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At least 19 recordsLinked to original sources
PubMed1999

The return of Cyclospora in 1997: another outbreak of cyclosporiasis in North America associated with imported raspberries. Cyclospora Working Group.

BACKGROUND: In the spring of 1996, an outbreak of cyclosporiasis associated with fresh Guatemalan raspberries occurred in the United States and Canada. Another multistate outbreak of cyclosporiasis occurred in North America in the spring of 1997. OBJECTIVE: To identify the vehicle of the outbreak that occurred in the spring of 1997. DESIGN: Retrospective cohort studies of clusters of cases associated with events (such as banquets) and traceback investigations of sources of implicated produce. SETTING: United States and Canada. PATIENTS: Persons who attended events associated with clusters of cases of cyclosporiasis. MEASUREMENTS: Identification of clinically defined or laboratory-confirmed cases of cyclosporiasis and risk factors for infection. RESULTS: 41 clusters of cases were reported in association with events held from 1 April through 26 May in 13 U.S. states, the District of Columbia, and 1 Canadian province. The clusters comprised 762 cases of cyclosporiasis, 192 (25.2%) of which were laboratory confirmed. In addition, 250 laboratory-confirmed sporadic cases were reported in persons who developed gastrointestinal symptoms from April through 15 June, for a total of 1012 cases. Fresh raspberries were the only food common to all 41 events and were the only type of berry served at 9 events (22.0%). Statistically significant associations between consumption of raspberry-containing items and cyclosporiasis were documented for 15 events (40.5% of 37). For 31 of the 33 events with well-documented traceback data, the raspberries either definitely came from Guatemala (8 events) or could have come from Guatemala (23 events). The mode of contamination of the raspberries remains unknown. The outbreak ended shortly after the exportation of fresh raspberries from Guatemala was voluntarily suspended at the end of May 1997. CONCLUSIONS: Similar multistate, multicluster outbreaks of cyclosporiasis associated with consumption of Guatemalan raspberries have occurred in consecutive years. These outbreaks highlight the need for better understanding of the biology and epidemiology of Cyclospora cayetanensis and for stronger prevention and control measures to ensure the safety of produce eaten raw.

Animals↗
PubMed1997

An outbreak in 1996 of cyclosporiasis associated with imported raspberries. The Cyclospora Working Group.

BACKGROUND: Cyclospora cayetanensis is a parasite that causes gastroenteritis. Until last year most of the documented cases of cyclosporiasis in North America were in overseas travelers. In 1996, a large outbreak of cyclosporiasis occurred in North America. We investigated this outbreak. METHODS: Health departments solicited information from clinicians and laboratories on cases of cyclosporiasis, which were then reported to the Centers for Disease Control and Prevention and to Health Canada. We conducted retrospective cohort studies for the cases associated with events (e.g., luncheons) and attempted to identify the sources of the implicated food. RESULTS: A total of 1465 cases of cyclosporiasis were reported by 20 states, the District of Columbia, and 2 provinces. Of these cases, 978 (66.8 percent) were laboratory confirmed and 725 (49.5 percent) were associated with 55 events that were held from May 3 through June 14. Raspberries were definitely served at 50 events and may have been served at 4 events. For 27 of the 41 events for which adequate data were available (65.8 percent), the associations between the consumption of berries (raspberries with or without other berries) and cyclosporiasis were statistically significant (P<0.05). For all 29 events for which there were good data, the raspberries definitely came from Guatemala (21 events, 72.4 percent) or may have come from Guatemala (8 events, 27.6 percent). As few as five Guatemalan farms could have accounted for the 25 events for which the raspberries could be traced to a single exporter per event. The mode of contamination of the raspberries remains unclear. CONCLUSIONS: This large outbreak of cyclosporiasis in North America in 1996 was associated with the consumption of Guatemalan raspberries. The outbreak illustrates the need to consider that a local cluster of foodborne illness may be part of a widespread outbreak and to pursue investigations to the source of the implicated vehicle.

Adolescent↗
PubMedDate not supplied

Cyclosporiasis associated with imported raspberries, Florida, 1996.

