

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.

Cyclospora cayetanensis: un protozoo intestinal emergente / Cyclospora cayetanensis: an emerging intestinal protozoan

Resumen Cyclospora cayetanensis es un protozoo patógeno emergente causante de diarrea el cual se ha estado notificando cada vez con mayor frecuencia a escala mundial en personas de todas las edades, independientemente de su estado inmunológico. Esta coccidia ha sido descrita como causa de diarrea del viajero y de brotes de diarrea debido a la ingestión de frutas y vegetales, particularmente de áreas tropicales. La enfermedad que causa, cyclosporosis, está caracterizada principalmente como un síndrome de diarrea aguda autolimitada que puede ocasionar deshidratación y llegar hasta provocar diarrea prolongada o crónica. Otras manifestaciones como perdida de peso, anorexia, fatiga, astenia, borborismos, flatulencia y distensión abdominal pueden estar presentes, lo que hace esta afección indistinguible de otras diarreas infecciosas causadas por parásitos intestinales. El diagnóstico depende básicamente de la identificación del microorganismo en muestras fecales. Su tratamiento consiste en mantener el equilibrio hidromineral y electrolítico, al tiempo que se prescribe tratamiento antibiótico entre ellos se usa fundamentalmente el trimetoprín- sulfametoxazol, aunque se ha reportado la utilidad de otras drogas entre las que se cuentan la ciprofloxacina y la nitazoxanida. Esta revisión presenta diferentes aspectos actuales del manejo de la infección por Cyclospora cayetanensis y pone en relieve interrogantes sobre esta parasitosis donde factores relacionados con el protozoo, el ambiente y el susceptible quedan por esclarecer.

Detection of cyclospora cayetanensis infections among diarrheal children attending Suez Canal University Hospital

The objective of the present study is to detect the occurrence of Cyclospora cayetanensis among diarrheal children with or without immunosuppressant conditions. Stool samples were collected and examined for identification of the parasite using different concentration methods [Formaline ethely acetate, Potassium hydroxide and Sheather's floatation] and different stains [acid fast, modified Ziehl Neelsen, modified Kinyoun and modified safranin]. Confirmation of the results was performed using autofluorescence technique. Cyclospora oocysts were detected in 19.6% of 230 diarrheal children without immunosuppressant conditions and 34.6% of 230 diarrheal children with immunosuppressant conditions with significant difference between the two groups. Sheather's floatation method was significantly more sensitive than direct smear, FEA and KOH sedimentation methods [with sensitivities of 93.6%, 63.7%, 75.8% and 79.8%, respectively]. Additionally, the modified safranin was the best staining method as it was significantly more sensitive than the acid fast and the modified Ziehl Neelsen staining. On the other hand, no significant differences were found between the acid fast, the modified Ziehl Neelsen or the modified Kinyoun staining. Cyclosporiasis predominated in the age group 1-4 years compared to other age groups. There was a significant association between infection with Cyclospora and low socioeconomic level, living in rural areas and using tap water. Cyclospora was found as a sole parasite in 55 out of 124 [44.4%] infected children. Co-infection with other pathogenic parasites occurred in 69 cases; most commonly Cryptosporidium [30/124]. It was concluded that cyclosporiasis is common among diarrheal children especially if it is associated with immunosuppressant conditions. Feces examination for oocysts using Sheather's floatation and the modified safranin staining are recommended for diagnosis

Molecular identification of Cycospora spp. using multiplex PCR from diarrheic children compared to others conventional methods

Cyclospora organisms named C. cercopitheci, C. colobi and C. papionis were identified in stool samples from several primates. They were morphologically indistinguishable from C. cayetanensis but genetically different. In the present work, Cyclospora infection was diagnosed among 140 diarrheic children with three conventional diagnostic methods and was confirmed using nested PCR. The possibility of infection with not only C. cayetanensis but the three Cyclospora species of primates was identified by multiplex PCR among all cyclosporiasis patients diagnosed by different methods. The results showed that Cyclospora was detected in 25 [17.8%], 31 [22.2%], 32 [22.9%] and 35 [25%] patients using modified Kinyoun stain, auto-fluorescent characteristics, sporulation process of the oocysts and nested PCR respectively. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Kappa test were calculated in relation to nested PCR. The single nucleotide polymorphisms [SNPs] in the 18S rRNA gene of C. cayetanensis were identified in 35 cyclosporiasis patients and only one patient had the possibility of human co-infection with primates Cyclospora species [C. cercopitheci, C. colobi and C. papionis] and C. cayetanensis by appearance of a 361-bp. Scanning electron microscopy proved no morphological differences could be detected among Cyclospora oocysts isolated from this patient

