Abstract
The intestinal coccidian parasites Cryptosporidium spp. and Cyclospora cayetanensis have emerged as significant human pathogens worldwide. The reports of Cyclospora cayetanensis infection in the Middle East are sporadic and no case has been reported from Kuwait. Stool specimens were collected from six individuals presenting with watery diarrhoea of varying degree and severity at the District General hospitals, Kuwait. Four patients were male, two were female and their ages ranged from 5 to 64 years. Three cases were seen among the migrant population from the Indian subcontinent who had recently returned to Kuwait and two cases were seen in the local population with no history of travel abroad. The stool smears were stained with modified acid-fast stain and examined under ultraviolet (UV) fluorescence illumination. Cyclospora cayetanensis oocysts with variable staining characteristics were detected by microscopy. Two of the cases were also associated with other enteric pathogens. Clinical suspicion of Cyclospora infection was not recorded for any of the cases. All patients showed remarkable symptomatic and parasitologic improvements upon treatment with trimethoprim/sulfamethoxazole. Cyclospora spp. are important aetiological agents of diarrhoea in the Middle East. An awareness of the parasitic infection and use of appropriate diagnostic modalities are essential to elucidate the clinical and epidemiological significance of the parasitosis in this geographic area.
Highlights
The intestinal coccidian parasites Cryptosporidium spp. and Cyclospora cayetanensis have emerged as significant human pathogens worldwide
We demonstrate that Cyclospora spp. are both imported and endemic in
We present six cases that highlight the problems encountered in a routine laboratory in the diagnosis of Cyclospora cayetanensis in patients with diarrhoea to clarify and resolve some of the dilemmas and to elaborate on the clinical and epidemiological significance of the findings (Table 1)
Summary
The intestinal coccidian parasites Cryptosporidium spp. and Cyclospora cayetanensis have emerged as significant human pathogens worldwide. The reports of Cyclospora cayetanensis infection in the Middle East are sporadic and no case has been reported from Kuwait. Cyclospora cayetanensis is an important emerging cause of diarrhoea worldwide that generally causes mild to moderate self-limiting diarrhoea in immunocompetent hosts and prolonged severe diarrhoea in immunocompromised individuals [1]. It was first described as causing prolonged, watery diarrhoea in humans in Papua New Guinea, by Ashford in 1979 [2].
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