cyclospora

Cyclospora infections are typically acquired after consumption of food or water that is fecally contaminated with Cyclospora oocysts. In the United States, most of these infections have been traced to imported fresh produce from tropical areas or have occurred in persons who have traveled to areas of endemicity. The incubation period is approximately 1 week. Infected patients typically report watery diarrhea, decreased appetite, weight loss, crampy abdominal pain, bloating, flatulence, nausea, fatigue, and (sometimes) fever. Symptoms can last for several weeks and may be more pronounced in HIV-infected patients. Diagnosis is typically established microscopically by visualization of oocysts with modified acid-fast staining, microscopy with ultraviolet fluorescence, or molecular testing. Trimethoprim-sulfamethoxazole is recommended for treatment of symptomatic infection.

This patient has travel-associated Cyclospora infection and should be treated with trimethoprim-sulfamethoxazole. Cyclospora protozoan infections are typically acquired after consumption of fecal-contaminated food or water, particularly in countries where the parasite is endemic, such as Peru, Guatemala, Haiti, and Nepal. Cyclospora infections may also be acquired through consumption of fresh produce imported from tropical areas. The incubation period is approximately 1 week (range, 2 days to ≥2 weeks). The clinical presentation usually consists of crampy abdominal pain, anorexia, bloating, decreased appetite, fatigue, flatulence, low-grade fever, malaise, nausea, watery diarrhea, and weight loss. Persons with HIV infection may have more severe symptoms associated with wasting.

Diagnosis can be established microscopically by visualization of oocysts with modified acid-fast staining; fluorescence microscopy can be used as well. Several stool specimens may be required because Cyclospora oocysts may be shed intermittently and at low levels, even in persons with profuse diarrhea. Polymerase chain reaction assays appear to have the greatest sensitivity for the diagnosis of a Cyclospora infection.

The recommended treatment is one double-strength tablet of trimethoprim-sulfamethoxazole taken orally twice daily for 7 to 10 days. The Centers for Disease Control and Prevention states no effective alternative treatments have been identified for persons who are allergic to or cannot tolerate trimethoprim-sulfamethoxazole; observation and symptomatic care is recommended for those patients.