Abstract
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.
Highlights
Cyclospora spp. are protozoan parasites in the phylum Apicomplexa, class Sporozoasida, subclass Coccidiasina, order Eimeriorina, family Eimeriidae
Cyclospora cayetanensis is the only species of the genus Cyclospora known to infect humans
There were reports of organisms initially known as Cyanobacterium-like body or coccidian-like body, blue-green alga, large Cryptosporidium or small Isospora-like organisms associated with diarrhea in humans, which in retrospect were probably C. cayetanensis [3]
Summary
Cyclospora spp. are protozoan parasites in the phylum Apicomplexa, class Sporozoasida, subclass Coccidiasina, order Eimeriorina, family Eimeriidae. Some other species of the genus Cyclospora have been described in non-human primates [4,5,6,7,8,9] and most probably are host-specific. Oocysts resembling Cyclospora have been found in the feces of several animals, including dogs, mice, rats, monkeys, ducks, chickens, and other avian species [13,14,15,16,17,18]. Other authors suggest that free living nematodes, insects, and rotifers could play a role in the spread of Cyclospora [3] Together, these data seem to confirm that humans are the only natural host for C. cayetanensis and, the major reservoir. This review presents updated aspects on the biology, epidemiology, outbreaks, clinical symptoms, diagnosis, treatment, control and prevention of C. cayetanensis and outlines future research needs to fill the knowledge gaps for this parasite
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