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      Brote epidémico por Cyclospora cayetanensis en Medellín, Colombia Translated title: An outbreak of Cyclospora cayetanensis in Medellín, Colombia

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          Abstract

          Objetivo Describir un brote epidémico de enfermedad gastrointestinal en un grupo de 56 pacientes de Medellín, Colombia. Metodología En abril de 2002 se presentó un número inusitado de casos de diarrea y a partir del hallazgo de Cyclospora cayetanensis en uno de los pacientes, se recolectaron 56 muestras de materia fecal de igual número de individuos. Se realizó una encuesta clínico-epidemiológica, coprológico directo, concentración con formol-éter y coloración de Zielh Neelsen modificada. Además, se estudiaron por directo y Zielh Neelsen muestras de algunos alimentos para la búsqueda del parásito. Resultados Del total de pacientes evaluados, 55,4 % (31/56) fueron positivos para C. cayetanensis, de éstos, el 77,4 % (24/31) fueron mujeres, y el 83,9 % (26/31) pertenecía a la Universidad de Antioquia, de los cuales el 88,6 % eran empleados no docentes. No se encontraron diferencias significativas entre pacientes positivos y negativos para Cyclospora con respecto a las manifestaciones clínicas, excepto en la deshidratación que fue mayor en los pacientes con ciclosporidiasis. Sin embargo, se encontró una diferencia significativa con relación al consumo de ensaladas y jugos, la cual fue mayor entre los pacientes positivos que los negativos. Conclusión Se presentó un brote epidémico de C. cayetanensis en pacientes sintomáticos atendidos por el grupo GIEPI en abril de 2002.

          Translated abstract

          Objective Describing an outbreak of gastrointestinal disease in a group of 56 patients from Medellín, Colombia. Methods An unusual number of cases of diarrhoea appeared in April 2002 and 56 samples of stool from the same number of individuals were collected because a patient proved Cyclospora cayetanensis positive. A clinical-epidemiological survey, direct coprology, formol-ether concentration and modified Zielhs Neelsen staining were then carried out. Some food samples were also studied for parasites by direct and modified Zielh Neelsen staining. Results 55,4 % (31/56) of the patients being evaluated proved positive for C. cayetanensis. 77,4 % (24/31) were women and 83,9 % (26/31) belonged to the University of Antioquia, 88,6 % of whom were not teachers. There was no statistically significant difference between positive and negative patients for Cyclospora regarding clinical manifestations, except for dehydration which was greater in patients having cyclosporiasis. However, there was a significant difference regarding consuming salads and juice, this being greater amongst positive patients than negative ones. Conclusion An outbreak of C. cayetanensis appeared in symptomatic patients being taken care of by the GIEPI group during April 2002.

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          Most cited references58

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

          B Herwaldt (2000)
          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.
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            Cyclospora species--a new protozoan pathogen of humans.

            Organisms referred to as "cyanobacterium-like bodies" have now been identified worldwide in the feces of both immunocompetent and immunocompromised patients with diarrhea. Organisms with a similar appearance have been isolated from Peruvian patients since 1985. From 1988 to 1991 we studied prospectively two cohorts of infants and young children infected with this organism. We now attempt to identify it. Fecal samples were collected weekly from the children and examined with the use of acid-fast staining and staining with a monoclonal antibody specific for cryptosporidium. Stools positive for cyanobacterium-like bodies were preserved in potassium dichromate and exposed to conditions allowing coccidian sporulation and excystation. Both unsporulated and sporulated oocysts were fixed by freeze-substitution techniques and then examined by electron microscopy. Organisms isolated from the feces of Peruvian patients and two patients from the United States were identified as belonging to the coccidian genus cyclospora, after sporulation and excystation of the oocysts according to standard techniques. Complete sporulation occurred within 5 to 13 days in oocysts maintained in potassium dichromate at 25 or 32 degrees C. Complete excystation resulted in the liberation of two sporozoites from the two sporocysts within each oocyst (cryptosporidia have four naked sporozoites within each oocyst). The presence of organelles characteristic of coccidian organisms was confirmed by electron microscopy. We have identified organisms of the genus cyclospora that are remarkably similar to cryptosporidia in their morphologic features and the diarrheal disease that they produce in humans. The complete life cycle and epidemiology of this new protozoan parasite remain to be described.
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              Detection of Cyclospora cayetanensis in travellers returning from the tropics and subtropics using microscopy and real-time PCR.

              We examined 100 stool specimens of returning travellers with diarrhoea for the presence of Cyclospora cayetanensis using fluorescence microscopy and real-time PCR. C. cayetanensis was found in four cases with microscopy and PCR. One additional sample was positive only by PCR, and could be confirmed by microscopic examination of several additional slides. C. cayetanensis was the most frequent parasitic cause of diarrhoea after Giardia duodenalis.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rsap
                Revista de Salud Pública
                Rev. salud pública
                Instituto de Salud Publica, Faculdad de Medicina -Universidad Nacional de Colombia (Bogotá )
                0124-0064
                December 2006
                : 8
                : 3
                : 258-268
                Affiliations
                [1 ] Universidad de Antioquia
                [2 ] Universidad de Antioquia
                [3 ] Consultor independiente en Sistemas de Gestión de Inocuidad de Alimentos
                [4 ] Universidad de Antioquia
                Article
                S0124-00642006000300011
                10.1590/S0124-00642006000300011
                ac51e36d-5806-4583-bd1a-83828410569f

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Colombia

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=0124-0064&lng=en
                Categories
                Health Policy & Services

                Public health
                Cyclosporiasis,Cyclospora cayetanensis,diarrhoea,enteritis,outbreak,Ciclosporiasis,diarrea,Brote epidémico

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