First case report of Cyclosporiasis from eastern India: Incidence of Cyclospora cayetanensis in a patient with unusual diarrheal symptoms

Abstract

Cyclospora cayetanensis, a recently described coccidian parasite causes severe gastroenteric disease worldwide. Limited studies are found on the incidence of C. cayetanensis infection from India; hence remains largely unknown. To date, no case of cyclosporiasis from eastern India has been reported. In this study, we described an incidental case of C. cayetanensis in a 30 years old Bengali female patient with no travel history from eastern India. In June 2022, the patient presented with a history of diarrhoea persisting for more than two months with continuous passage foul smelling stools for which she took multiple antibiotics that were ineffective. There were no Salmonella, Shigella, or Vibrio-like organisms in the patient's faecal sample, and Toxin A/B of Clostridium difficile was also not detected by ELISA. The patient was HIV-negative. Finally, UV autofluorescence and DNA-based diagnosis confirmed the presence of C. cayetanensis, and the treatment with a combination of appropriate antibiotics was successful. This case report could raise awareness about C. cayetanensis associated diarrhoeal cases in India.

Food and Drinking Water as Sources of Pathogenic Protozoans: An Update

“…Asexual and sexual multiplication are analogous to those described for Cryptosporidium species [235]. There is still little information on the infective dose, the environmental conditions that favor oocyst persistence and sporulation, and reservoir existence [235,239].…”

“…These sporulate in the environment and become infectious after days or weeks from release at 22 • C to 32 • C [237,238]. The sporulated oocysts contain two ovoid sporocysts, each containing two sporozoites, which are released in the gastrointestinal tract when ingested and invade the epithelial cells of the small intestine [235,239]. Asexual and sexual multiplication are analogous to those described for Cryptosporidium species [235].…”

“…Enterocyte invasion by C. cayetanensis causes damage to the epithelium of the small intestine with disruption of the brush border, loss of membrane-bound digestive enzymes, and atrophy of villi. Consequently, water, nutrients, and electrolyte uptake in the small intestine are reduced, and symptoms manifest as watery diarrhea, abdominal cramps, bloating, nausea, fatigue, low-grade fever, anorexia, and weight loss [235,239]. Prolonged diarrhea may cause death in rare cases involving infants and individuals immunocompromised or with co-morbidities [235].…”

“…Prolonged diarrhea may cause death in rare cases involving infants and individuals immunocompromised or with co-morbidities [235]. Infection is often mild or asymptomatic in residents of countries in which C. cayetanensis is endemic, while a more severe disease occurs in travelers from non-endemic countries [235,239].…”

“…C. cayetanensis was isolated from stool and identified by PCR and DNA sequencing, so she was treated with tab nitazoxanide and recovered. The source of infection was suspected to be contaminated water or fruits and fresh vegetables available locally [239]. A 76-year-old Spanish man with diffuse large B cell lymphoma and long-lasting diarrhea was also treated with ciprofloxacin without success.…”