Cyclospora Blog

About Cyclospora - a knol by William Marler

marler@marlerclark.com (Cyclospora Attorney) — Wed, 08 Oct 2008 19:21:01 -0800

About Cyclospora

Cyclospora

William Marler

Marler Clark LLP PS

comments: 1

Article rating:

Your rating:

4 Ratings

No rating

Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a large form of Cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans. The first known human cases of illness caused by Cyclospora infection (that is, cyclosporiasis) were first discovered in 1977. An increase in the number of cases being reported began in the mid-1980s, in part due to the availability of better diagnostic techniques. Over 15,000 cases are estimated to occur each year in the United States. The first outbreak in North America occurred in 1990 from contaminated water. Since then, several outbreaks of cyclosporiasis have been reported in the U.S. and Canada, many associated with eating fresh fruits or vegetables. In some developing countries, cyclosporiasis is common among the population and travelers to those areas have become infected as well.

Cyclospora

Where does Cyclospora come from?

Cyclospora is spread by people ingesting water or food contaminated with infected stool. For example, exposure to contaminated water among farm workers may have been the original source in raspberry-associated outbreaks in North America. Cyclospora needs time (one to several weeks) after being passed in a bowel movement to become infectious. Therefore, it is unlikely that Cyclospora is passed directly from one person to another. It is not known whether or not animals can be infected and pass infection to people.

Diagnosis

Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, bloating, increased gas, stomach cramps, loss of appetite, nausea, low-grade fever, and fatigue. In some cases, vomiting, explosive diarrhea, muscle aches, and substantial weight loss can occur. Some people who are infected with Cyclospora do not have any symptoms. The time between becoming infected and becoming ill is usually about one week. If not treated, the illness may last from only a few days up to six weeks. Symptoms also may recur one or more times (relapse). In addition, people who have previously been infected with Cyclospora can become infected again.

When diagnosing Cyclospora, health care providers should ask the patient to submit stool specimens to see if he or she is infected. Because testing for Cyclospora infection can be difficult, the patient may be asked to submit several stool specimens over several days. Identification of this parasite in stool requires special laboratory tests that are not routinely done. Therefore, health care providers should specifically request testing for Cyclospora if it is suspected. A patient's health care provider might have his or her stool checked for other organisms that can cause similar symptoms.

Treatment

The recommended treatment for infection with Cyclospora is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim, Septra, or Cotrim. People who have diarrhea should rest and drink plenty of fluids. No alternative drugs have been identified yet for people with Cyclospora infection who are unable to take sulfa drugs. Some experimental studies, however, have suggested that ciprofloxacin or nitazoxanide may be effective, although to a lesser degree than trimethoprim-sulfamethoxazole. See your health care provider to discuss alternative treatment options.

Serious and long-term risks

Cyclospora has been associated with a variety of chronic complications such as Guillain-Barré syndrome, reactive arthritis or Reiter's syndrome, biliary disease, and acalculous cholecystitis. Since Cyclospora infections tend to respond to the appropriate treatment, complications are more likely to occur in individuals who are not treated or not treated promptly. Extraintestinal infection also appears to occur more commonly in individuals with a compromised immune system.

Prevention

Avoiding water or food that may be contaminated is advisable when traveling. Drinking bottled or boiled water and avoiding fresh ready-to-eat produce should help to reduce the risk of infection in regions with high rates of infection. Improving sanitary conditions in developing regions with poor environmental and economic conditions is likely to help to reduce exposure. Washing fresh fruits and vegetables at home may help to remove some of the organisms, but Cyclospora may remain on produce even after washing.

References

1. Division of Parasitic Diseases - Cyclospora Infection

Fact sheets and studies with cause, symptoms, prevention, and treatment.

www.cdc.gov/node.do/id/0900f3ec80006cb4

2. Cyclospora Facts - People most likely get cyclospora infection by eating food or drinking water.

www.dhpe.org/infect/cyclospora.html

3. Cyclospora cayetanensis – History

www.k-state.edu/parasitology/cyclospora/cyclospora.html

4. US FDA/CFSAN - Bad Bug Book - Cyclospora cayetanensis

Provides basic facts about cyclospora cayetanensis.

www.cfsan.fda.gov/~mow/cyclosp.html

5. Cyclospora Parasite - Digestion and digestive-related information. Digestion information covering the digestion system and related diseases, procedures and tests, medications, and treatments.

