Cyclosporiasis natural history, complications and prognosis: Difference between revisions
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==Natural History== | ==Natural History== | ||
Following inoculation of ''[[C. cayetanensis]], the typical incubation period is about 7 days<ref name="pmid9605784">{{cite journal| author=Fleming CA, Caron D, Gunn JE, Barry MA| title=A foodborne outbreak of Cyclospora cayetanensis at a wedding: clinical features and risk factors for illness. | journal=Arch Intern Med | year= 1998 | volume= 158 | issue= 10 | pages= 1121-5 | pmid=9605784 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9605784 }} </ref><ref name="pmid9164810">{{cite journal| author=Herwaldt BL, Ackers ML| title=An outbreak in 1996 of cyclosporiasis associated with imported raspberries. The Cyclospora Working Group. | journal=N Engl J Med | year= 1997 | volume= 336 | issue= 22 | pages= 1548-56 | pmid=9164810 | doi=10.1056/NEJM199705293362202 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9164810 }} </ref> | |||
* Symptoms of cyclosporiasis begin an average of 7 days (range, 2 days to > 2 weeks) after ingestion of sporulated [[oocysts]] (the infective form of the parasite). | * Symptoms of cyclosporiasis begin an average of 7 days (range, 2 days to > 2 weeks) after ingestion of sporulated [[oocysts]] (the infective form of the parasite). | ||
* If a person ill with cyclosporiasis is not treated, symptoms can persist for several weeks to a month or more. Some symptoms, such as [[diarrhea]], can return, and some symptoms, such as [[muscle aches]] and [[fatigue]], may continue after the gastrointestinal symptoms have gone away. | * If a person ill with cyclosporiasis is not treated, symptoms can persist for several weeks to a month or more. Some symptoms, such as [[diarrhea]], can return, and some symptoms, such as [[muscle aches]] and [[fatigue]], may continue after the gastrointestinal symptoms have gone away. | ||
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* Reported complications from Cyclospora infection are rare, but have included [[malabsorption]] and [[cholecystitis]]. | * Reported complications from Cyclospora infection are rare, but have included [[malabsorption]] and [[cholecystitis]]. | ||
* Some people with Cyclospora infection experience no symptoms at all, particularly persons living in areas where the disease is endemic. | * Some people with Cyclospora infection experience no symptoms at all, particularly persons living in areas where the disease is endemic. | ||
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Cyclospora infection is characterized by anorexia, nausea, flat- ulence, fatigue, abdominal cramping, diarrhea (however, the average duration of diarrhea for HIV-positive patients is longer than that for HIV-negative patients (199 days and 57.2 days, respectively) (163, 172)), low-grade fever, and weight loss (42, 68, 83, 140, 171). | |||
The clinical presentation is somewhat different in areas of endemicity, where asymptomatic infections are more frequent. | |||
Nevertheless, younger children have more severe clinical symptoms. In endemic settings, in- fections tend to be milder as children get older, as the duration of the infection is shorter and the severity of disease decreases. As in young children, the elderly may also present with a more severe illness. | |||
In areas where Cyclospora is not endemic, infections are almost invariably symptomatic, and there are reports of se- vere clinical manifestations. An HIV-positive patient returning from a trip to Southeast Asia presented with excessive watery diarrhea and pronounced fatigue (127). There are infrequent reports of fatalities associated with Cyclospora infections. It was suggested that the cause could be a possible complication after febrile illness including Cyclospora infection that could poten- tially lead to fatal ventricular dysrhythmia. | |||
Symptoms associated with cyclosporiasis are more severe in HIV/AIDS patients. Moderate weight losses (3.5 kg) were reported for non-AIDS patients (170, 171), whereas losses (7.2 kg) were more severe in AIDS patients (171). The me- dian incubation period is about 7 days (68, 83); however, the average duration of diarrhea for HIV-positive patients is longer than that for HIV-negative patients (199 days and 57.2 days, respectively) (163, 172). | |||
