داء الأبواغ الحلقية

(تم التحويل من Cyclosporiasis)
Cyclosporiasis
الأسماء الأخرىcyclosporosis
Cyclospora cayetanensis
التخصصInfectious disease

Cyclosporiasis is a disease caused by infection with Cyclospora cayetanensis, a pathogenic apicomplexan protozoan transmitted by feces or feces-contaminated food and water.[1] Outbreaks have been reported due to contaminated fruits and vegetables. Because the oocysts of Cyclospora must sporulate in the environment for 1–2 weeks before they become infectious, direct person-to-person transmission is very unlikely,[2]. Still, it can be a hazard for travelers as a cause of diarrhea. It is known to cause explosive diarrhea.

العلامات والأعراض

Cyclosporiasis infections are often mild or have no symptoms.[3] When cyclosporiasis does cause symptoms, it frequently causes profuse, watery diarrhea, abdominal pain and cramps, fatigue, mild fever, appetite loss, and weight loss.[3] Disease tends to be more severe in vulnerable people, including infants, the elderly, people who do get sick but do not reside in endemic countries, and people with a weakened immune system, such as people with HIV/AIDS.[3] Dehydration and malnutrition may complicate cases of cyclosporiasis when severe diarrhea occurs.[3]

السبب

Cyclosporiasis primarily affects humans and other primates. When an oocyst of Cyclospora cayetanensis enters the small intestine, it invades the mucosa, where it incubates for about one week.

The parasite particularly affects the jejunum of the small intestine. Of nine patients in Nepal who were diagnosed with cyclosporiasis, all had inflammation of the lamina propria along with an increase of plasma in the lamina propria. Oocysts were also observed in duodenal aspirates.[4]

Oocysts are often present in the environment as a result of using contaminated water or human feces as fertilizer.

التشخيص

Diagnosis can be difficult due to the lack of recognizable oocysts in the feces. PCR-based DNA tests and acid-fast staining can help with identification.[3] A history of recent consumption of foods more likely to be contaminated with Cyclospora oocysts, such as fresh leafy greens, basil, cilantro, or fresh berries, within two weeks of a compatible diarrheal illness during the summer months (peak months of May through August in the USA) should prompt suspicion for cyclosporiasis.[3]

الوقاية

There is no vaccine to prevent cyclosporiasis in humans.[3] One is available to reduce fetal losses in sheep.[citation needed]

Washing hands with soap and water before preparing food and washing fruits and vegetables under running water are the best-known methods to help prevent the spread of cyclosporiasis. It is spread by fecal contamination of food or drinking water and is not likely to be killed by routine sanitization.[5]

العلاج

The infection is often treated with trimethoprim/sulfamethoxazole,[3] also known as Bactrim or co-trimoxazole, because traditional anti-protozoal drugs are insufficient. For people unable to take trimethoprim/sulfamethoxazole (e.g., due to a sulfonamide allergy), nitazoxanide or ciprofloxacin are recommended as alternative agents.[3] However, they are somewhat less effective.[3] To prevent transmission, food should be cooked thoroughly, and drinking fresh water from streams should be avoided.

الانتشار

The first recorded cases of cyclosporiasis in humans were as recently as 1977, 1978, and 1979. They were reported by Ashford, a British parasitologist who discovered three cases while working in Papua New Guinea. Ashford found that the parasite had very late sporulation, from 8–11 days, making the illness difficult to diagnose. When examining feces, the unsporulated oocysts can easily be mistaken for fungal spores and thus are overlooked.[6]

In 2007, Indian researchers published a case report that found an association between Cyclospora infection and Bell's palsy. This was the first reported case of Bell's palsy following chronic Cyclospora infection.[7] In addition to other extra-intestinal reports, cyclosporiasis might be involved in either reversible neuronal damage or other unknown mechanisms to lead to Guillain-Barré syndrome or Bell's palsy.