www.medicinenet.com/script/main/art.asp?articlekey=570

6. Food Research Institute Briefings: Cryptosporidium and Cyclospora. Few people, even in the medical establishment, knew much about Cyclospora and Cryptosporidium until recently. www.wisc.edu/fri/briefs/crypto.htm

7. eMedicine - Cyclospora : Article by William H Shoff, MD, DTMandH. Cyclospora - Cyclospora cayetanensis (8-10 µm in diameter), a coccidian protozoan parasite, produces an intestinal infection.

www.emedicine.com/MED/topic3393.htm

8. Nebraska HHS System: Cyclospora Epidemiology Fact Sheet

Cyclospora is a parasite that is composed of one cell.

www.hhs.state.ne.us/epi/cyclosp.htm

9. Cyclospora Lawyer & Attorney: Marler Clark: Cyclospora Blog

Cyclosporiasis is a disease due to Cyclospora cayetanensis, an emerging coccidian.

www.cyclosporablog.com

Cyclospora "Season" Is Not Over Until November

marler@marlerclark.com (Cyclospora Attorney) — Mon, 04 Aug 2008 21:05:23 -0800

We missed "Digging for Mummies" in June when the blog published an item about the "season" for Cyclospora. From Nepal writer Andrew J. Ulasich from some personal experience and research advised:

"Cyclospora season starts each year in May and peaks in June and July. The risk of infection decreases from August until the organism disappears altogether in November. Formerly known as "blue-green algae," it is a protozoan parasite that infects the upper intestine causing profound fatigue, loss of appetite, and diarrhea....Untreated, the infection can last from two to twelve weeks....

"...7-11 percent of all expatriates living in Kathmandu during this season are affected each year. The risk is highest among new foreign residents..." (The CIWIC Clinic Health News, June 2006)

Thanks to CIWIC and a little something called Bactrim, the little parasite in my intestine will be gone for good in a matter of days."

You can find the blog entry here.

At Least For Now, Cyclospora Is No Longer No. 1

marler@marlerclark.com (Cyclospora Lawyer) — Sat, 26 Jul 2008 17:54:29 -0800

Ten years, Guatemalan raspberries put one in the record books by causing an outbreak of Cyclospora in the 15 U.S. states and Canada that made more than 900 people sick. It was the largest fresh produce outbreak in modern history.

We thought it worth noting here that record no longer stands as its been bested by Mexican hot peppers that have now made almost 1,300 ill with Salmonella Saintpaul in 43 U.S. states, the District of Columbia and Canada.

The 1997-98 Cyclospora outbreak have been subject to much academic research and medical reviews. Just as tomatoes were first fingered in the Salmonella Saintpaul outbreak, strawberries were initially thought responsible for the Cyclospora outbreak.

WebMD has a paper on its website that details what happened. There were actually several years where Guatemalan raspberries were a problem, and it took some doing to eradicate it. WebMD says:

The year 2000 was the fifth year since 1995 (i.e., 1995, 1996, 1997, 1998, and 2000) that outbreaks of cyclosporiasis occurred in the spring in the United States or Canada that definitely or probably were associated with Guatemalan raspberries.^[7] However, the recent outbreaks have been much smaller than the multistate outbreaks in 1996 and 1997.^[7] After the outbreaks in 1996 and 1997,^[2,3]

FDA began working with the Guatemalan government and berry industry to improve farming and exporting practices for raspberries. Only farms that meet certain standards--including water, sanitation, and worker hygiene issues--have been allowed to export fresh raspberries to the United States during the "spring season" (March through August). The standards are reviewed and updated yearly. During the spring of 2000, five Guatemalan farms were allowed to export to the United States. After the outbreaks in Pennsylvania and Georgia, FDA did not allow the farm that was in common to the events to export raspberries to the United States during the spring of 2001. No U.S. outbreaks of cyclosporiasis associated with Guatemalan raspberries were identified that spring. During the spring of 2002, only three farms, which have never been implicated in outbreaks of cyclosporiasis, were allowed to export raspberries to the United States.

You can find the rest with the footnotes and such here.

Former FDA Official Jim O'Hara Compares Tomato Outbreak To Cyclospora Outbreak of 1995

marler@marlerclark.com (Cyclospora Attorney) — Fri, 13 Jun 2008 21:29:00 -0800

The current crisis recalls concerns raised in 1995 when it was raspberries contaminated by cyclospora, in 1997 when it was strawberries with hepatitis A and in 2006 when it was spinach with E. coli.