The time at which untreated expatriates in Nepal presented with diarrhea was at 19 to 57 days (171). Diarrhea lasted more than 3 weeks in people who contracted Cyclospora infection at a wedding in the United States (68). The reported frequency of bowel movements in immunocompetent people with diarrhea is 5 to 15 times a day. In addition to the explosive loss of fluids, D-xylose malabsorption has also been reported (44). | |||
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==Complications== | ==Complications== | ||
Biliary disease has also been reported after Cyclospora in- fections (50, 172). Acalculous cholecystitis was reported for HIV-positive and AIDS patients (172, 196) and resolved after initiation of treatment. These patients presented with right upper quadrant abdominal pain and elevated alkaline phos- phatase levels (171). | |||
Coinfection with Cyclospora, Cryptosporidium, and other parasites has been described for immunocompetent and im- munocompromised individuals (9). Guillain-Barr ́e syndrome (GBS) (158) and Reiter syndrome (41) have also been re- ported following Cyclospora infection. In the first case, 18 h after admission the patient was quadriparetic, areflexic, and mechanically ventilated. Circumstantial evidence suggested a Cyclospora-induced immune response resulting in severe GBS (158). In the second case, the patient had cyclosporiasis and was sulfa allergic and thus could not be treated with tri- methoprim-sulfamethoxazole (TMP-SMX). Later, this patient developed ocular inflammation, inflammatory oligoarthritis, and sterile urethritis. Although Reiter syndrome could have been coincidental, the authors proposed Cyclospora as another infectious trigger for Reiter syndrome | |||
==Prognosis== | ==Prognosis== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The symptoms usually start within one week of ingestion of contaminated food and water. If left untreated, symptoms may persist for weeks and months. This infection is not life threatening and is rarely associated with complications. People living in endemic area might have asymptomatic infections.
Natural History
Following inoculation of C. cayetanensis, the typical incubation period is about 7 days[1][2]
- Symptoms of cyclosporiasis begin an average of 7 days (range, 2 days to > 2 weeks) after ingestion of sporulated oocysts (the infective form of the parasite).
- If a person ill with cyclosporiasis is not treated, symptoms can persist for several weeks to a month or more. Some symptoms, such as diarrhea, can return, and some symptoms, such as muscle aches and fatigue, may continue after the gastrointestinal symptoms have gone away.
- Infection is not usually life-threatening.
- Reported complications from Cyclospora infection are rare, but have included malabsorption and cholecystitis.
- Some people with Cyclospora infection experience no symptoms at all, particularly persons living in areas where the disease is endemic.
Complications
Biliary disease has also been reported after Cyclospora in- fections (50, 172). Acalculous cholecystitis was reported for HIV-positive and AIDS patients (172, 196) and resolved after initiation of treatment. These patients presented with right upper quadrant abdominal pain and elevated alkaline phos- phatase levels (171).
Coinfection with Cyclospora, Cryptosporidium, and other parasites has been described for immunocompetent and im- munocompromised individuals (9). Guillain-Barr ́e syndrome (GBS) (158) and Reiter syndrome (41) have also been re- ported following Cyclospora infection. In the first case, 18 h after admission the patient was quadriparetic, areflexic, and mechanically ventilated. Circumstantial evidence suggested a Cyclospora-induced immune response resulting in severe GBS (158). In the second case, the patient had cyclosporiasis and was sulfa allergic and thus could not be treated with tri- methoprim-sulfamethoxazole (TMP-SMX). Later, this patient developed ocular inflammation, inflammatory oligoarthritis, and sterile urethritis. Although Reiter syndrome could have been coincidental, the authors proposed Cyclospora as another infectious trigger for Reiter syndrome
Prognosis
References
- ↑ Fleming CA, Caron D, Gunn JE, Barry MA (1998). "A foodborne outbreak of Cyclospora cayetanensis at a wedding: clinical features and risk factors for illness". Arch Intern Med. 158 (10): 1121–5. PMID 9605784.
- ↑ Herwaldt BL, Ackers ML (1997). "An outbreak in 1996 of cyclosporiasis associated with imported raspberries. The Cyclospora Working Group". N Engl J Med. 336 (22): 1548–56. doi:10.1056/NEJM199705293362202. PMID 9164810.