Cyclospora Clinical Presentation

  • Author: William H Shoff, MD, DTM&H; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Feb 26, 2010
 

History

After exposure in nonimmune individuals, the incubation period is usually 1-11 days (mean, 7 d). The onset of illness may be abrupt in as many as 30% of cases. It may be preceded by a flulike illness. After a few days, acute symptoms subside and then may recur (61% of cases) in a waxing-waning pattern. Alternatively, a patient may experience persistent symptoms. The illness usually lasts 6-7 weeks but has been reported to persist for several months. The duration can be several months to a year in patients with HIV.

  • Watery diarrhea (may be explosive) with a median of 6 stools per day; frequency of diarrhea possibly many times higher; no diarrhea in some patients.
  • Anorexia
  • Weight loss (0.9-3.6 kg in one study)
  • Fatigue, often pronounced
  • Abdominal cramping
  • Belching
  • Abdominal bloating
  • Vomiting
  • Low-grade fever (25%)
  • Flatulence
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Physical

Vital signs are normal in most cases. Fever is unusual but, when present, is low grade. In the presence of moderate to severe dehydration, compensatory tachycardia, systolic blood pressure (SBP) less than 90 mm Hg, and decreased skin turgor may occur, and the patient may appear ill.

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Causes

Risk of infection is secondary to the consumption of contaminated fruits, vegetables, water, or other foodstuffs (see Deterrence/Prevention for strategies that decrease the risk of acquiring this infection). The infectious inoculum is not known but is thought to be small.

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Contributor Information and Disclosures
Author

William H Shoff, MD, DTM&H  Director, PENN Travel Medicine, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania

William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Glaxo Smith Kline None None; Glaxo Smith Kline Honoraria Speaking and teaching

Coauthor(s)

Amy J Behrman, MD  Associate Professor, Department of Emergency Medicine, Director, Division of Occupational Medicine, University of Pennsylvania School of Medicine

Amy J Behrman, MD is a member of the following medical societies: American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM  Associate Professor, Education Officer, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey D Band, MD  Clinical Professor of Medicine, Wayne State University School of Medicine; Director, Division of Infectious Diseases and International Medicine, Corporate Epidemiologist, William Beaumont Hospital

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

John W King, MD  Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi

Disclosure: emedicine $50.00 author of chapter; MERCK None Other

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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Table 1. Epidemiology of C cayetanensis *
Pattern of Spread Countries Comments
EndemicBangladesh, 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 Prevalence (1-15%†) varies significantly with the season and from year to year; children (≤ 9 y, most studies) account for 70-80% cases, which are typically asymptomatic (72-94%); asymptomatic disease is higher in older children (10-18 y) and adults (>18 y); infection rate in those with HIV is significantly higher than overall prevalence
International travel-relatedAustralia, Belgium, Czech Republic, Germany, Greece, Ireland, Italy, Japan, The Netherlands, Spain, Switzerland, United Kingdom, United States ≤4% returning travelers with diarrhea
Foodborne outbreaksCanada, United States, Germany, MexicoCanada/United States: raspberries, blackberries, mesclun, basil‡; Germany: lettuce imported from Southern France/Southern Italy; Mexico: watercress
Waterborne outbreaksUnited States (Chicago), Nepal14 cases of cyclosporiasis; tap water in medical dormitory, suspected source was contaminated water storage tank; 12 of 14 developed cyclosporiasis
* Community-based studies



† Highest in spring and early summer



‡ Fresh produce. Raspberries from Guatemala; blackberries from Guatemala or undetermined source; mesclun (young salad greens, eg, spring mix, field greens, baby greens, gourmet salad mix) from Peru or United States; basin from Mexico or United States



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