JIM O'HARA
Associate Commissioner for Public Affairs
U.S. Food & Drug Administration, 1993-1997

Mr. O'Hara's comparison of the current 25-state Salmonella Saintpaul outbreak involving tomatoes to the last big outbreak of cyclospora in the United States came in a Letter to the Editor published today in the Washington Post. He writes:

One question is paramount: Why hasn't the Food and Drug Administration put in place mandatory, enforceable standards for the growing, harvesting and processing of fresh produce?

The standards should be risk-based and commodity-specific and allow for evolving science.

The "why not" is all the more perplexing, given that not only consumer groups but major trade associations have called for this reform.

Damn good questions Mr. O'Hara. Let us know if you get any answers.

IFST Issues New Statement on Cyclospora

marler@marlerclark.com (Cyclospora Attorney) — Tue, 13 May 2008 10:03:58 -0800

The independent Institute of Food Science & Technology has issued a new Information Statement on Cyclospora dated May 2008, replacing that of March 2003.

The updated version makes the following new conclusions:

Care must be exercised in implicating any source of food or water as the source of any pathogen before the pathogen has both been identified and shown to occur in the incriminated vehicle.
Both national and international reporting and communicating cases/outbreaks of food or water borne disease need to be improved.
Every importer of fresh products (i.e. not pasteurised by heat/irradiation or other means), especially if these come from tropical countries, should be alert to the possibility that hazards, little known in the developed world, may be present and ensure that best practice is followed throughout the chain from farm to table.
Chlorination may be an inadequate safeguard against some such contaminants.
Routine laboratory analysis may be inadequate to identify all pathogens, some of which call for unusually sophisticated analytical techniques.

The Institute of Food Science & Technology (IFST) is the independent professional qualifying body for food scientists and technologists. It is totally independent of government, of industry, and of any lobbying groups or special interest groups. Its entire new Cyclospora paper can be found here.

Cyclospora Picking Up Rear In Food-borne Illnesses Study

marler@marlerclark.com (Cyclospora Attorney) — Thu, 17 Apr 2008 16:37:56 -0800

The FoodNet system gives a close up count on food-borne illnesses in states that contain about 45 million people or about 15 percent of the U.S. population. The data on laboratory-confirmed cases of food-borne illnesses provides a way of comparing the incidents of one type of illness to another.

FoodNet shows Cyclospora is clearing bring up the rear when it comes to food-borne illnesses in the covered states of Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, and Tennessee, plus parts of California, Colorado, and New York.

Here's how it stacks up according to the Center for Infectious Disease Research & Policy (CIDRAP) at the University of Minnesota:

A total of 17,883 foodborne infections were reported in 2007, up slightly from the 17,252 reported in 2006, according to the full FoodNet report published today in Morbidity and Mortality Weekly Report.

Salmonella led the list, with 6,790 confirmed cases (38% of the total), or 14.92 cases per 100,000 population. Case totals and rates per 100,000 population for the other pathogens were: Campylobacter, 5,818, 12.79; Shigella, 2,848, 6.26; Cryptosporidium, 1,216, 2.67; E coli O157:H7, 545, 1.20; Shiga toxin–producing E coli (STEC) non-O157:H7, 260, 0.57; Yersinia, 163, 0.36; Listeria, 122, 0.27; Vibrio, 108, 0.24; and Cyclospora, 13, 0.03.

Yes, that's 13 cases of Cyclospora for a rate of 0.03 per 100,000. People returning from third world countries are usually said to be most at risk of Cyclospora. And, as we learned a decade ago, all it takes for an large Cyclospora outbreak in the U.S. is to import the wrong berries from the wrong place.

Pharma-YNG Offers TD Advice That Includes Cyclospora

marler@marlerclark.com (Cyclospora Attorney) — Tue, 12 Feb 2008 16:00:45 -0800

Maybe its because we are thinking about a spring trip to some destination in South or Central America that an especially good write up on Travelers' Diarrhea caught our attention. Its on a blog called Pharma-YNG and it includes just about all causes of TD with suggested treatements.

