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Article ID: WMC001899 2046-1690

An Infection Case of Cyclospora Cayetanensis in aPatient with Chronic ThyroiditisCorresponding Author:Dr. Ulku Karaman,Academic Member, Ordu University, 52100 - Turkey

Submitting Author:Dr. Ulku Karaman ,Academic Member, Ordu University , 52100 - Turkey

Article ID: WMC001899

Article Type: Case Report

Submitted on:25-Apr-2011, 01:31:20 PM GMT Published on: 26-Apr-2011, 07:35:05 PM GMT

Article URL: http://www.webmedcentral.com/article_view/1899

Subject Categories:PARASITOLOGY

Keywords:Cyclospora Cayetanensis, Chronic Thyroiditis, Non-Immune Deficiency

How to cite the article:Karaman U , Karci E , Karadan M , Karbek B . An Infection Case of CyclosporaCayetanensis in a Patient with Chronic Thyroiditis . WebmedCentral PARASITOLOGY 2011;2(4):WMC001899

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This study was presented as an abstract at the XVI th National Parasitology Congress on 1-7 Nov. 2009.

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An Infection Case of Cyclospora Cayetanensis in aPatient with Chronic ThyroiditisAuthor(s): Karaman U , Karci E , Karadan M , Karbek B

Abstract

Cyclospora cayetanensis, which is a protozoon, fallsinto the coccidia subclass of Apicomplexa branch. Ithas been reported that this parasite can infect all agegroups and cause diarrhea among patients withnon-immune deficiency and immune deficiency.Moreover, it is known that the prevalence of C.cayetanensis increased in tropical and subtropicalregions. In the present case, a 45 year-old femalepatient having L-tyrosine treatment for chronicthyroiditis and traced as eutiroid visits the interiordisease polyclinic with complaint about severediarrhea for one week. Following examination forparasite using Kinyoun's acid-fast staining methodrevealed C. cayetanensis oocysts. The parasite in thepresent case can be an agent of persistent diarrheaespecially among patients with suppressed immunesystem. Moreover, this case is also presented to notethat it can be a cause of diarrhea among non-immunedeficiency patients based on the case stories reported.

Introduction

It has been reported that Cyclospora cayetanensis isan agent of diarrhea among patients of all ages, whoare either healthy or with immune deficiency1.Cyclospora infection is reported to be common intropical and subtropical regions2,3. The parasiteoocysts discharged with human feces are round andabout 10 µm. They are stained with acid-fast methodand they are not mature when discharged4.Sporulation is needed for this oocysts to becomeinfective after they get mature outside, which affectsthe epidemiology of this parasite 2.Due to the difficulty of the identification of theCyclospora oocysts, it is recommended to examine thefeces samples after they are concentrated to facilitatethe diagnosis5. It has been reported that it is useful toexamine the fresh feces samples under ultravioletfluoresanmicroscope thanks to the ability of cyclosporaoocysts to give otofluoresan and that oocysts givegreen fluoresan under 450-490 nm excitation filter 6.The present parasite case is presented in order tonote that it can cause diarrhea among non-immunedeficiency patients since it can cause persistent

diarrhea among patients with suppressed immunesystem and also it has been generally reported incases.

Case Description

A 45 year-old female patient having L-Tyrosinetreatment for Cronic Tirioditis and traced as euthyroidvisits the interior disease polyclinic and complaintsabout severe diarrhea which started one week ago.Routine examinations were demanded and the patientwas forwarded to parasitology laboratory due todiarrhea complaint. The anamnesis of the patientrevealed diarrhea of excessively watery and ingushing nature, stomachache, and exhaustion. Afterthe blood examination and thyroid functions testsrevealed normal, the patient’s feces sample wasexamined, and as some dubious structures thought tobelong to Coccidias were found using native-lughole(Figure 1), C. cayetanensis oocysts were detectedusing Kinyoun's acid-fast staining method (Figure 2,3).Native preparates were examined via fluoresanmicroscope under 40X objective with 380-420 nmwave length filter, and it was determined thatmentioned structures gave autofluoresan. The patientbegan to receive a two-week 2X160/240 mgtrimetoprimsulphametoksazol treatment, after whichpatient stated that her complaints ceased and noparasite were found in her feces examination.

