Cyclosporiasis

In recent years, foodborne illnesses have become more recognised for their public health impact, especially in developing countries. One such infection is Cyclosporiasis, which is caused by ingesting food or water contaminated with the Cyclospora cayetanensis parasite. It is most common in tropical and subtropical regions but has also led to multiple outbreaks in developed nations through imported produce.

Cyclosporiasis can cause prolonged, watery diarrhoea and gastrointestinal discomfort, often disrupting daily life. This guide presents an in-depth understanding of the condition, focusing on its causes, diagnosis, management, and prevention.

Cyclosporiasis is an intestinal infection caused by the single-celled parasite Cyclospora cayetanensis. The parasite is primarily transmitted through ingestion of contaminated food or water. Unlike many other parasitic infections, person-to-person transmission is unlikely because the oocysts (eggs) need days to weeks in the environment to become infectious.

The disease affects both adults and children and can range from mild to severe depending on an individual’s immune status. In immunocompromised people, symptoms can persist longer and require more aggressive treatment.

Globally, cyclosporiasis has been reported in over 56 countries, with the highest burden in tropical and subtropical regions. Outbreaks in the United States and Canada are often linked to imported fresh produce such as basil, raspberries, lettuce, and coriander.

In India, the disease is underreported, but a few regional studies have highlighted Cyclospora presence, especially in the monsoon and post-monsoon seasons due to water contamination and poor sanitation.

Cyclosporiasis doesn’t have different types in the traditional medical sense. However, it may be classified based on:

1. Acute Cyclosporiasis: Short-term infection in healthy individuals.
2. Chronic or Recurrent Cyclosporiasis: Seen in immunocompromised individuals such as HIV/AIDS patients or those on immunosuppressive therapy.

Cyclosporiasis is caused by the ingestion of food or water contaminated with Cyclospora cayetanensis oocysts. Key causes include:

• Consumption of raw or undercooked produce (e.g. berries, lettuce, coriander)
• Poor food hygiene practices during harvesting, handling, and packaging
• Drinking untreated or contaminated water
• Travelling to endemic regions with poor sanitation

Symptoms usually begin about a week (2-14 days) after ingestion of contaminated food or water. Common signs include:

• Profuse, watery diarrhoea (most prominent symptom)
• Abdominal cramps or pain
• Nausea
• Bloating and gas
• Fatigue
• Low-grade fever
• Loss of appetite
• Weight loss
• Vomiting (in some cases)

If untreated, symptoms may last for several weeks and relapse even after temporary improvement.

Diagnosing cyclosporiasis requires specific laboratory testing. Diagnosis methods include:

1. Microscopic Stool Examination:
   
   • Modified acid-fast staining to detect Cyclospora oocysts.
      
2. Molecular Testing:
   
   • Polymerase Chain Reaction (PCR) tests for Cyclospora DNA.
      
3. Stool Concentration Techniques:
   
   • Increases the chances of identifying oocysts.
      

Due to the similarity of symptoms with other gastrointestinal illnesses, diagnosis often requires repeat stool samples.

Treatment is usually straightforward with antimicrobial therapy. The standard treatment includes:

• Trimethoprim-sulfamethoxazole (TMP-SMX): A combination antibiotic that is highly effective.
  
  • Adults: 160 mg/800 mg twice daily for 7-10 days
  • Children: Dosed according to body weight. (Brand: Septran Tablet\)

If allergic to sulfa drugs, alternative treatment options are limited, and symptom management becomes important:

• Rehydration with fluids and electrolytes(Walatral ORS)
• Antidiarrhoeal medications (only under medical advice)

Immunocompromised individuals may require longer courses and close monitoring.

There is limited evidence supporting alternative therapies for cyclosporiasis. However, some supportive remedies may include:

• Probiotics: Help restore gut flora balance during or after antibiotic treatment.
• Herbal remedies like ginger or peppermint tea to ease nausea.
• Rehydration with ORS and coconut water to replenish lost fluids naturally.

Alternative therapies should not replace standard medical treatment.

Certain factors increase the risk of acquiring cyclosporiasis:

• Travel to tropical or subtropical countries
• Consuming unwashed fruits and vegetables
• Drinking untreated water
• Poor hand hygiene
• Immunosuppressed conditions (e.g. HIV/AIDS, cancer treatment)
• Occupation (agriculture, food handling)

If left untreated or in immunocompromised individuals, cyclosporiasis can lead to:

• Severe dehydration
• Electrolyte imbalance
• Malnutrition due to prolonged diarrhoea
• Weight loss
• Chronic fatigue
• Relapsing infections

In rare cases, hospitalisation may be necessary for severe cases or persistent dehydration.

While most cases are temporary, coping with symptoms can be challenging. These tips can help manage the condition:

• Stay hydrated: Drink plenty of fluids to combat dehydration
• Rest: Fatigue is common; ensure adequate sleep and recovery time
• Maintain a bland diet: Eat easily digestible foods such as rice, bananas, and toast
• Monitor symptoms: Keep a symptom journal and consult your doctor if diarrhoea persists
• Follow medication strictly: Complete the full course even if symptoms improve

1. Myth: It spreads from person to person.
   
   
   • Fact: The oocysts require days to become infectious in the environment, making direct transmission unlikely.
      
2. Myth: Only poor countries are affected.
   
   
   • Fact: Several outbreaks in the U.S. and Canada show it can occur anywhere due to global food trade.
      
3. Myth: Washing produce with water is enough.
   
   
   • Fact: Proper disinfection is often needed. Rinse thoroughly and peel if possible.
      

Seek medical advice if:

• Diarrhoea persists for more than 3 days
• You notice blood or mucus in stool
• You experience severe abdominal pain or fever
• You're immunocompromised and develop gastrointestinal symptoms
• Symptoms return after initial recovery
• Early diagnosis prevents complications and ensures quicker recovery.

• What tests are needed to confirm cyclosporiasis?
• How long will treatment last?
• Are there dietary restrictions I should follow?
• Can I travel during treatment?
• Is it safe to return to work or school?
• What should I do if symptoms come back?
   

Supportive care from family and friends can help with faster recovery:

• Encourage fluid intake and healthy meals
• Help with chores or responsibilities during recovery
• Be empathetic and avoid minimising their symptoms
• Accompany them to doctor appointments if needed
• Ensure they take prescribed medication regularly
   

Cyclosporiasis is a preventable and treatable intestinal infection caused by the Cyclospora parasite. With rising international trade and travel, awareness of this illness is increasingly important. Timely diagnosis, appropriate antimicrobial therapy, and prevention through hygiene and food safety can drastically reduce the burden of the disease. While often mild in healthy individuals, immunocompromised people should be especially cautious.

By educating the public and improving sanitary conditions, especially in developing regions, cyclosporiasis can be effectively managed and controlled.