It includes this about treatment of TD caused by protozoa like cyclospora:

"The most common parasitic cause of TD is Giardia intestinalis, and treatment options include metronidazole, tinidazole, and nitazoxanide (10). Although cryptosporidiosis is usually a self-limited illness in immunocompetent persons, nitazox-anide can be considered as a treatment option. Cyclosporiasis is treated with TMP-SMX. Treatment of amebiasis is with metronidazole or tinidazole, followed by treatment with a luminal agent such as iodoquinol or paromomycin."

All in all, the Pharma-YNG summary of TD is very well done.

Its the sort of helpful advice that you might want to slip into your permanent travel file. It can be found here.

Africa Views Cyclospora

marler@marlerclark.com (Cyclospora Attorney) — Wed, 16 Jan 2008 18:19:14 -0800

Cyclosporiasis is an emerging public health concern around the world and in Africa, reports the Makerere Medical School journal African Health Sciences.

The purpose of the article was to highlight cyclosporiasis and its relevance to public health in East Africa and Africa at large. Among the findings:

In Sub Saharan Africa, cyclosporiasis has been reported in at least 3 countries, including Tanzania, in East Africa, occurring in both 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 the public and medical profession concerning the disease, and therefore not routinely checked at the health centres. Cyclosporiasis is characterized 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.

The authors, who are all from Kenya, say that since Cyclospora became known to doctors in the 1970s, it has created a rapidly changing situation. They say that "many aspects of this disease and its transmission remain an enigma."

The full text of the article, along with an abstract, can be found here.

Cyclospora endemic in 27 countries listed here

marler@marlerclark.com (Cyclospora Attorney) — Mon, 31 Dec 2007 14:05:04 -0800

If your international travel plans for 2008 include any of these counties---Bangladesh, Brazil, Chile, China, Cuba, Dominican Republic, Egypt, Guatemala, Haiti, India, Indonesia, Jordan, Mexico, Morocco, Nepal, Nigeria, Pakistan, Peru, Puerto Rico, Romania, Saudi Arabia, Tanzania, Thailand, Turkey, Venezuela, Viet Nam, Zimbabwe ---then you should plan on combating Cyclospora.

Cyclospora is endemic in those 27 countries, according to Dr. William H. Shoff, Director of PENN Travel Medicine and the author of a 2007 article on Cyclospora found on Emedicine from WebMD.

Countries with many international travelers are the next category of concern for Dr. Shoff. Those include: Australia, Belgium, Czech Republic, Germany, Greece, Ireland, Italy, Japan, The Netherlands, Spain, Switzerland, United Kingdom, and the United States. About 4 percent of those returning from an endemic country return with diarrhea.

Food-borne Cyclospora is also common in the U.S., Mexico, Canada, and Germany. Water-borne cases have been recorded in Chicago and Nepal.

Dr. Shoff gives a straight description of this nasty little bug: "Cyclospora is a small bowel pathogen. After ingestion, Cyclospora oocysts excyst in the GI tract and invade small bowel epithelia, where they undergo asexual division followed by sexual division and produce mature oocysts that are shed in the stool."

We will continue to look for the medical news on Cyclospora, and we trust you will be careful during all your international travels!

17,252 confirmed cases of food poisoning in 2006 in US

bmarler@marlerclark.com (Bill Marler) — Sun, 22 Apr 2007 08:19:29 -0800

The CDC today released its preliminary 2006 food-borne illness data from 10 states: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee. A total of 17,252 confirmed cases (actual cases may be anywhere between 20 and 30 times the confirmed cases) of food-borne illness were reported in those states in 2006, according to the CDC. The most commonly reported illnesses were:

Salmonella: 6,655 cases

Campylobacter: 5,712 cases

Shigella: 2,736 cases

Cryptosporidium: 859 cases

E. coli O157: 590 cases

E. coli non-O157: 209 cases

Yersinia: 158 cases

Vibrio: 154 cases

Listeria: 138 cases

Cyclospora: 41 cases

Foodborne Illnesses On The Rise

marler@marlerclark.com (Cyclospora Attorney) — Thu, 19 Apr 2007 16:27:52 -0800

The Centers For Disease Control and Prevention have stated that the rate of some foodborne illnesses such as E. coli and salmonella in the United States are on the rise

A new report released by the United States government finds that the amounts of food born illnesses such as e. coli and salmonella are on the rise.

The report states that although it appears that e. coli and salmonella cases are on the rise, that other food born illnesses have leveled off when it comes to their infection prevalence rate.

