Outbreaks of Cyclosporiasis -- United States, 1997
In April and May 1997, CDC received reports of seven
event-associated clusters of cases of cyclosporiasis from five
states (California, Florida, Nevada, New York, and Texas).
Approximately 80 cases of infection with human-associated
Cyclospora, a recently characterized coccidian parasite (1), have
been laboratory-confirmed. State and local health departments, CDC,
and the Food and Drug Administration are conducting investigations
to identify the vehicles of infection.
Both foodborne and waterborne outbreaks of cyclosporiasis have
previously been reported in the United States during spring and
summer months (2-4). In 1996, a total of 978 laboratory-confirmed
cases of cyclosporiasis in the United States and Canada were
reported in association with a widespread foodborne outbreak (3).
The average incubation period of cyclosporiasis is 1 week. Illness
can be protracted (from days to weeks) with frequent, watery stools
and other gastrointestinal symptoms; symptoms may remit and
relapse. Health-care providers should consider Cyclospora infection
in persons with prolonged diarrheal illness and specifically
request laboratory testing for this parasite (5,6), which is not
routinely performed by most laboratories.
Cyclosporiasis can be treated with a 7-day course of oral
trimethoprim (TMP)-sulfamethoxazole (SMX) (for adults, 160 mg TMP
plus 800 mg SMX twice daily; for children, 5 mg/kg TMP plus 25
mg/kg SMX twice daily) (7). Treatment regimens for patients who
cannot tolerate sulfa drugs have not yet been identified.
Health departments that identify cases of cyclosporiasis
should contact CDC's Division of Parasitic Diseases, National
Center for Infectious Diseases, telephone (770) 488-7760.
Reported by: State and local health departments. Office of
Regulatory Affairs, and Center for Food Safety and Applied
Nutrition, Food and Drug Administration. Div of Parasitic Diseases,
National Center for Infectious Diseases, CDC.
References
Ortega YR, Sterling CR, Gilman RH, Cama VA, Dæaz F. Cyclospora
species -- a new protozoan pathogen of humans. N Engl J Med
1993;328:1308-12.
CDC. Update: outbreaks of Cyclospora cayetanensis infection --
United States and Canada, 1996. MMWR 1996;45:611-2.
Herwaldt BL, Ackers M-L, Cyclospora Working Group. An outbreak
in 1996 of cyclosporiasis associated with imported raspberries.
N
Engl J Med 1997;336:1548-56 (in press).
Huang P, Weber JT, Sosin DM, et al. The first reported outbreak
of diarrheal illness associated with Cyclospora in the United
States. Ann Intern Med 1995;123:409-14.
Soave R. Cyclospora: an overview. Clin Infect Dis
1996;23:429-37.
Garcia LS, Bruckner DA. Diagnostic medical parasitology. 3rd ed.
Washington, DC: American Society for Microbiology, 1997:66-9.
Hoge CW, Shlim DR, Ghimire M, et al. Placebo-controlled trial of
co-trimoxazole for Cyclospora infections among travellers and
foreign residents in Nepal. Lancet 1995;345:691-3.
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