Cyclosporiasis: an Emerging Public Health Concern around the World and in Africa

Background: Cyclosporiasis is an emerging gastro-enteric disease caused by the coccidia protozoan Cyclospora cayetanensis. It isassociated with diarrhoea among children in developing countries; in the Americas where C. cayetanensis is endemic; traveller's diarrhoea and/or food and waterborne outbreaks in the developed countries. Objectives: The aim of this review is to highlight cyclosporiasis and its relevance to public health in East Africa and Africa at large. Methods: All literature on Cyclospora; C. cayetanensis; cyclosporiasis in Africa; and endemic cyclosporiasis was searched from libraries;colleagues and internet but only literature on its history; clinical presentation; epidemiology in endemic settings; and occurrence inAfrica were scrutinised. Results: In Sub Saharan Africa; cyclosporiasis has been reported in at least 3 countries; including Tanzania; in East Africa; occurring inboth immunocompromised and immunocompetent patients. Zoonotic species of Cyclospora have also been identified in East African primates; indicating likely endemicity of this little reported disease in the region. This can be attributed to lack of awareness in thepublic and medical profession concerning the disease; and therefore not routinely checked at the health centres. Cyclosporiasis ischaracterized by intermittent diarrhoea; and secondary conditions or sequelae such as reactive arthritis syndrome (Reiter's syndrome); have been associated with progression of the disease. Its management is based on antibiotics; an unusual scenario for a protozoa. Conclusions: Although many aspects of this disease and its transmission remain an enigma; the situation has been rapidly changing since the disease first came to medical attention in the 1970s

Diagnóstico laboratorial de enteroparasitoses oportunistas, com ênfase nas microsporidioses humanas, em Goiânia-GO / Laboratory diagnosis of opportunistic intestinal parasites with emphasis on human microsporidiosis, in Goiânia-Go

Os microsporídios são protozoários, emergentes e oportunistas, responsáveis por patologias de alta morbi-mortalidade, principalmente em indivíduos com distúrbios imunes. Este estudo visa determinar o perfil clínico-laboratorial destes agentes. No total, foram avaliados 723 pacientes divididos em dois grupos: I) Indivíduos imunodeprimidos/imunossuprimidos; II) Indivíduos aparentemente imunocompetentes. Estes, após livre e esclarecido consentimento, foram entrevistados e cederam amostras fecais, sendo todas submetidas a técnicas de HPJ, Rugai, Faust e colorações específicas para coccídios e microsporídios. A freqüência de microsporídios foi 1,3 por cento (5/393) no grupo I, enquanto no outro grupo foi quatro vezes menor. A ocorrência de outras enteroparasitoses oportunistas também foi maior no grupo I. Conclui-se, por um lado, que estes agentes estão em nosso meio, e por outro, necessitamos aprimorar o diagnóstico clínico e laboratorial, para definir a distribuição geográfica destes agentes no Estado de Goiás e no Brasil.

Microsporidia are emergent and opportunistic protozoa that are responsible for diseases with high morbidity and mortality, especially among individuals with immune disorders. This study had the aim of determining the clinical-laboratory profile of these agents. In total, 723 patients were evaluated, divided into two groups: I) Immunosuppressed/immunodepressed individuals; II) Apparently immunocompetent individuals. After obtaining free informed consent, these patients were interviewed and gave fecal samples. These samples were all subjected to the HPJ, Rugai and Faust techniques and to specific staining for Coccidia and Microsporidia. The frequency of Microsporidia was 1.3 percent (5/393) in group I, whereas it was a quarter of this in group II. The occurrence of other opportunistic intestinal parasites was also greater in group I. It was concluded, firstly, that these agents are present in our environment and, secondly, that there is a need to improve the clinical and laboratory diagnosis, in order to define the geographic distribution of these agents in the State of Goiás and throughout Brazil.

Brote epidémico por Cyclospora cayetanensis en Medellín, Colombia / An outbreak of Cyclospora cayetanensis in Medellín, Colombia