Listeria, Shigella, Campylobacter, and Yersinia are all food born bacterial infections that according to data gathered from 10 states have fallen in prevalence since the 90's.

Keep reading here

Cyclospora cayetanensis

marler@marlerclark.com (Cyclospora Lawyer) — Thu, 18 Jan 2007 16:47:11 -0800

The blog, Messaged from the Outhouse, posted two pictures of Cyclospora in June of 2006. In addition to the photos, the blog's author included a short description of Cyclospora cayatenensis, which includes the following:

UV-light photography of Cyclospora cayatenensis, a human parasite only discovered in 1994 in Peru. This protozoon is transmitted via the faecal-oral route has been popping up all over the world, but seems to be most prevalent in tropical and subtropical regions. It causes a prolonged course of up to 12 weeks of watery diarrhoea, abdominal pain, fevers, muscle aches and flatulence, and, when untreated, can lapse regularly.

Visit the blog post to see the pictures of Cyclospora, which are said to look like a new galaxy.

Be Healthy

marler@marlerclark.com (Cyclospora Lawyer) — Thu, 11 Jan 2007 12:22:08 -0800

The Be Healthy blog write a recent article on food safety. The lessons to be learned were mostly related to food safety in summer, but the message can be applied year-round. See Be Healthy for the entire post. Here is an excerpt:

Many of the pathogens of greatest concern today (e.g., Campylobacter jejuni, Escherichia coli O157:H7, Listeria monocytogenes, Cyclospora cayetanensis) were not recognized as causes of foodborne illness just 20 years ago.
Do you know how long that potato salad has sat out? Do you know what may have stopped by to ‘visit’ your container of mayo salad dressing topping that’s on the table, next to the hot dogs? Never take food safety lightly. Just to emphasize the point, spend some time on this site from a mother who lost her daughter to food poisoning: http://www.geocities.com/tysca66/kelly.html.
Here are some tips how you can practice food safety at your summer barbeques and picnics:

Wash hands. Frequently wash your hands – before and after eating. If you anticipate no running water available where you are, be sure to pack a waterless hand sanitizer in your bag. Remind family members to do the same.

Check that cold foods are cold. Be certain that foods you are eating are as cold as they should be. Be sure bowls of cold food are nesting in bowls filled with ice.

Check how the meats are cooked. Before biting into a burger – break it open to be sure it looks thoroughly cooked – brown in the middle. Be sure you do not eat chicken that has pink inside.
Pay attention to how food is served. Check that each salad or plate of food has its own serving utensils.
Eat once food is served. Eating once food is brought out lessens the chance of bacteria growing as it sits out.
Ask your host. Finally – if you have any questions about how the food was prepared or how long something has been out – ASK. Chances are your host or hostess will want to assure you that she has taken appropriate food-safety precautions as she prepared for the barbecue."

Google - Cyclospora Search

marler@marlerclark.com (Cyclospora Attorney) — Sun, 07 Jan 2007 10:03:50 -0800

1. Division of Parasitic Diseases - Cyclospora Infection
Fact sheets and studies with cause, symptoms, prevention, and treatment.
www.cdc.gov/node.do/id/0900f3ec80006cb4

2. Cyclospora Facts - People most likely get cyclospora infection by eating food or drinking water.
www.dhpe.org/infect/cyclospora.html

3. Cyclospora cayetanensis – History
www.k-state.edu/parasitology/cyclospora/cyclospora.html

4. US FDA/CFSAN - Bad Bug Book - Cyclospora cayetanensis
Provides basic facts about cyclospora cayetanensis.
www.cfsan.fda.gov/~mow/cyclosp.html

5. Cyclospora Parasite - Digestion and digestive-related information. Digestion information covering the digestion system and related diseases, procedures and tests, medications, and treatments.
www.medicinenet.com/script/main/art.asp?articlekey=570

6. Food Research Institute Briefings: Cryptosporidium and Cyclospora. Few people, even in the medical establishment, knew much about Cyclospora and Cryptosporidium until recently. www.wisc.edu/fri/briefs/crypto.htm

7. eMedicine - Cyclospora : Article by William H Shoff, MD, DTMandH. Cyclospora - Cyclospora cayetanensis (8-10 µm in diameter), a coccidian protozoan parasite, produces an intestinal infection.
www.emedicine.com/MED/topic3393.htm

