FYI: cyclospora -- exotic parasite outbreak alerts - various

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June 19, 1996

Alert Is Sounded on Spread Of Exotic Parasitic Infection By LAWRENCE K.

ALTMAN

 

At least 35 people in the New York City area have been stricken since early

May by an exotic parasitic intestinal infection whose source is unknown, health

officials said yesterday.

New York City Health Department officials said they were alerting doctors and

laboratories to look for the parasite, Cyclospora cayetanensis, among patients

with unexplained intestinal symptoms. There have been no deaths, and doctors say

the illness is generally not fatal.

 

The infection can cause cramping, abdominal pain, severe diarrhea, nausea, a

mild fever up to 102 degrees Fahrenheit and extreme fatigue. The illness often

subsides for a few days, then recurs. The course of illness can usually be

shortened with a combination antibiotic, trimethoprim sulfamethoxazole, which is

sold as Septra or Bactrim.

 

But if cyclospora is untreated, doctors say it can cause weeks of debilitating

fatigue and loss of appetite, leading to a loss of 15 to 20 pounds.

 

Epidemiologists say they are puzzled by the source of the disease, which was

first reported in Nepal in 1989. Dr. James Miller and Dr. Marcel Layton, two

Health Department officials, said there seemed to be no connection among the

people in New York City who had contracted the disease in recent weeks. " None of

the cases have had contact with another case that we can determine, and none

were together at any one place, " Dr. Miller said.

The health officials said they were focusing on the possibility that the

infections resulted from contaminated foods like vegetables or fresh fruit.

Officials are also trying to determine how many other cases have not been

reported, and they are looking into the possibility that the parasite may have

entered the United States with returning tourists.

 

The Health Department said it is prudent to wash fruit and vegetables before

they are eaten. The parasite does not appear to be inside fruits with unbroken

skin or surfaces.

 

Because it is so rare, New York and other cities do not keep track of the

number of cyclospora cases. But because of the unusual number of cases this

year, the Health Department is asking that doctors and laboratories report all

such cases to it.

 

So far, 31 of the 35 cases have been reported in residents of New York City.

Four additional cases were reported in residents of Westchester County and New

Jersey, and diagnosed by doctors in New York City.

 

New York Hospital's parasitology laboratory has confimed 31 cases, but not all

were included in the Health Department totals yesterday because of a reporting

lag that is common in unusual situations.

 

Last year, 32 people became ill from cyclospora infections after an event at

the Old Oaks Country Club in Purchase, N.Y., said Mary Landrigan, a spokeswoman

for the Westchester County Health Department. There were no deaths.

Epidemiologists did not identify a single food item as a source of the outbreak,

and suspicion focused on a contaminated water supply at the club, Ms. Landrigan

said.

 

In the latest cases from New York City, the initial wave came from New York

Hospital-Cornell Medical Center, where doctors have been studying the disease

for several years.

Dr. Bradley A. Connor, a gastroenterologist at the center, said some of the

patients with cyclospora he had treated had had extreme fatigue disproportionate

to their symptoms. " Some have had to go home to rest at lunch, " Dr. Connor said.

 

Dr. Connor said it was his impression that many cases involved people in the

middle- to upper-income groups. The impression was based in part by a call to an

expert on parasitic diseases at a hospital in the Bronx who had not detected any

cases, Dr. Connor said.

Health Department officials said they were not focusing their questions on

socioeconomic status and that more cases might have been reported from New York

Hospital because of the doctors' interest in the disease. Cases have been

reported from other areas of the city since alerts were first sent out to

hospitals and laboratories last week, health officials said.

The Health Department is working with the Federal Centers for Disease Control

and Prevention and health officials elsewhere to determine the extent of the

problem.

 

Although the cyclospora parasite was first detected only a few years ago,

experts presume that it has been around for a long time but is being recognized

now partly because of improved laboratory techniques.

 

Relatively few cyclospora cases have been reported in this country. Limited

experience indicates that the illness follows a seasonal pattern, beginning in

the spring and stopping about October.

http://query.nytimes.com/gst/fullpage.html?res=9A06E3D71439F93AA25755C0A96095826\

0 & sec=health & spon= & pagewanted=print

 

see also --

http://query.nytimes.com/gst/fullpage.html?sec=health & res=9B07E1DC1339F933A05755\

C0A960958260 & n=Top%2fNews%2fScience%2fTopics%2fParasites

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

http://www.cdc.gov/ncidod/dpd/parasites/cyclospora/

 

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Guillain-Barré syndrome after Cyclospora infection.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve & db=PubMed & list_uids=957225\

3 & dopt=Abstract

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Berry Berry Quite Contrary...Cyclospora Outbreaks 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.

