Cyclospora cayetanensis Infection in Developed Countries: Potential Endemic Foci?

Cyclospora cayetanensis infection has emerged as a significant public health concern worldwide. Developed countries are generally considered non-endemic for infection. However, sporadic cases and non-travel-related outbreaks of C. cayetanensis infections associated with domestically grown produce are becoming more common in developed countries. Cyclospora cayetanensis has been detected in fresh produce, surface water, wastewater, irrigation water, and soil in these countries, suggesting that the parasite may be more common in areas with advanced sanitation than previously thought and illustrating the potential risk for exposure and indigenous/autochthonous infections. The evidence suggests the possibility of foci of endemicity in developed countries, particularly in communities where sanitary conditions are compromised, and raises transmission issues that require further research to better define the risks for infection, how widespread C. cayetanensis may be in these areas, and to guide interventions against this infection. The main purpose of the present opinion was to evaluate the presence of cyclosporiasis in developed countries, which is a very important and ongoing issue in food safety.

Factors associated with Cyclospora infection in a Venezuelan community: extreme poverty and soil transmission relate to cyclosporiasis.

BACKGROUND: Transmission dynamics of Cyclospora cayetanensis in endemic areas and the factors associated with soil contamination remain unclear. The effects of environmental factors on Cyclospora have been insufficiently studied, particularly in South America, thus a Venezuelan community was studied to profile risk factors for infection. METHODS: A cross-sectional stool survey of 732 individuals was conducted. For Cyclospora screening, an acid-fast-stained smear of formalin-ethyl acetate concentrate and ultraviolet (UV) epifluorescence examination of a wet mount were used. Water (n=14), soil (n=50) and produce (n=77) samples were collected, processed and examined by UV epifluorescence. Data were analysed using multivariate logistic regression. RESULTS: Cyclospora infections were identified in 73 (9.9%) subjects. Variables associated with the infection were age ≤10 y (odds ratio [OR] 14), hut living (OR 5), well water use (OR 18.5), drinking untreated water (OR 7.6), toilet absence (OR 8), having contact with faeces-contaminated soil (OR 4) and poultry exposure (OR 3). Infections (63%) were clustered in 25 huts. Oocysts were identified in 28.6%, 18% and 3.9% of the water, soil and produce samples, respectively. CONCLUSIONS: There was an explicit association of Cyclospora infection with extreme poverty and soil transmission reflecting the household socio-economic correlate of cyclosporiasis in this community.

Seasonal trends of Cyclospora cayetanensis infections in a community of Falcon State, Northwestern Venezuela.

BACKGROUND: Cyclosporiasis has a marked seasonality. Few community-based studies have addressed this issue and there are no reports from Venezuela. A study was conducted to determine the seasonal variation of infection in a community from Falcon State, Venezuela. METHODS: A sample of 732 individuals was collected for 1 y. Stools were examined with modified Ziehl-Neelsen carbolfuchsin staining of ethyl acetate-formalin concentrates and ultraviolet epiflorescence of wet mounts. RESULTS: Cyclospora prevalence was 9.9% (73/732) with monthly variation from 0% to 35.3%. A trend of increased infections coinciding with the rainy time was observed (p<0.001). CONCLUSIONS: Cyclosporiasis is common in this area with high endemicity during the rainy periods.

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

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 modified 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.

Introducción. Los protozoos Apicomplexa intestinales son causa reconocida de gastroenteritis. Estas parasitosis son endémicas en Honduras y su epidemiologia varía según los grupos poblacionales. Objetivo. Identificar 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 modificada 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; IC95% 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.

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.

Cyclosporiasis in travellers returning to the United Kingdom from Mexico in 2017: lessons from the recent past to inform the future.

During the summers of 2015 and 2016, the United Kingdom experienced large outbreaks of cyclosporiasis in travellers returning from Mexico. As the source of the outbreaks was not identified, there is the potential for a similar outbreak to occur in 2017; indeed 78 cases had already been reported as at 27 July 2017. Early communication and international collaboration is essential to provide a better understanding of the source and extent of this recurring situation.

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: 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...