8. Nebraska HHS System: Cyclospora Epidemiology Fact Sheet
Cyclospora is a parasite that is composed of one cell.
www.hhs.state.ne.us/epi/cyclosp.htm

9. Cyclospora Lawyer & Attorney: Marler Clark: Cyclospora Blog
Cyclosporiasis is a disease due to Cyclospora cayetanensis, an emerging coccidian.
www.cyclosporablog.com

Cyclospora outbreak in Guatemala: a study

marler@marlerclark.com (Cyclospora Lawyer) — Mon, 27 Nov 2006 12:11:22 -0800

A recent study titled, "Cyclosporiasis: a point source outbreak acquired in Guatemala," appears in the No vember-December 2006 Journal of Travel Medicine. The following is an abstract:

"Cyclosporiasis is a disease due to Cyclospora cayetanensis, an emerging coccidian parasite first described in 1979. It is an orally transmitted disease that is more frequent in tropical and subtropical areas. Cyclospora cayetanensis has been mainly described as a cause of travelers' diarrhea. This pathogen has given rise to a number of epidemic outbreaks attributable to ingestion of imported foods, particularly from tropical areas. Methods. Descriptive study of clinical and epidemiological data of a small epidemic outbreak of C cayetanensis-induced gastroenteritis. Results. Seven confirmed cases of C cayetanensis among Spanish nationals who had traveled to Antigua Guatemala are described. The incubation period was 6 days. Diarrhea, asthenia, anorexia, borborygmi, flatulence, and abdominal distension were present in all cases. Fever and heart burn in 85.7%. Weight loss in 71.4%. Abdominal pain, rectal tenesmus, and nausea in 42.8%. Vomiting and eructation in 14.2%. Heart burn was a frequent symptom, a finding not often previously described. The infection was probably acquired from raspberry juice. All cases improved with trimethoprim/sulphametoxazol. Conclusions. Cyclosporiasis is a cause of travelers' diarrhea. Parasitology laboratories must be advised of clinical suspicion of cyclosporiasis so that they can conduct a suitable targeted study; otherwise, false negative results may arise."

More information about the Journal of Travel Medicine can be found on the Blackwell Publishing Web site.

What is Cyclospora?

marler@marlerclark.com (Cyclospora Attorney) — Tue, 12 Sep 2006 21:21:00 -0800

Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a large form of Cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans. The first known human cases of illness caused by Cyclospora infection (that is, cyclosporiasis) were first discovered in 1977. An increase in the number of cases being reported began in the mid-1980s, in part due to the availability of better diagnostic techniques. Over 15,000 cases are estimated to occur each year in the United States. The first outbreak in North America occurred in 1990 from contaminated water. Since then, several outbreaks of cyclosporiasis have been reported in the U.S. and Canada, many associated with eating fresh fruits or vegetables. In some developing countries, cyclosporiasis is common among the population and travelers to those areas have become infected as well.

Great Overview from CDC of the Cyclospora Parasite

marler@marlerclark.com (Cyclospora Attorney) — Sat, 09 Sep 2006 18:17:54 -0800

Cyclospora Infection or Cyclosporiasis (sigh-clo-spore-EYE-uh-sis)

Cyclospora cayetanensis (SIGH-clo-SPORE-uh KYE-uh-tuh-NEN-sis) is a parasite composed of one cell, too small to be seen without a microscope. The first known human cases of illness caused by Cyclospora infection (that is, cyclosporiasis) were reported in 1979. Cases began being reported more often in the mid-1980s. In the last several years, outbreaks of cyclosporiasis have been reported in the United States and Canada.Cyclospora is spread by people ingesting something, for example, water or food that was contaminated with infected stool. For example, outbreaks of cyclosporiasis have been linked to various types of fresh produce. Cyclospora needs time (days or weeks) after being passed in a bowel movement to become infectious. Therefore, it is unlikely that Cyclospora is passed directly from one person to another. It is not known whether or not animals can be infected and pass infection to people.

People of all ages are at risk for infection. In the past, Cyclospora infection was usually found in people who lived or traveled in developing countries. However, nowadays the infection is found worldwide.

Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, with frequent, sometimes explosive, bowel movements. Other symptoms can include loss of appetite, substantial loss of weight, bloating, increased gas, stomach cramps, nausea, vomiting, muscle aches, low-grade fever, and fatigue. Some people who are infected with Cyclospora do not have any symptoms.

The time between becoming infected and becoming sick is usually about 1 week.