OBJECTIVES: Until 1995, infection with Cyclospora cayetanenis, a parasite that causes gastroenteritis, was diagnosed in the US primarily in overseas travelers; its modes of transmission were largely unknown. In 1995, 45 cases of cyclosporiasis were diagnosed in Florida residents who had no history of recent foreign travel, but an investigation could not pinpoint a source for the parasite. In 1996, a North American outbreak of cyclosporiasis resulted in more than 1400 cases, 180 of them in Florida. The authors investigated the 1996 Florida outbreak to identify the vehicle of transmission. METHODS: The authors conducted a matched case-control study in which each of 86 laboratory-confirmed sporadic cases was matched with up to four controls. They also investigated nine clusters of cases associated with common meals and attempted to trace implicated foods to their countries of origin. RESULTS: In the case control study, eating raspberries was strongly associated with cyclosporiasis (matched odds ratio = 31.9; 95% confidence interval [CI] 7.4, 138.2). In the cluster investigation, raspberries were the only food common to all nine clusters of cases; a summary analysis showed a strong association between consumption of raspberries and confirmed or probable cyclosporiasis (risk ratio = 17.6; 95% CI 1.9, 188.8). Guatemala was the sole country of origin for raspberries served at six of nine events. CONCLUSIONS: Guatemalan raspberries were the vehicle for the 1996 Florida cyclosporiasis outbreak. Cyclospora is a foodborne pathogen that may play a growing role in the etiology of enteric disease in this country as food markets become increasingly international.

Adult↗
PubMed1998

A foodborne outbreak of cyclosporiasis caused by imported raspberries.

BACKGROUND: Cyclospora cayetanensis is a recently recognized parasite that causes prolonged diarrheal illness. Its modes of transmission have not been fully determined, although some investigations before 1996 implicated water. Outbreaks of cyclosporiasis in the United States in 1996 and 1997 are evidence of the increasing incidence of this disease. This report describes an outbreak of cyclosporiasis in persons who attended a luncheon on May 23, 1996, near Charleston, South Carolina. METHODS: In this retrospective cohort study, we interviewed all 64 luncheon attendees and the chef regarding food and beverage exposures. A case of cyclosporiasis was defined as diarrhea (> or = 3 loose stools per day or > or = 2 loose stools per day if using antimotility drugs) after attending the luncheon. We identified sporadic cases of cyclosporiasis and traced the implicated food. RESULTS: Of 64 luncheon attendees, 38 (59%) met the case definition. Persons who ate raspberries (relative risk [RR] = 5.4; 95% confidence interval [CI], 2.2-13.2) or potato salad (RR = 1.8; 95% CI, 1.2-2.6) were at significantly increased risk for illness. The population attributable risk percentages were 73% for raspberries and 20% for potato salad. Cyclospora oocysts were found in stools from 11 (85%) of the 13 case patients submitting specimens for testing. Implicated raspberries originated in Guatemala. CONCLUSIONS: Our investigation is one of the first studies to implicate a specific food (raspberries) as a vehicle for transmission of Cyclospora. Because of the apparent increasing incidence of cyclosporiasis in the United States, family physicians should consider testing for Cyclospora in any patient with prolonged, unexplained diarrhea.

Adult↗
PubMed2002

Epidemiologic differences between cyclosporiasis and cryptosporidiosis in Peruvian children.

We compared the epidemiologic characteristics of cyclosporiasis and cryptosporidiosis in data from a cohort study of diarrhea in a periurban community near Lima, Peru. Children had an average of 0.20 episodes of cyclosporiasis/year and 0.22 episodes of cryptosporidiosis/year of follow-up. The incidence of cryptosporidiosis peaked at 0.42 for 1-year-old children and declined to 0.06 episodes/child-year for 5- to 9-year-old children. In contrast, the incidence of cyclosporiasis was fairly constant among 1- to 9-year-old children (0.21 to 0.28 episodes/child-year). Likelihood of diarrhea decreased significantly with each episode of cyclosporiasis; for cryptosporidiosis, this trend was not statistically significant. Both infections were more frequent during the warm season (December to May) than the cooler season (June to November). Cryptosporidiosis was more frequent in children from houses without a latrine or toilet. Cyclosporiasis was associated with ownership of domestic animals, especially birds, guinea pigs, and rabbits.

Animals↗
PubMed2005

Outbreak of cyclosporiasis in British Columbia associated with imported Thai basil.

