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

ABSTRACT

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