Background: Cyclospora cayetanensis is an
intestinal protozoon that can infect the
mucosal epithelium of the small intestine. It can cause either acute or chronic gastroenteritis depending on the
immune status of the hosts. We report herein the data regarding demography,
clinical features, diagnostics, treatment, and outcomes of cyclosporiasis at
King Chulalongkorn Memorial Hospital (KCMH), Bangkok, Thailand.
Methods: A retrospective study was carried out in all
patients with cyclosporiasis who attended at KCMH from January 2006 to October 2015.
Results: There were 6 patients including 3 (50%) males with the median age of 31 (IQR 26.25, 44.75) years. Four (66.67%) patients had co-morbid diseases including human immunodeficiency virus infection (HIV) with CD4 count lower than 100 cells/mm3 (2, 33.33%) and diabetes mellitus (2, 33.33%). The median duration of illness before the diagnosis was 3.5 (IQR 3, 16) days. The admission rate was 66.67% with the median length of hospital stay was 9 (IQR 3.75, 15.75) days. Watery diarrhea was the most common presenting symptom (5 patients, 83.33%), followed by abdominal pain (4, 66.67%), nausea (4, 66.67%), vomiting (4, 66.67%), malabsorption syndrome (3, 50%), and fever (2, 33.33%). One patient was asymptomatic. Regarding the degree of dehydration, there were 3, 2, and 1 patients with severe, moderate, and mild dehydration; no patient had hypovolemic shock. The diagnosis was made by the direct simple examination (5 patients, 50%), concentration technique examination (6, 100%) and direct modified acid-fast staining (6, 100%) (Figure). Three (50%) patients had co-infection including giardiasis, Pneumocystis pneumonia, salmonellosis and late latent syphilis. Five (83.33%) patients improved after treatment with volume and electrolytes replacement as well as cotrimoxazole for eradication of the parasite in 2 (33.33%) patients with HIV infection. The mortality rate was zero %.
Conclusion: In our institute, the patients with cyclosporiasis can present with acute or chronic watery dirrhea and malabsorption syndrome either in immunocompetent or immunocompromised host. All patients have made a dramatic response to the specific and supportive treatment.
Figure. The stool examaination for the diagnosis of Cyclospora cayetanensis. A. Multiple oocysts on direct examination and B. Oocyts on modified acid-fast staining (X400).
S. Wiwatrojanagul, None