Cyclosporiasis in travellers returning to the United Kingdom from Mexico in summer 2017: lessons from the recent past to inform the future

Marques, Diogo F P; Alexander, Claire L.; Chalmers, Rachel M.; Elson, Richard; Freedman, Joanne; Hawkins, Gillian; Lo, Janice; Robinson, Guy; Russell, Katherine; Smith‐Palmer, Alison; Kirkbride, Hilary; Chiodini, Peter L.; Godbole, Gauri

doi:10.2807/1560-7917.es.2017.22.32.30592

Cited by 14 publications

(8 citation statements)

References 14 publications

(14 reference statements)

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“…The two cases of C. cayetanensis were from group B and would routinely only have been tested for bacterial agents. Since the detection rate was so low, no conclusions can be drawn, but C. cayetanensis has increased in, for example, the USA [16], and attention should be given to a potential increase in other places.…”

Section: Discussionmentioning

confidence: 99%

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Protozoan infections are under-recognized in Swedish patients with gastrointestinal symptoms

Ögren

Dienus

Beser

et al. 2020

Eur J Clin Microbiol Infect Dis

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In acute gastroenteritis (GE), identification of the infectious agent is important for patient management and surveillance. The prevalence of GE caused by protozoa may be underestimated in Swedish patients. The purpose was to compare the prevalence of E. histolytica, Cryptosporidium spp., G. intestinalis, and C. cayetanensis in samples from patients where the clinician had requested testing for gastrointestinal parasites only (n = 758) to where testing for bacterial GE only (n = 803) or where both parasite and bacterial testing (n = 1259) was requested and a healthy control group (n = 197). This prospective cohort study was conducted in Region Jönköping County, Sweden (October 2018–March 2019). Fecal samples were analyzed with microscopy and real-time PCR. Cryptosporidium spp. was detected in 16 patients in the bacterial GE group and in 13 in the both bacterial and parasite group; no cases were detected in the group were only parasite infection was suspected. C. cayetanensis was detected in two patients in the bacterial GE group. One case of E. histolytica was detected in the bacterial group and one in the both bacterial and parasite group. G. intestinalis was detected in 14 patients in the parasite only group, 12 in the both parasite and bacterial group, three in the bacterial GE group, and one in the control group. Diarrhea caused by protozoa, especially Cryptosporidium was under–recognized by clinicians and is likely more common than hitherto estimated in Sweden. A more symptom-based diagnostic algorithm may increase detection and knowledge about protozoan infections.

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Section: Discussionmentioning

confidence: 99%

“…Cyclospora cayetanensis is an intestinal parasite that has caused major outbreaks in the USA, Canada, and Mexico in recent years [16]. The incidence in Sweden is unknown because the infection is not subject to notification.…”

Section: Introductionmentioning

confidence: 99%

Protozoan infections are under-recognized in Swedish patients with gastrointestinal symptoms

Ögren

Dienus

Beser

et al. 2020

Eur J Clin Microbiol Infect Dis

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“…Countries visited were: Bali, Bangladesh, Bolivia, Bulgaria, Cambodia, China, Colombia, Costa Rica, Cuba, the Dominican Republic, Gabon, the Greek Islands, Guatemala, Hong-Kong, India, Indonesia, Java, Lebanon, Madagascar, Malaysia, Mexico, Morocco, Nepal, Nigeria, Pakistan, Peru, Puerto Rico, Singapore, the Solomon Islands, South-East Asia, Sri Lanka, Thailand, Turkey and Vietnam [3]. In some European countries, including Spain [112,113,114], the UK [45,115,116,117]; Poland [118] or Germany [119], all C. cayetanensis cases diagnosed were related to traveler’s diarrhea. In the Czech Republic, out of six cases reported, five had traveled to endemic areas while the other patient did not have any travel history outside the country [120].…”

Section: Transmission and Epidemiologymentioning

confidence: 99%

Cyclospora cayetanensis and Cyclosporiasis: An Update

2019

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Cyclospora cayetanensis is a coccidian parasite of humans, with a direct fecal–oral transmission cycle. It is globally distributed and an important cause of foodborne outbreaks of enteric disease in many developed countries, mostly associated with the consumption of contaminated fresh produce. Because oocysts are excreted unsporulated and need to sporulate in the environment, direct person-to-person transmission is unlikely. Infection by C. cayetanensis is remarkably seasonal worldwide, although it varies by geographical regions. Most susceptible populations are children, foreigners, and immunocompromised patients in endemic countries, while in industrialized countries, C. cayetanensis affects people of any age. The risk of infection in developed countries is associated with travel to endemic areas and the domestic consumption of contaminated food, mainly fresh produce imported from endemic regions. Water and soil contaminated with fecal matter may act as a vehicle of transmission for C. cayetanensis infection. The disease is self-limiting in most immunocompetent patients, but it may present as a severe, protracted or chronic diarrhea in some cases, and may colonize extra-intestinal organs in immunocompromised patients. Trimetoprim-sulfamethoxazole is the antibiotic of choice for the treatment of cyclosporiasis, but relapses may occur. Further research is needed to understand many unknown epidemiological aspects of this parasitic disease. Here, we summarize the biology, epidemiology, outbreaks, clinical symptoms, diagnosis, treatment, control and prevention of C. cayetanensis; additionally, we outline future research needs for this parasite.

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“…Cases in temperate regions are often associated with travel to countries where the disease is endemic or with foodborne outbreaks linked to various types of imported fresh produce ( 2 – 4 ). Cases in Canada and the United Kingdom have in recent years been increasingly associated with travel to the Riviera Maya and Cancun areas in Mexico ( 5 , 6 ).…”

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confidence: 99%

Mitochondrial Junction Region as Genotyping Marker for Cyclospora cayetanensis

Nascimento¹,

Barta²,

Whale³

et al. 2019

Emerg. Infect. Dis.

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Cyclosporiasis is an infection caused by Cyclospora cayetanensis , which is acquired by consumption of contaminated fresh food or water. In the United States, cases of cyclosporiasis are often associated with foodborne outbreaks linked to imported fresh produce or travel to disease-endemic countries. Epidemiologic investigation has been the primary method for linking outbreak cases. A molecular typing marker that can identify genetically related samples would be helpful in tracking outbreaks. We evaluated the mitochondrial junction region as a potential genotyping marker. We tested stool samples from 134 laboratory-confirmed cases in the United States by using PCR and Sanger sequencing. All but 2 samples were successfully typed and divided into 14 sequence types. Typing results were identical among samples within each epidemiologically defined case cluster for 7 of 10 clusters. These findings suggest that this marker can distinguish between distinct case clusters and might be helpful during cyclosporiasis outbreak investigations.

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Cyclosporiasis in travellers returning to the United Kingdom from Mexico in summer 2017: lessons from the recent past to inform the future

Cited by 14 publications

References 14 publications

Protozoan infections are under-recognized in Swedish patients with gastrointestinal symptoms

Protozoan infections are under-recognized in Swedish patients with gastrointestinal symptoms

Cyclospora cayetanensis and Cyclosporiasis: An Update

Mitochondrial Junction Region as Genotyping Marker for Cyclospora cayetanensis

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