Objetivo: Describir un brote epidémico de enfermedad gastrointestinal en un grupo de 56 pacientes de Medellín, Colombia. Metodología En abril de 2002 se presentó un número inusitado de casos de diarrea y a partir del hallazgo de Cyclospora cayetanensis en uno de los pacientes, se recolectaron 56 muestras de materia fecal de igual número de individuos. Se realizó una encuesta clínico-epidemiológica, coprológico directo, concentración con formol-éter y coloración de Zielh Neelsen modificada. Además, se estudiaron por directo y Zielh Neelsen muestras de algunos alimentos para la búsqueda del parásito. Resultados Del total de pacientes evaluados, 55,4 por ciento (31/56) fueron positivos para C. cayetanensis, de éstos, el 77,4 por ciento (24/31) fueron mujeres, y el 83,9 por ciento (26/31) pertenecía a la Universidad de Antioquia, de los cuales el 88,6 por ciento eran empleados no docentes. No se encontraron diferencias significativas entre pacientes positivos y negativos para Cyclospora con respecto a las manifestaciones clínicas, excepto en la deshidratación que fue mayor en los pacientes con ciclosporidiasis. Sin embargo, se encontró una diferencia significativa con relación al consumo de ensaladas y jugos, la cual fue mayor entre los pacientes positivos que los negativos. Conclusión Se presentó un brote epidémico de C. cayetanensis en pacientes sintomáticos atendidos por el grupo GIEPI en abril de 2002.

Objective: Describing an outbreak of gastrointestinal disease in a group of 56 patients from Medellín, Colombia. Methods An unusual number of cases of diarrhoea appeared in April 2002 and 56 samples of stool from the same number of individuals were collected because a patient proved Cyclospora cayetanensis positive. A clinical-epidemiological survey, direct coprology, formol-ether concentration and modified Zielhs Neelsen staining were then carried out. Some food samples were also studied for parasites by direct and modified Zielh Neelsen staining. Results 55,4 percent (31/56) of the patients being evaluated proved positive for C. cayetanensis. 77,4 percent (24/31) were women and 83,9 percent (26/31) belonged to the University of Antioquia, 88,6 percent of whom were not teachers. There was no statistically significant difference between positive and negative patients for Cyclospora regarding clinical manifestations, except for dehydration which was greater in patients having cyclosporiasis. However, there was a significant difference regarding consuming salads and juice, this being greater amongst positive patients than negative ones. Conclusion An outbreak of C. cayetanensis appeared in symptomatic patients being taken care of by the GIEPI group during April 2002.

Cyclosporiasis in an infant.

This report describes cyclosporiasis in a seven month old infant who presented with incessant crying and refusal of feeds. The routine modified ZN stained smears showed the oocysts of Cyclospora when all other tests failed to reveal enteric pathogens. The need for the clinical laboratory to screen faeces samples for all possible pathogens in a given clinical situation needs to be emphasized.

Opportunistic infections in patients with Hiv and Aids fungal and parasitic infections

Since the advent of highly active antiretroviral therapy [HAART], the incidence of specific fungal and parasitic opportunistic infections as observed in HIV disease has been in decline. However, in many parts of the world, and in areas where access to HAART is limited, these specific opportunistic infections are still observed in HIV patients. In this manuscript, we review the epidemiology, clinical manifestations, diagnosis, and treatment of common fungal and parasitic opportunistic infections

Co-infection with cryptosporidium parvum and cyclospora cayetanensis in ummunocompromised patients

Forty nine stool specimens collected from severe diarrheic patients. Eight were suffering from Hodgkin's lymphoma, and the rest were suffering from acute lymph plastic leukaemia. All were examined microscopically for protozoan parasites mainly, Cryptosporidium parvum and Cyclospora cayetanensis. Of the patients, 34 [69.4%] were positive and 15 [30.6%] were negative by both microscopy and nested PCR. An additional 12 [24.5%] who were negative by microscopy were positive by nested PCR. Stool examination revealed 16 cases with C. parvum, and 6 with C. cayetanensis, and 3 cases showed mixed infection. The results were compared with the established nested PCR assay to detect DNA directly from stool specimens. The patients <3 years old more affected by Cryptosporidium infection, unlike Cyclospora sp. Infection was in older age groups, which reflected the modes of parasite' transmission. Diarrheal illness was stronger for Cyclospora than for Cryptosporidium. After the extraction of DNA from stool, a 402-bp fragment of C. parvum, and 602 bp fragment of C. cayetanensis was amplified. The amplified products, 194-bp DNA fragment for C. parvum, and 306 bp DNA fragment of C. cayetanensis were used for the second run. This study indicated that primers were specific for DNA of C. parvum and C. cayetanensis. PCR detected a total of 22 [44.9%] positives for C. parvtim infection [6 negative by AF stool examination], and 12[24.5%] positives for C. cayetanensis. Infection [6 negative by AF stool examination], 7[14.3%] showed mixed infection [4 negative by AF stool examination], all microscopic negative specimens were positive by successive stool examination. Microscopy exhibited sensitivity of 72.7% for C. parvwn, 50% for C. cayetanensis and 100% specificity for both parasites compared to 100% sensitivity and specificity with PCR. So, PCR is more sensitive and easier to interpret but required more hands-on time to perform and is more expensive. However, PCR batch analysis reduces the cost considerably