 

The CDC has provided the following information:

 

What is Cyclospora?

Cyclospora is a parasite that is composed of one cell. It is too small to be

seen without a microscope. Its full name is Cyclospora cayetanensis.

 

The first known human cases of Cyclospora infection were diagnosed in 1977.

Cases began being reported more often in the mid-1980s. This may be in part

because better techniques are now being used to detect the parasite in specimens

of stool (bowel movements). Because Cyclospora is a newly recognized infectious

organism, many questions remain about the ways it is transmitted and the illness

it causes.

 

How is Cyclospora transmitted?

Cyclospora is transmitted by a person putting something in his or her mouth that

was contaminated with infected stool. For example, the parasite can be

transmitted by swallowing contaminated water or food. Cyclospora needs time

(days or weeks) after being passed in a bowel movement to develop into an

infectious organism. Therefore, transmission of Cyclospora directly from an

infected person to an uninfected person is unlikely.

 

Who is at risk for infection?

Persons of all ages are at risk for infection. In the past, Cyclospora infection

was usually found in persons living or traveling in tropical countries. More and

more, cases are being recognized in countries such as the United States and

Canada. The risk may vary with season. Infection may be most common in spring

and summer. However, we do not yet know how common Cyclospora infection is.

 

What are the symptoms of infection?

Cyclospora infects the small intestine (bowel) and usually causes watery

diarrhea, with frequent bowel movements. Other symptoms include loss of

appetite, weight loss, bloating, increased gas, stomach cramps, nausea,

vomiting, tiredness, muscle aches, and low-grade fever. Other infectious

organisms can cause similar illness. Some persons infected with Cyclospora do

not develop any symptoms.

 

The time between becoming infected and developing symptoms is usually several

days to a week. If not treated, the illness may last for a few days to a month

or longer. It may also return one or more times.

 

What should you do if you think you may be infected?

If you think you may be infected with Cyclospora, you should consult your

physician. Identification of this parasite in stool requires special laboratory

tests that are not routinely used. Therefore, your physician should specifically

request testing for Cyclospora. More than one stool sample may be needed. Your

physician may also want to have your stool checked for other infectious

organisms that can cause similar symptoms.

 

How is infection treated?

Infection with Cyclospora is treated with antibiotics. Trimethoprim-

sulfamethoxazole, also known as Bactrim*, Septra*, or Cotrim* (a combination of

two antibiotics), is recommended. Infected persons with diarrhea should rest and

drink plenty of fluids. They should seek their physician's advice before taking

medicine to slow their diarrhea.

 

How is infection prevented?

Cyclospora infection can be prevented by avoiding water or food that may be

contaminated with stool. Persons who have previously been infected with

Cyclospora can become infected again.

 

For more information about Cyclospora infection, refer to the following

articles.

Chiodini PL. A " new " parasite: human infection with Cyclospora cayetanensis.

Trans R Soc Trop Med Hyg 1994;88;369-71.

 

 

Hoge CW, et al. Placebo-controlled trial of co- trimoxazole for cyclospora

infection among travellers and foreign residents in Nepal. Lancet

1995;345:691-3.

 

 

Hoge CW, et al. Epidemiology of diarrhoeal illness associated with

coccidian-like organisms among travellers and foreign residents in Nepal. Lancet

1993;341:1175-9.

 

 

Huang P, et al. The first reported outbreak of diarrheal illness associated

with Cyclospora in the United States. Ann Intern Med 1995;123:409-14.

 

 

Ortega YR, et al. Cyclospora species - a new protozoan pathogen of humans. N

Engl J Med 1993;328:1308-12.

 

 

Pape JW, et al. Cyclospora infection in adults infected with HIV: clinical

manifestations, treatment, and prophylaxis. Ann Intern Med 1994;121:654-7.

 

 

Wurtz R. Cyclospora: a newly identified intestinal pathogen of humans. Clin

Infect Dis 1994;18:620-3.

 

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

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