In 2010, a report of Cyclospora transmission via swimming in the Kathmandu Valley was published in the Journal of Institute of Medicine.[8] The researchers found that openly defecated human stool samples around the swimmer's living quarters and near the swimming pool were positive for Cyclospora. However, they did not find the parasite in dog stool, bird stool, cattle dung, vegetable samples, or water samples. They concluded that pool water contaminated via environmental pollution might have caused the infection, as the parasite can resist chlorination in water.[9]

Cyclosporiasis infections have been reported in Nepal. In one study, Tirth Raj Ghimire, Purna Nath Mishra, and Jeevan Bahadur Sherchan collected samples of vegetables, sewage, and water from ponds, rivers, wells, and municipal taps in the Kathmandu Valley from 2002 to 2004.[10] They found Cyclospora in radish, cauliflower, cabbage, and mustard leaves, as well as sewage and river water. This first epidemiological study determined the seasonal character of cyclosporiasis outbreaks in Nepal during the rainy season, from May to September.[11]

داء حلقيات الأبواغ في مرضى الإيدز

At the beginning of the AIDS epidemic in the early 1980s, cyclosporiasis was identified when found in stool samples of AIDS patients, alongside cryptosporidium which known to be one of the most important opportunistic infections among AIDS patients.[12]

In 2005, Ghimire and Mishra reported a case of cyclosporiasis in a patient with low hemoglobin. They suggested that this coccidian might be involved in reducing hemoglobin due to a lack of the immune system.[13] In 2006, their groups published a paper about the role of cyclosporiasis in HIV/AIDS patients and non-HIV/AIDS patients in the Kathmandu Valley.[14]

In 2008, Indian researchers published a report about the epidemiology of Cyclospora in HIV/AIDS patients in Kathmandu.[15] They examined samples of soil, river water, sewage, chicken stool, dog stool, and stool in the streets, and found them positive for Cyclospora. They also evaluated several risk factors for cyclosporiasis in AIDS patients.[15]

التفشي

Although it was initially thought that Cyclospora was confined to tropical and subtropical regions, cyclosporiasis outbreaks are becoming more frequent in North America. According to the Centers for Disease Control and Prevention, there have been at least 11 documented cyclosporiasis outbreaks in the U.S. and Canada since the 1990s. The CDC also recorded 1,110 laboratory-confirmed sporadic instances of cyclosporiasis.[16]

Between June and August 2013, multiple independent outbreaks of the disease in the U.S. sickened at least 631 people across 25 states.[17][18] Investigations later identified a bagged salad mixture as the cause of an outbreak in Iowa and Nebraska.[19]

In 2015, the CDC was notified of 546 persons with confirmed cyclosporiasis infection across 31 states. Cluster investigations in Texas, where the greatest number of infections was reported, indicated that contaminated cilantro was the culprit.[20]

During July 21–August 8, 2017, the Texas Department of State Health Services (DSHS) was notified of 20 cases of cyclosporiasis among persons who dined at a Mediterranean-style restaurant chain (chain A) in the Houston area.[21]

On July 31, 2018, the United States Department of Agriculture (USDA) issued a public health alert for certain beef, pork and poultry salad and wrap products potentially contaminated with Cyclospora.[22] The contamination came from the chopped romaine lettuce used in these products.

In June 2020, the CDC and other regulatory bodies began investigating an outbreak of Cyclosporiasis in the Midwestern United States linked to bagged salad mix.[23] On June 27, 2020, Fresh Express announced a voluntary recall of over 91 Fresh Express and private label salad products.[24]

In April 2025, the CDC reported an outbreak of Cyclosporiasis in Alabama from cilantro sourced from Mexico that occurred in June 2023.[25] Thirty-eight cases were confirmed, and another nine were suspected from the outbreak.

التفشي بالولايات المتحدة 2026

In 2026, between May 1 and June 16, at least 145 cases of cyclosporiasis were reported across 17 U.S. states, prompting public health officials to investigate potential links to contaminated fresh produce, with the highest case counts reported in New York, Illinois, and Texas.[26][27] In early July 2026, the CDC identified at least eight additional cyclosporiasis clusters in Alabama, Kentucky, Michigan, Ohio, Pennsylvania, Tennessee, Virginia, and West Virginia. Case interviews for these clusters were still pending, and the agency cautioned that investigations remained in their early stages.[28]

The largest of these clusters is in Michigan, which typically logs about 50 cases of cyclosporiasis per year but has recorded 1562 cases[29] since June 22 — a rate pointing to an outbreak with a shared source.[28] Cases are concentrated in the state's southeast region, particularly Wayne County, home to Detroit.[30] Dr. Natasha Bagdasarian, Michigan's chief medical executive, described the case count as a "moving target" likely to keep rising.[30]

Ohio reported 177 cyclosporiasis cases since the start of the year across 43 counties, with 171 of those reported since June 20. New York State reported 112 cases outside New York City, with 107 reported since May 1.