Sporadic outbreaks of cyclosporiasis, a common cause of protracted diarrhoea in underdeveloped countries, are often undetected and undiagnosed in industrial countries. In May 2001, an outbreak of Cyclospora cayetanensis gastroenteritis was identified in British Columbia, Canada, with 17 reported cases. We conducted a case-control study involving 12 out of the 17 reported and confirmed case patients. Eleven (92%) of the patients had consumed Thai basil, an essential ingredient in Vietnamese cuisine, compared to 3 out of 16 (19%) of the control patients (P = 0.003). Trace-back investigations implicated Thai basil imported via the United States as the vehicle for this outbreak. This is the first documented sporadic outbreak of cyclosporiasis linked to Thai basil in Canada, and the first outbreak of cyclosporiasis identified in an ethnic immigrant population. This outbreak provides the opportunity to increase our understanding of this emerging pathogen and improve on our prevention and control for future outbreaks.

Adult↗
PubMedDate not supplied

Cyclosporiasis: a point source outbreak acquired in Guatemala.

BACKGROUND: Cyclosporiasis is a disease due to Cyclospora cayetanensis, an emerging coccidian parasite first described in 1979. It is an orally transmitted disease that is more frequent in tropical and subtropical areas. Cyclospora cayetanensis has been mainly described as a cause of travelers' diarrhea. This pathogen has given rise to a number of epidemic outbreaks attributable to ingestion of imported foods, particularly from tropical areas. METHODS: Descriptive study of clinical and epidemiological data of a small epidemic outbreak of C cayetanensis-induced gastroenteritis. RESULTS: Seven confirmed cases of C cayetanensis among Spanish nationals who had traveled to Antigua Guatemala are described. The incubation period was 6 days. Diarrhea, asthenia, anorexia, borborygmi, flatulence, and abdominal distension were present in all cases. Fever and heart burn in 85.7%. Weight loss in 71.4%. Abdominal pain, rectal tenesmus, and nausea in 42.8%. Vomiting and eructation in 14.2%. Heart burn was a frequent symptom, a finding not often previously described. The infection was probably acquired from raspberry juice. All cases improved with trimethoprim/sulphametoxazol. CONCLUSIONS: Cyclosporiasis is a cause of travelers' diarrhea. Parasitology laboratories must be advised of clinical suspicion of cyclosporiasis so that they can conduct a suitable targeted study; otherwise, false negative results may arise.

Adult↗
PubMed2004

Outbreak of cyclosporiasis associated with snow peas--Pennsylvania, 2004.

During June-July 2004, public health officials in Pennsylvania were notified of cases of the parasitic disease cyclosporiasis among persons associated with a residential facility (e.g., residents, staff, and volunteers). CDC confirmed the diagnosis of Cyclospora cayetanensis infection by examining stool specimens from multiple patients. By early July, local public health officials had been notified of approximately 50 potential cases of cyclosporiasis associated with the facility; onsets of illness were from early June through early July. This report describes the findings of the epidemiologic and traceback investigations, which determined the cases were linked to consumption of raw Guatemalan snow peas at five special events, for which food was prepared by the facility staff, from late May through late June. This is the first documented outbreak of cyclosporiasis linked to snow peas. The Food and Drug Administration (FDA) and CDC are working with Guatemalan officials to determine the sources of the snow peas and possible modes of contamination.

Cluster Analysis↗
PubMed1997

Update: outbreaks of cyclosporiasis -- United States and Canada, 1997.

Since April 1997, CDC has received reports of outbreaks of cyclosporiasis in the United States and Canada (1,2). As of June 11, there have been 21 clusters of cases of cyclosporiasis reported from eight states (California, Florida, Maryland, Nebraska, Nevada, New York, Rhode Island, and Texas) and one province in Canada (Ontario). These clusters were associated with events (e.g., receptions, banquets, or time-place-related exposures [meals in the same restaurant on the same day]) that occurred during March 19-May 25 and comprise approximately 140 laboratory-confirmed and 370 clinically defined cases of cyclosporiasis. In addition, four laboratory-confirmed and approximately 220 clinically defined cases have been reported among persons who, during March 29-April 5, were on a cruise ship that departed from Florida. Approximately 70 laboratory-confirmed sporadic cases (i.e., cases not associated with events, the cruise, or recent overseas travel) have been reported in the United States and Canada. The most recent laboratory-confirmed sporadic case occurred in a person who had onset of symptoms on June 3.