If not treated, the illness may last from a few days to a month or longer. Symptoms may seem to go away and then return one or more times (relapse).

If you think you might be infected with Cyclospora, see your health care provider.

Your health care provider will ask you to submit stool specimens to see if you are infected. Because testing for Cyclospora infection can be difficult, you may be asked to submit several stool specimens over several days. Identification of this parasite in stool requires special laboratory tests that are not routinely done. Therefore, your health care provider should specifically request testing for Cyclospora. Your health care provider might have your stool checked for other organisms that can cause similar symptoms.

The recommended treatment for infection with Cyclospora is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim*, Septra*, or Cotrim*. People who have diarrhea should rest and drink plenty of fluids.

No alternative drugs have been identified yet for people with Cyclospora infection who are unable to take sulfa drugs. See your health care provider to discuss other possible treatment options.

Avoiding water or food that may be contaminated with stool may help prevent Cyclospora infection. People who have previously been infected with Cyclospora can become infected again.

A Great Overview of a Nasty Bug

marler@marlerclark.com (Cyclospora Lawyer) — Fri, 08 Sep 2006 18:16:59 -0800

Cyclospora

Cyclospora [SIGH-clo-SPOR-uh] infection is a newly emerging parasitic illness that can cause severe diarrhea.
People most likely get cyclospora infection by eating food or drinking water that was contaminated with stool from an infected person.
Cyclospora infection is treatable with antibiotics.
Cyclospora infection can probably be prevented by avoiding food or water that might be contaminated with stool.

What is cyclospora infection?

Cyclospora infection is a rare infection of the intestines that can cause severe diarrhea.

What is the infectious agent that causes cyclospora infection?

Cyclospora infection is caused by Cyclospora cayetanensis, a microscopic one-celled parasite.

How do people get cyclospora infection?

Cyclospora is different from many other organisms because it is not infectious when it is passed in the stool of an infected person. Cyclospora needs days or weeks after being passed in a bowel movement to become infectious. Therefore, it is unlikely that the parasite is passed directly from one person to another. People most likely get Cyclospora infection by ingesting food or water that was contaminated with stool from an infected person. It is unknown if animals can be infected and pass infection to people.

In 1996, a large outbreak of cyclospora infection in the United States and Canada was caused by imported raspberries. It is not clear how the fruit became contaminated, but it might have happened when fruit touched the ground or when contaminated water was sprayed over fruit fields by sprinkling systems.
What are the signs and symptoms of cyclospora infection?

Cyclospora infects the small intestine and usually causes watery diarrhea, with frequent, sometimes explosive, bowel movements. Other symptoms can include loss of appetite, loss of weight, bloating, increased gas, stomach cramps, nausea, vomiting, muscle aches, low-grade fever, and tiredness. Some people who are infected with cyclospora have no symptoms.

How soon after exposure do symptoms appear?

The time between becoming infected and developing symptoms is unusually long for a disease spread by food -- about 1 week. If not treated, the illness can last for a few days to a month or longer. If untreated, it can also return one or more times.

How is cyclospora infection diagnosed?

Identification of this parasite in stool requires special laboratory tests that are not routinely done. A health-care provider must specifically request testing for Cyclospora. Because Cyclospora can be difficult to diagnose, more than one stool sample might be needed.

Who is at risk for infection?

Anyone can get Cyclospora infection.

What complications can result from cyclospora infection?

Without treatment, the infection can cause weeks of severe tiredness, loss of appetite, dehydration (loss of fluids), and weight loss.

What is the treatment for cyclospora infection?

Cyclospora infection is treated with an oral medicine that is a combination of two sulfa-based antibiotics: trimethoprim and sulfamethoxazole. For people with diarrhea Cyclospora can be difficult to diagnose. If Cyclospora infection is suspected, people should consult with their health-care provider before taking medicine for diarrhea.

How common is cyclospora infection?

Cyclospora infection is very rare in this country, and most states do not keep track of the number of cases. In the past, the infection was usually found in persons living or traveling in tropical countries. Increasingly, however, cases are being recognized in the United States and Canada. In the United States, infection is most common during spring and summer.

Is cyclospora an emerging infection?

Yes. The first human cases were reported in 1979, but cases began being reported more often in the mid-1980s. This may be partly because of the availability of better tests to detect the parasite in stool specimens. Several recent, very large outbreaks linked to raspberries, mesclun lettuce, and possibly basil have increased concerns about Cyclospora and stimulated health officials to learn more about how it is transmitted and what factors contribute to its spread.