Separately, federal officials were investigating earlier clusters in Illinois, New York City, New York State, Pennsylvania, and Texas that appeared linked to Mexican-style restaurants, a grocery chain, and a catered event, according to an internal CDC email obtained by CNN.[28] Investigators noted that cyclosporiasis is unusually difficult to trace to a single source. Unlike bacterial pathogens such as E. coli or Salmonella, which can be matched to contaminated food through DNA sequencing via the PulseNet surveillance network, Cyclospora cannot be cultured in a lab, and its sexual reproduction cycle causes its genetic profile to vary significantly between generations. Dr. Max Teplitski, former head of the USDA's Division of Food Safety, noted these traits make source attribution considerably harder than with typical foodborne pathogens.[28] The CDC has increasingly relied on genotyping to group cases into likely strains, though officials say this method still lacks the precision achieved with other pathogens.

المراجع

  1. ^ Talaro, Kathleen P., and Arthur Talaro. Foundations in Microbiology: Basic Principles. Dubuque, Iowa: McGraw-Hill, 2002.
  2. ^ CDC (2024-09-04). "About Cyclosporiasis". Cyclosporiasis (in الإنجليزية الأمريكية). Retrieved 2025-10-24.
  3. ^ أ ب ت ث ج ح خ د ذ ر Mathison, BA; Pritt, BS (September 2021). "Cyclosporiasis—Updates on Clinical Presentation, Pathology, Clinical Diagnosis, and Treatment". Microorganisms. 9 (9): 1863. doi:10.3390/microorganisms9091863. PMC 8471761. PMID 34576758.
  4. ^ Sanchez, Roxana; Ortega, Ynés R. (2005-10-26). "Update on Cyclospora cayetanensis, a Food-Borne and Waterborne Parasite | Clinical Microbiology Reviews". Clinical Microbiology Reviews. Cmr.asm.org. 23 (1): 218–234. doi:10.1128/CMR.00026-09. PMC 2806662. PMID 20065331.
  5. ^ CDC (2024-08-08). "Preventing Cyclosporiasis". Cyclosporiasis (in الإنجليزية الأمريكية). Retrieved 2026-07-02.
  6. ^ Strausbaugh, Larry (1 October 2000). "Cyclospora cayetanensis: A Review, Focusing on the Outbreaks of Cyclosporiasis in the 1990s". Clinical Infectious Diseases. 31 (4): 1040–1057. doi:10.1086/314051. PMID 11049789.
  7. ^ Ghimire TR, Mishra PN, Sherchand JB, Ghimire LV: Bell's Palsy and Cyclosporiasis: Causal or Coincidence? Nepal Journal of Neuroscience 4:86- 88, 2007. http://neuroscience.org.np/neuro/issues/uploads/abstract_K3M0aH6IUP.pdf Archived 2018-07-08 at the Wayback Machine
  8. ^ T. R. Ghimire; L.V. Ghimire; R.K. Shahu; P.N. Mishra (April 2010). "Cryptosporidium and Cyclospora infection transmission by swimming". Journal of Institute of Medicine. 32 (1). doi:10.3126/jiom.v32i1.4003. Retrieved 2019-08-21.
  9. ^ Ghimire TR, Ghimire LV, Shahu RK, Mishra PN. Cryptosporidium and Cyclospora infection transmission by swimming. Journal of Institute of Medicine. 2010; 32 (1): 43–45.https://www.nepjol.info/index.php/JIOM/article/download/4003/3392
  10. ^ Ghimire TR, Mishra PN, Sherchand JB. The seasonal outbreaks of Cyclospora and Cryptosporidium in Kathmandu, Nepal. Journal of Nepal Health Research Council 2005; 3(1): 39–48.http://jnhrc.com.np/index.php/jnhrc/article/view/99/96
  11. ^ Ghimire TR, Mishra PN, Sherchand JB. The seasonal outbreaks of Cyclospora and Cryptosporidium in Kathmandu, Nepal. Journal of Nepal Health Research Council 2005; 3(1): 39–48. http://jnhrc.com.np/index.php/jnhrc/article/view/99/96 Archived 2020-12-01 at the Wayback Machine