Animals↗
PubMed2001

Outbreak of cyclosporiasis associated with basil in Missouri in 1999.

During the summer of 1999, an outbreak of cyclosporiasis occurred among attendees of 2 events held on 24 July in different counties in Missouri. We conducted retrospective cohort studies of the 2 clusters of cases, which comprised 62 case patients. The chicken pasta salad served at one event (relative risk [RR], 4.25; 95% confidence interval [CI], 1.80-10.01) and the tomato basil salad served at the other event (RR, 2.95; 95% CI, 1.72-5.07) were most strongly associated with illness. The most likely vehicle of infection was fresh basil, which was included in both salads and could have been grown either in Mexico or the United States. Leftover chicken pasta salad was found to be positive for Cyclospora DNA by means of polymerase chain reaction analysis, and 1 sporulated Cyclospora oocyst was found by use of microscopy. This is the second documented outbreak of cyclosporiasis in the United States linked to fresh basil and the first US outbreak for which Cyclospora has been detected in an epidemiologically implicated food item.

Adolescent↗
PubMed2004

Cyclosporiasis associated with diarrhoea in an immunocompetent patient in Turkey.

Cyclospora cayetanensis, the parasitic agent responsible for human cyclosporiasis, is an emerging worldwide cause of diarrhoea in immunocompetent people as well as in immunocompromised patients, such as those with AIDS. Reported here is the case of a 30-year-old Turkish woman, a lawyer, who was admitted to hospital in July 2002 with complaints of watery diarrhoea, anorexia, nausea, vomiting, abdominal pain and weight loss over a period of 1 week. Cyclospora sp. oocysts were determined by using modified Kinyoun's acid-fast stain. The patient was treated with trimethoprim/sulfamethoxazole (160/800 mg) b.i.d. for 7 days. This report is the first example of autochthonous cyclosporiasis in an immunocompetent patient in Turkey.

Adult↗
PubMed2002

Outbreak of cyclosporiasis associated with imported raspberries, Philadelphia, Pennsylvania, 2000.

An outbreak of cyclosporiasis occurred in attendees of a wedding reception held in Philadelphia, Pennsylvania, on June 10, 2000. In a retrospective cohort study, 54 (68.4%) of the 79 interviewed guests and members of the wedding party met the case definition. The wedding cake, which had a cream filling that included raspberries, was the food item most strongly associated with illness (multivariate relative risk, 5.9; 95% confidence interval, 3.6 to 10.5). Leftover cake was positive for Cyclospora DNA by polymerase chain reaction analyses. Sequencing of the amplified fragments confirmed that the organism was Cyclospora cayetanensis. The year 2000 was the fifth year since 1995 that outbreaks of cyclosporiasis definitely or probably associated with Guatemalan raspberries have occurred in the spring in North America. Additionally, this is the second documented U.S. outbreak, and the first associated with raspberries, for which Cyclospora has been detected in the epidemiologically implicated food item.

Adolescent↗
PubMed2006

Incidence of cyclosporiasis in patients with gastrointestinal symptoms in western Turkey.

BACKGROUND: This study was designed to investigate the distribution of cyclosporiasis between October 2003 and October 2004 and the relationship between Cyclospora infection and seasonal as well as patient factors in western Turkey. MATERIAL/METHODS: Stool samples from 4660 immunocompetent patients with gastrointestinal symptoms and 326 immunocompetent patients with allergic symptoms from western Turkey were examined between October 2003 and October 2004 using wet preparation, formalin-ethyl acetate concentration, Trichrome stain, and modified Kinyoun's acid-fast staining methods. RESULTS: Twenty-three patients were found to be infected with Cyclospora oocysts. Parasites such as Cryptosporidium, Giardia intestinalis, Entamoeba histolytica/dispar, Blastocystis hominis and others were also observed. The incidence of cyclosporiasis was higher in summer and early autumn and most of the Cyclospora-infected patients were without diarrhea. CONCLUSIONS: Clinicians with patients from Turkey and abroad who have intestinal symptoms after visiting the country should be aware that Cyclospora infections could be considered as a possible cause of gastrointestinal symptoms in the absence of diarrhea in immunocompetent patients during the summer period in Turkey.

