Cyclospora
                                ==========
þ Cyclospora organism:
 - originally thought to be cyanobacterium, recently proven to be a
   coccidium like Cryptosporidium.  Infects upper intestine, causes
   malabsorption.
 - Bactrim very effective if for 7-10 days.  Very seasonal in Nepal.
   Diarrhea, fatigue, and marked anorexia.  Norfloxaxin and Flagyl
   ineffective.

þ CDC Information on Cyclospora, 3/04:
 - Disease Symptoms and Characteristics

   Cyclospora is spread by people ingesting something (e.g. water or food)
   that was contaminated with infected stool.  Cyclospora needs time (days or
   weeks) after being excreted in stool into the environment to become
   infectious. Therefore, it is unlikely that Cyclospora is passed directly
   from one person to another.

   The incubation period between acquisition of infection and onset of
   symptoms averages 1 week. Cyclospora infects the small intestine and
   typically causes watery diarrhea, with frequent, sometimes explosive, bowel
   movements. Other symptoms can include loss of appetite, substantial loss of
   weight, bloating, increased flatus, stomach cramps, nausea, vomiting,
   muscle aches, low-grade fever, and fatigue. If untreated, illness may last
   for a few days to a month or longer, and may follow a remitting-relapsing
   course. Some infected persons are asymptomatic.

- Treatment Protocol

   Trimethoprim/sulfamethoxazole (TMP/SMX, or Bactrim*, Septra*, or Cotrim*)
   has been shown in a placebo-controlled trial to be effective treatment for
   Cyclospora infection. Adults should receive TMP 160 mg plus SMX 800 mg (one
   double-strength tablet) orally twice a day for 7 days. Children should
   receive 5 mg/kg of the TMP (25 mg/kg of SMX) twice a day for 7 days. Some
   patients may require longer courses of therapy. Patients with AIDS may need
   higher doses of trimethoprim/sulfamethoxazole and long-term maintenance
   treatment.

- Reporting:

   Healthcare providers and laboratory staff should report suspect and
   confirmed cases of cyclosporiasis to their local and State health
   departments. State Health Departments should report cases to DPD/CDC: EISO:
   Adria Prosser (770-488-4520; aprosser@cdc.gov) Epidemiologic associate:
   Michele Hlavsa (770-488-7319; mhlavsa@cdc.gov) Medical epidemiologist:
   Barbara Herwaldt (770-488-7772; bherwaldt@cdc.gov) For more information on
   cyclosporiasis see:
   http://www.cdc.gov/ncidod/dpd/parasites/cyclospora/default.htm