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Epidemiology and treatment of Cyclospora cayetanensis infection in Peruvian children
G Madico1, J McDonald, R H Gilman
1Universidad Peruana Cayetano Heredia and Asociación Benéfica PRISMA, Lima, Peru.
Abstract:
Cyclospora cayetanensis was detected in fecal specimens from 63 (1.1%) of 5,836 Peruvian children studied over 2 years; the protozoan was detected by modified acid-fast staining and autofluorescence under ultraviolet light. The highest prevalence occurred among children between 2 and 4 years of age. Thirty-two percent (20) of the 63 C. cayetanensis-infected children were symptomatic. Nineteen infected children were enrolled in a double-blind, placebo-controlled trial of a 3-day course of trimethoprim-sulfamethoxazole (TMP-SMZ; 5/25 mg/[kg x d]). Children were followed up with daily stool examinations (mean number of samples examined per child +/- SE, 19 +/- 4). The mean duration of oocyst excretion +/- SE was 4.8 +/- 1.2 days for TMP-SMZ recipients compared with 12.1 +/- 6.1 days for placebo recipients (P < .02). The prevalence of C. cayetanensis infection decreases during winter months and as children age; it decreases precipitously by adulthood. In children in areas of endemicity, C. cayetanensis usually causes mild disease that is often asymptomatic. TMP-SMZ therapy significantly decreases the duration of oocyst excretion.
Insights
Cyclospora cayetanensis infection in Peruvian children is often asymptomatic and decreases with age. Trimethoprim-sulfamethoxazole (TMP-SMZ) treatment significantly reduced oocyst excretion duration in infected children.
Area of Science:
- Infectious Diseases
- Parasitology
- Public Health
Background:
- Cyclospora cayetanensis is an emerging enteric protozoan pathogen.
- Prevalence and clinical presentation in endemic areas, particularly in children, require further investigation.
- Understanding transmission dynamics and effective treatment is crucial for public health.
Purpose of the Study:
- To determine the prevalence of Cyclospora cayetanensis infection in Peruvian children.
- To investigate the clinical manifestations and risk factors associated with infection.
- To evaluate the efficacy of trimethoprim-sulfamethoxazole (TMP-SMZ) in reducing oocyst excretion.
Main Methods:
- Fecal specimens from 5,836 Peruvian children were analyzed over 2 years using modified acid-fast staining and UV autofluorescence.
- Prevalence was assessed based on age and seasonality.
- A double-blind, placebo-controlled trial evaluated TMP-SMZ treatment in infected children, with daily stool examinations for oocyst excretion.
Main Results:
- Cyclospora cayetanensis was detected in 1.1% (63/5,836) of children, with highest prevalence in 2-4 year olds.
- 32% of infected children were symptomatic; infection prevalence decreased with age and during winter months.
- TMP-SMZ treatment significantly reduced the mean duration of oocyst excretion (4.8 days) compared to placebo (12.1 days) (P < .02).
Conclusions:
- Cyclospora cayetanensis infection is prevalent in Peruvian children, often asymptomatic or mild.
- Age and season influence infection prevalence.
- TMP-SMZ is an effective treatment for reducing the duration of oocyst shedding in children with Cyclospora cayetanensis infection.