Discussion

It was emphasized that C.cayetanensis, which wasfirst found to infect man in Papua New Gina in 1979, isa significant reason of chronic diarrhea amongpatients with immune deficiencies including those withAIDS7. The infection of the parasite show waterydiarrhea, stomachache, nausea and loss of weigh8,9.Similarly in the present case, severe stomachache andwatery diarrhea for one week were observed.It was also reported that the parasite was seen amongBritish troops in 1994, that a tab-water-relatedcyclospora epidemic broke out in a small military troopin Pokhara/Nepal and parasite was isolated from thetab water. It was understood that some water-relatedepidemics, the causes of which not explained



adequately before, were caused by C. cayetanensis10.Recently some diarrhea epidemics have beenreported about C. cayetanensis, which shows acosmopolite distribution around the world8-10. In thepresent case, it was found that the patient had avegetable-rich diet and consumed tab water.The first case in our country was detected by Koç etal.9 while a HIV positive patient’s chronic diarrheaetiology was examined. Next, Turgay et al.8 and Yazaret al.2,3 also reported cases. In Malatya, Çelik et al.11reported the parasite in a boy. In this case study, itwas intended to note that C. cayetanensis can be acause of diarrhea among non-immune deficiencypatients and it must be examined in unclear diarrhea.

References

1.Long EG, Ebrahimzadeh A, White EH, Swisher BL,Callaway CS. Alga associated with diarrhea in patientswith acquired immunodeficiency syndrome and intravelers. J Clin Microbiol 1990;28: 1101-1104. 2.Yazar S, Yalç?n ?, ?ahin ?. Cyclosporacayetanensis. Türkiye Parazitol Derg 2003;27 (1):56-63.3.Yazar S, M?st?k S, Yaman O, Y?ld?z O, Özcan H,?ahin ?. Kayseri'de Cyclospora cayetanensis Kaynakl?Üç ?shal Olgusu. Türkiye Parazitol Derg 2009;33(1):085-088.4.Albert MJ, Kabir I , Azim T, Hossain A,Ansaruzzaman M, Unicomb L. Diarrhea associatedwith Cyclospora sp. in Bangladesh. Diagn MicrobiolInfect Dis 1994;19: 47-49.5.Eberhard ML, Pieniazek NJ, Arrowood MJ.Laboratory diagnosis of Cyclospora infections. ArchPathol Lab Med 1997;121: 792-797.6.Garcia SL, Bruckner AD. Intestinal protozoa:Coccidia and Microsporidia in Diagnostic edicalparasitology. American Society for Microbiology,Washington, D.C., 1997;54-89.7.Ashfort RW. Occurrence of a undescript coccidian inman in Papua New Guinea. Ann Trop Med Par 1979;73: 497-500.8.Turgay N, Yolasigmaz A, Erdogan DD, Zeyrek FY,Uner A. Incidence of cyclosporiasis in patients withgastrointestinal symptoms in western Turkey. Med SciMonit 2007;13(1): CR34-39.9.Koç AN, Aygen B, ?ahin ?, Kayaba? Ü. Cyclosporasp. associated with diarrhea in a patient with AIDS inTurkey. Tr J Med Sciences 1998;28:557-558.10.Rabold JG, Hoge CW, Shlim DR, Kefford C, RajahR, Echeverria P. Cyclospora outbreak associated withchlorinated drinking water. Lancet 1994;344:1360-1361.

11.Celik T, Karincao?lu Y, Karaman U, Daldal NÜ.Co-infection of cyclospora cayetanensis andcryptosporidium parvum in an immunocompetentpatient with urticaria without diarrhea: case report. TheAmerican Journal of Case Report 2008;9:163-166.



Illustrations

Illustration 1

Figure 1 : C. cayetanensis oocysts (native) 400X



Illustration 2

Figure 2 : C. cayetanensis oocysts (Kinyoun's acid-fast) 1000X



Illustration 3

Figure 3 : C. cayetanensis oocysts (Kinyoun's acid-fast) 1000X



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an infection case of cyclospora cayetanensis in a patient ... · an infection case of cyclospora...

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