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Key Features

Essentials of Diagnosis

  • Acute diarrhea, especially in children in developing countries

  • Outbreaks of diarrhea secondary to contaminated water or food

  • Prolonged diarrhea in immunocompromised persons

  • Diagnosis mostly by identifying organisms in specially stained stool specimens

General Considerations

  • Causes of coccidiosis

    • Cryptosporidium spp, particularly C parvum and C hominis

    • Isospora belli

    • Cyclospora cayetanensis

    • Sarcocystis species

  • Sarcocystis infects many species

  • Humans are intermediate hosts (infected by ingestion of fecal sporocysts) for some species

  • Humans are definitive hosts for Sarcocystis bovihominis and Sarcocystis suihominis (infected by ingestion of tissue cysts in undercooked beef and pork, respectively)

Demographics

  • Occurs worldwide, particularly in tropics and in regions where hygiene is poor

  • Clustering of cases occurs in households, day care centers, and among sexual partners

Clinical Findings

Symptoms and Signs

  • Usually asymptomatic

  • Gastrointestinal symptoms (eg, diarrhea)

  • Cysts in muscle may cause

    • Myalgias

    • Fever

    • Bronchospasm

    • Pruritic rash

    • Lymphadenopathy

    • Subcutaneous nodules

Differential Diagnosis

  • Infections caused by I belli, C cayetanensis, and Cryptosporidium species

  • Giardiasis

  • Viral gastroenteritis, eg, rotavirus

  • Other traveler's diarrhea, eg, Escherichia coli

  • Cryptosporidiosis

  • Other causes of diarrhea in AIDS, eg, cytomegalovirus colitis

  • Trichinosis

Diagnosis

  • Eosinophilia

  • Elevated creatine kinase

  • Diagnosis is by identification of acid-fast organisms in stool or by identification of trophozoites or bradyzoites in tissue biopsies

Treatment

  • No specific treatment is established

  • Patients may respond to albendazole or trimethoprim-sulfamethoxazole

Outcome

Prevention

  • Water purification

  • Immunocompromised patients should boil or filter drinking water and should consider avoidance of lakes and swimming pools

  • Routine precautions (handwashing, gloves, disinfection) should prevent institutional patient-to-patient spread

References

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Almeria  S  et al. Cyclospora cayetanensis and cyclosporiasis: an update. Microorganisms. 2019 Sep 4;7(9):E317.
[PubMed: 31487898]
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Giangaspero  A  et al. Human cyclosporiasis. Lancet Infect Dis. 2019 Jul;19(7):e226–36.
[PubMed: 30885589]
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Hemphill  A  et al. Comparative pathobiology of the intestinal protozoan parasites Giardia lamblia, Entamoeba histolytica, and Cryptosporidium parvum. Pathogens. 2019 Jul 29;8(3):E116.
[PubMed: 31362451]

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