  12. ^ Ortega YR, Sanchez R. Update on Cyclospora cayetanensis, a Food-Borne and Waterborne Parasite. Clinical Microbiology Reviews 2010 23(1): 218-234. http://cmr.asm.org/content/23/1/218.full"
  13. ^ Ghimire TR, Mishra PN. Intestinal parasites and Haemoglobin concentration in the people of two different areas of Nepal. Journal of Nepal Health Research Council 2005; 3(2): 1–7.http://jnhrc.com.np/index.php/jnhrc/article/view/103/100
  14. ^ Ghimire TR, Mishra PN. Intestinal parasites in the Human Immunodeficiency Virus Infected Patients in Kathmandu, Nepal. The Nepalese Journal of Zoology. 2006; 1(1): 9–19.
  15. ^ أ ب Ghimire TR, Mishra PN, Sherchan JB. Epidemiology of Cyclospora cayetanensis and other intestinal parasites in the HIV infected patients in Kathmandu, Nepal. Journal of Nepal Health Research Council 2008; 6(12): 28–37.https://www.nepjol.info/index.php/JNHRC/article/download/2441/2177
  16. ^ "Surveillance for Laboratory-Confirmed Sporadic Cases of Cyclosporiasis --- United States, 1997--2008". cdc.gov.
  17. ^ "Case Count Maps - Outbreak Investigations 2013 - Cyclosporiasis - CDC". cdc.gov. 2019-04-12.
  18. ^ "CDC: 425 cases of cyclospora infection identified across 16 states". cbsnews.com. 5 August 2013.
  19. ^ http://www.idph.state.ia.us/IDPHChannelsService/file.ashx?file=2721EA4A-DB6B-4746-9FF4-0BF09C9BF3BE Archived 2016-03-04 at the Wayback Machine Iowa Cyclospora Outbreak 2013 /Outbreak Update 7.31.13, Iowa State Department of Public Health. Downloaded 6 Aug 2013.
  20. ^ "Outbreak Investigations 2015 | Cyclosporiasis | CDC". Cdc.gov. 2019-04-12. Retrieved 2019-08-21.
  21. ^ Keaton, A. A.; Hall, N. B.; Chancey, R. J.; Heines, V.; Cantu, V.; Vakil, V.; Long, S.; Short, K.; Franciscus, E.; Wahab, N.; Haynie, A.; Gieraltowski, L.; Straily, A. (2018-06-01). "Notes from the Field: Cyclosporiasis Cases Associated with Dining at a Mediterranean-Style Restaurant Chain — Texas, 2017 | MMWR". MMWR. Morbidity and Mortality Weekly Report. Cdc.gov. 67 (21): 609–610. doi:10.15585/mmwr.mm6721a5. PMC 6038903. PMID 29851947.
  22. ^ "FSIS Issues Public Health Alert for Beef, Pork and Poultry Salad and Wrap Products due to Concerns about Contamination with Cyclospora". usda.gov. 31 July 2018. Archived from the original on August 1, 2018.
  23. ^ "Cyclosporiasis Outbreak Investigations — United States, 2020". www.cdc.gov (in الإنجليزية الأمريكية). 2020-06-26. Retrieved 2020-06-27.
  24. ^ "Update: New Bagged Salad Products Linked to Cyclospora Outbreak". 30 June 2020.
  25. ^ Goetzman J, Carter A, Oliveira A, Ingram LA. Outbreak of Cyclosporiasis Among Patrons of a Mexican-Style Restaurant — Limestone County, Alabama, May–June 2023. MMWR Morb Mortal Wkly Rep 2025;74:217–221. DOI: http://dx.doi.org/10.15585/mmwr.mm7413a1
  26. ^ CDC (2026-07-01). "Surveillance of Cyclosporiasis". Cyclosporiasis (in الإنجليزية الأمريكية). Retrieved 2026-07-07.
  27. ^ "'Explosive Diarrhea Parasite' Is on the Rise in the US. These States Have the Most Cases, CDC Says". TODAY.com (in الإنجليزية). 2026-07-06. Retrieved 2026-07-07.
  28. ^ أ ب ت ث "What to know about cyclospora, the gut-churning parasite causing illness in several U.S. states, and how to avoid it". CNN. 7 July 2026.
  29. ^ "Infectious Disease Outbreaks". www.michigan.gov.
  30. ^ أ ب "Cases of parasitic infection growing in 2 states: Health officials". ABC News. 7 July 2026.

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