| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
 |
ABSTRACT |
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION
REFERENCES |
|---|
|
INTRODUCTION |
|
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION
REFERENCES |
|---|
C. cayetanensis has been responsible for numerous outbreaks of food-borne diarrhea in the United States, Canada, and Europe in the late 1990s and 2005, associated with the consumption of imported fresh produce, including raspberries, mesclun lettuce, field greens, snow peas, and basil.6,7 This report details an outbreak of cyclosporiasis in a developing region among the local population.
|
METHODS |
|
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION
REFERENCES |
|---|
The outbreak investigation took place 5 days after the first case of diarrhea was recorded. Patients completed a questionnaire concerning demographics, living conditions, sanitary behaviors, eating habits, and food and beverages consumed during the previous 4 days. Stool samples from cases and controls were collected for identification of parasites using MIF media and stained with the Kinyoun method; BACTY® medium was used for bacterial isolation. There were no food samples available for testing. All laboratory testing was performed at the microbiology and parasitology laboratories of the U.S. Naval Medical Research Center Detachment (NMRCD) in Lima, Peru.
The database was analyzed with the statistical software EPI INFO version 3.3, October 2004 (CDC, Atlanta, Georgia). Statistical description of the data was performed. Categorical variables were compared using the 
2 or the Fisher’s exact test. Univariate odds ratios were calculated for exposure variables. All confidence intervals were obtained at 95%, 2-tailed P values were used, and P < 0.05 indicated statistical significance.
|
RESULTS |
|
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION
REFERENCES |
|---|
). All were male from poor socio-economic settings, with a mean age of 19 years for both case and control populations. The recruits ate all their meals at the base dining hall, as was required. The analysis of the epidemic curve of the outbreak, illustrated in Figure 2, suggests a common point source as mode of transmission with an incubation period between 2–6 days.
|
|
Unfortunately, because a bacterial pathogen was suspected at the outset of the investigation, the questionnaires for consumed foods focused on meals at the onset of the outbreak, and data collected was not pertinent given the mean 7–8 day incubation period of C. cayetanensis. In this investigation, clinical symptoms occurred with the frequencies listed in Table 1. More than 50% of the patients with diarrhea had nausea, discomfort, chills, fever and abdominal pain, consistent with previously reported case series.
|
|
DISCUSSION |
|
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION
REFERENCES |
|---|
In developing countries where cyclosporiasis is endemic, there are higher incidence and prevalence rates among certain groups. Prevalence rates have been reported as high as 28% in poor Peruvian children.4 A 2-year cross-sectional stool survey conducted among children in a shantytown in Peru reported the prevalence rate was highest in children between 2–4 years.13 The rate among children > 11 years was 0%, suggesting either that protective immunity develops with repeated exposure to C. cayetanensis early in life or there may be differential exposure risk in older individuals.3,13,14 Cyclosporiasis is not common in adults from lower socioeconomic groups, likely because of this acquired immunity,4 but adults who live in sanitary conditions have rates similar to children or non-immune patients when they are exposed.12
Reports of point source outbreaks of C. cayetanensis in endemic settings are limited. There have been reports from a wedding in Mexico,8 among expatriates in Indonesia,10 at a British Guhrka military camp in Nepal,15 and among Dutch microbiologists attending a scientific meeting in Indonesia,9 but these have focused on expatriates or upper class groups visiting the developing world. Our data demonstrate that outbreaks of cyclosporiasis do occur in the developing world among local populations. Several hypotheses may explain this being the first report of an outbreak among a local population from a developing region, including the lack of adequate diagnostic capability and the predominance of empirical treatment of presumed bacterial pathogens, often with inexpensive antibiotics such as cotrimoxazole. Also, it is interesting to note that recruit-training camps are extremely crowded and stressful environments, both of which may increase susceptibility to infection.
The exact source of this outbreak is impossible to determine in retrospect. Our questionnaire asked detailed questions about meals, but focused on several days after the likely infectious meal was served. There were no leftover samples of food or water to test for C. cayetanensis. Many potentially contaminated foods were served during this time, including peas, fresh vegetables, and salads. Perhaps most likely to be the source of this outbreak were some of the salsa sauces, which frequently contain basil and other fresh leafy vegetables, but we were unable to address this due to the lack of food samples.
This outbreak investigation contributes to the epidemiologic knowledge about cyclosporiasis, but it also raises many questions, including what constitutes durable immunity to C. cayetanensis, as well as which other factors are involved in clinical infection in local populations that are presumably continuously exposed. The epidemiology of this emerging pathogen has yet to be fully determined.
|
CONCLUSION |
|
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION
REFERENCES |
|---|
Received March 7, 2006. Accepted for publication May 3, 2006.
Acknowledgments: The authors express their gratitude to Dr. Eric Hall and the staff of the Bacteriology Program, NMRCD.
Financial support: This work was supported by DoD-GEIS 847705 82000 25GB B0016. Dr. Gilman received support via TMRC AI051976-02—New tools to Understand and Control Endemic Parasites—Peru.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.
* Address correspondence to David Blazes, Director, Emerging Infections Program American Embassy, Unit 3800 APO, AA 34031. E-mail: blazes{at}nmrcd.med.navy.mil 
The study protocol was approved as non-human subject research by the Naval Medical Research Center Institutional Review Board (Project # 12).
Copyright: Several of the authors are military service members. This work was prepared as part of their official duties. Title 17 U.S.C.
105 provides that ‘Copyright protection under this title is not available for any work of the United States Government’. Title 17 U.S.C. 101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.
Authors’ addresses: Paola A. Torres-Slimming and Jose Quispe, Alerta-DISAMAR System Peruvian Navy; Carmen C. Mundaca, Olga Colina, David J. Bacon, and Andres G. Lescano, Naval Medical Research Center Detachment, Peru; Manuel Moran, and Andres G. Lescano, DoD-Global Emerging Infections System (GEIS). Robert H. Gilman, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205. David Blazes, Director, Emerging Infections Program American Embassy, Unit 3800 APO, AA 34031, Naval Medical Research Center Detachment, Peru; DoD-Global Emerging Infections System (GEIS); and Uniformed Services University, Telephone: 0115115623848, Fax: 0115115613042, E-mail: blazes{at}nmrcd.med.navy.mil.
|
REFERENCES |
|
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION
REFERENCES |
|---|
This article has been cited by other articles:
|
|
 |
|
  Y. R. Ortega and R. Sanchez Update on Cyclospora cayetanensis, a Food-Borne and Waterborne Parasite Clin. Microbiol. Rev., January 1, 2010; 23(1): 218 - 234. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Jeremy Sueker, J.-P. Chretien, J. C. Gaydos, and K. L. Russell Global Infectious Disease Surveillance at DoD Overseas Laboratories, 1999-2007 Am J Trop Med Hyg, January 1, 2010; 82(1): 23 - 27. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Sturtevant, A. Anema, and J. S. Brownstein The New International Health Regulations: Considerations for Global Public Health Surveillance Disaster Med Public Health Preparedness, November 1, 2007; 1(2): 117 - 121. [Abstract] [Full Text] [PDF]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