How can cyclospora infection be prevented?

Based on what is known about Cyclospora, the best way to prevent infection is to avoid eating raw or undercooked foods or drinking untreated water that could be contaminated with stool. Cooking can kill Cyclospora, and freezing might, too. As a general food safety measure, always wash fresh produce, even if it is to be peeled before eating.

Parasite Playground

marler@marlerclark.com (Cyclospora Lawyer) — Mon, 31 Jul 2006 12:18:14 -0800

In a July 21, 2006 article in the New Haven Advocate, reporter Carole Bass wrote about a trip to the Centers for Disease Control and Prevention in Atlanta.

You might think a public health "boot camp" for reporters at the CDC would furnish a week-long break from politics. And indeed, the 23 journalists who convened there during the last week of June did spend most of our time in a windowless auditorium, watching PowerPoint presentations on "The Ecology of Disease" and "The U.S. Public Health Infrastructure." There were no sessions on the Lieberman-Lamont race, no gubernatorial gabbery, no aldermanic antics. Just doctors and scientists teaching about E. coli and cyclospora parasites, tobacco and TB and the H and N proteins that characterize flu viruses. I didn't read a newspaper all week.

Ms. Bass included commentary on a "boot camp" session about Cyclospora:

The morning's session is a case study in cyclosporiasis--yet another gastrointestinal illness caused by a microscopic parasite known as cyclospora. The disease was unknown in North America until 1996, when three Canadian businessmen came down with it.
Trainer Jeanette Stehr-Green walks us through the steps that epidemiologists took to track down the source of the outbreak. The Canadians, it turned out, had recently returned from a conference in Houston; many other attendees also developed diarrhea after the conference. By piecing together accounts of what food was served and what was eaten both the sick and non-sick people, Texas public health officials determined that California-grown strawberries were to blame. After they tracked a second cyclosporiasis outbreak, also in Houston, to California strawberries (from a different farm), the Texas public health department issued a warning about the berries.

The article is an interesting lesson on how the CDC engages reporters who cover health issues, and on what a reporter learned hands-on in a week in Atlanta.

Cyclospora Outbreaks

marler@marlerclark.com (Cyclospora Lawyer) — Thu, 25 May 2006 09:58:17 -0800

ATLANTA--Outbreaks of illness in the United States causing infectious watery diarrhea, nausea, and vomiting have been found to be related to a parasite called Cyclospora.

The Cyclospora parasite is transmitted to persons who contact objects contaminated with infected stool. In 1997, reports of outbreaks of Cyclospora infection were preliminarily associated with the consumption of fresh fruits, such as strawberries and raspberries.

The Center for Disease Control and Prevention (CDC) worked with the federal, state, and local health departments to determine the extent and causes of the recent outbreaks of Cyclospora. They pointed out that although it is prudent to thoroughly wash produce that will be eaten raw, this practice may not eliminate the risk of transmission of Cyclospora. Further, they recommend that health care providers consider Cyclospora infection in persons with prolonged diarrheal illness and specifically request laboratory testing for this parasite.

SOURCE: MedicineNet.com

Cyclospora Blog

About Cyclospora - a knol by William Marler

About Cyclospora

Cyclospora

William Marler

Contents

Where does Cyclospora come from?

Diagnosis

Treatment

Serious and long-term risks

Prevention

Cyclospora "Season" Is Not Over Until November

At Least For Now, Cyclospora Is No Longer No. 1

Former FDA Official Jim O'Hara Compares Tomato Outbreak To Cyclospora Outbreak of 1995

IFST Issues New Statement on Cyclospora

Cyclospora Picking Up Rear In Food-borne Illnesses Study

Pharma-YNG Offers TD Advice That Includes Cyclospora

Africa Views Cyclospora

Cyclospora endemic in 27 countries listed here

17,252 confirmed cases of food poisoning in 2006 in US

Foodborne Illnesses On The Rise

Cyclospora cayetanensis

Be Healthy

Google - Cyclospora Search

Cyclospora outbreak in Guatemala: a study

What is Cyclospora?

Great Overview from CDC of the Cyclospora Parasite

A Great Overview of a Nasty Bug

Parasite Playground

Cyclospora Outbreaks