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Cyclosporosis is the presence of parasites in the digestive tract caused by Cyclospora cayetanensis, a protozoan belonging to the coccidia. Infection with the parasite causes in the patient recurrent watery diarrhea accompanied by other gastrointestinal symptoms. Constipation is not uncommon during the diarrhea-free period.
Cyclosporosis — epidemiology
Cyclosporosis is a cosmopolitan parasitosis and its invasion is spread by the faecal-oral route. The source of infection is contaminated with oocysts Cyclospora cayetanensis:
- water,
- foods (especially vegetables and fruits).
Attention! Direct contact with a sick person does not pose a risk of infection with cyclosporosis.
During faecal excretion, Cyclospora cayetanensis oocysts are not infectious material to other humans. Only after several or several days in the external environment, the oocysts acquire invasive abilities. Cyclosporosis is one of the etiological factors of traveller’s diarrhea, and cases of invasions affect people traveling to countries with low sanitary, hygienic and socioeconomic standards of the warm and hot climate zone. Cyclospora cayetanensis is an opportunistic pathogen that causes diarrhea in immunocompromised individuals.
The causes of the occurrence of cyclosporosis
The causative agent of cyclosporosis is Cyclospora cayetanensis, a protozoan belonging to the coccidia.
Cyclosporosis – symptoms
The invasion causes inflammation of the lining of the small intestine. There have been reports of biliary involvement and symptoms of cholangitis.
Clinical symptoms of cyclosporosis
Infection with cyclosporosis causes the patient to have watery diarrhea that tends to recur. In addition, the disease is accompanied by other gastrointestinal symptoms, such as:
- nausea,
- stomach pain,
- flatulence
- constipation is not uncommon (in the period of relaxation).
Diagnostics of cyclosporosis
The diagnostic method of choice is microscopic examination of feces under ultraviolet light. Routine parasitological examination of faeces under a microscope is of little use. In addition, it is sometimes helpful in recognition staining of preparations by the Ziehl-Neelsen method. Viewing multiple faecal specimens is important due to the irregular excretion of Cyclospora cayetanensis oocysts, often in negligible numbers. The identification of the protozoan confirms the invasion.
Differentiation
Cyclosporosis should be differentiated from:
- giardiasis,
- cryptosporidiosis,
- isosporosis.
In addition, infectious diarrhea of a different etiology and disturbances in the functioning of the intestines must be taken into account.
Cyclosporosis – treatment
- In immunocompetent patients, nitazoxanide is administered in a dose of 500 mg twice daily for 2 days. The therapeutic effect is also achieved by the administration of trimoxazole at a dose of 7 mg twice daily for seven days.
- In the case of people with immune deficiencies, it is advisable to double the daily dose (4 times 960 mg) and extend the treatment to 10 days. This is followed by supportive treatment with 960 mg cotrimoxazole three times per week.
Ciprofloxacin is also used in the treatment of cyclosporosis. The recommended dosage is 2 times 500 mg for seven days. Maintenance therapy in immunocompromised patients is the administration of ciprofloxacin at a dose of 500 mg three times a week.
Important! The use of drugs that inhibit intestinal peristalsis is not recommended.
Can cyclosporosis be prevented?
The preventive treatment of cyclosporosis consists in:
- compliance with basic hygiene rules,
- consuming treated drinking water,
- avoiding food products that may be contaminated with pathogens, including Cyclospora cayetanensis oocysts.
What’s the prognosis?
The prognosis of the disease is favorable in people with an efficient immune system, in HIV-infected people dependent on effective cART.
Source: J. Cianciara, J. Juszczyk, Infectious and parasitic diseases; Czelej Publishing House