Adult↗
PubMedDate not supplied

The first reported cluster of food-borne cyclosporiasis in Canada.

INTRODUCTION: Prior to 1996, sporadic cases of cyclosporiasis in Canada were most often associated with foreign travel and outbreaks throughout the world were associated with contaminated drinking water. In May 1996, the North York Public Health Department was notified of three laboratory-confirmed cases of cyclosporiasis among persons who attended a luncheon at a religious institution. A ceremonial bath (mikvah) was initially identified as a possible source of exposure to contaminated water. METHODS: Guests of a luncheon were interviewed regarding food, beverage and water exposure. The institution kitchen and water sources were inspected and environmental testing was performed. RESULTS: Eating strawberry flan, decorated with rasberries and blueberries, was associated with developing illness (relative risk = 2.13, p = 0.02). There was no evidence that water exposure was associated with illness. DISCUSSION: This event was the index Canadian cluster of a widespread North American outbreak associated with imported Guatemalan raspberries. The local investigation highlights the role of public health departments in multijurisdictional food-borne outbreaks of emerging pathogens.

Adolescent↗
PubMed2000

Cyclospora cayetanensis: a review, focusing on the outbreaks of cyclosporiasis in the 1990s.

Cyclospora cayetanensis, a coccidian parasite that causes protracted, relapsing gastroenteritis, has a short recorded history. In retrospect, the first 3 documented human cases of Cyclospora infection were diagnosed in 1977 and 1978. However, not much was published about the organism until the 1990s. One of the surprises has been the fact that a parasite that likely requires days to weeks outside the host to become infectious has repeatedly caused foodborne outbreaks, including large multistate outbreaks in the United States and Canada. In this review, I discuss what has been learned about this enigmatic parasite since its discovery and what some of the remaining questions are. My focus is the foodborne and waterborne outbreaks of cyclosporiasis that were documented from 1990 through 1999. The occurrence of the outbreaks highlights the need for health care personnel to consider that seemingly isolated cases of infection could be part of widespread outbreaks and should be reported to public health officials. Health care personnel should also be aware that stool specimens examined for ova and parasites usually are not examined for Cyclospora unless such testing is specifically requested and that Cyclospora infection is treatable with trimethoprim-sulfamethoxazole.

Animals↗
PubMed2002

Cyclosporiasis outbreak in Germany associated with the consumption of salad.

This outbreak is the first foodborne cyclosporiasis outbreak reported from central Europe. The illness was reported in 34 persons who attended luncheons at a German restaurant. The overall attack rate was 85% (34/40). The only foods associated with significant disease risk were two salad side dishes prepared from lettuce imported from southern Europe and spiced with fresh green leafy herbs (p=0.0025).

Cyclospora↗
PubMed2003

A case of human cyclosporiasis causing traveler's diarrhea after visiting Indonesia.

This is the first case of human cyclosporiasis reported in Korea. We detected the oocyst of Cyclospora cayetanensis from a 14-yr old girl who complained of persistent diarrhea after traveling to Indonesia. Round oocysts sized about 8 to 9 m with wrinkle on the wall were found in modified acid fast stained stool specimen. Stainability was variable from red to pale. Oocyst wall showed typical autofluorescence under ultraviolet illumination. The exact diagnosis for the cause of diarrhea and treatment for this patient were not provided at the right moment from the hospital since the diagnostic system for the Cyclospora infection was not ready in the clinical laboratory of the hospital. More attention should be paid on Cyclospora as a cause of diarrhea especially for those returning from a trip to the tropics and an adequate diagnostic system for the Cyclospora infection should be implemented in clinical laboratories as soon as possible.

Adolescent↗
PubMed2006

Cyclosporiasis in an infant.

This report describes cyclosporiasis in a seven month old infant who presented with incessant crying and refusal of feeds. The routine modified ZN stained smears showed the oocysts of Cyclospora when all other tests failed to reveal enteric pathogens. The need for the clinical laboratory to screen faeces samples for all possible pathogens in a given clinical situation needs to be emphasized.

Animals↗