Coccidian/cyanobacterium-like body associated diarrhea in an Australian traveller returning from overseas

Coccidian/cyanobacterium-like body (CLB) associated diarrhea occurred in a 42 yr old Australian woman returning from Bali, Indonesia. The patient had a diarrheal illness of 10 days duration with symptoms of explosive diarrhea, nausea, anorexia and fever. Fecal examination revealed CLBs which were detected in modified Ziehl-Neelsen stained fecal smears. No other bacterial or parasite pathogens were found. CLBs were variably acid fast, showed an intense blue auto-fluorescence under UV microscopy and appeared as non-refractile hyaline spheres in direct wet mounts, being 8-9 microns in diameter. The taxonomic status of CLBs has been unclear but recent evidence supports that they are a coccidian parasite of the genus Cyclospora, rather than cyanobacterium. There is no specific therapy for CLB enteritis and spontaneous recovery occurs after what may be a prolonged diarrheal illness. CLBs may be a previously unrecognized enteric pathogen although their role in the pathology of diarrheal illness is still undetermined. There is consistency in the clinical and laboratory findings amongst the reported cases and CLBs should be considered in persons with unexplained gastroenteritis, especially travellers returning from tropical regions.