APH 1999, 57, 301-310:

Cyclospora cayetanesis: diagnosis and situation in Belgium.

T. Crucitti, M. Lontie, T. Vervoort, and JC. Libeer

Keywords: cyclospora cayetanensis, coccidia, EQA, stool examination

Cyclospora is an emerging or a re-emerging parasite, gaining some interest in the travel related pathology and in opportunistic infections in AIDS patients. The name Cyclospora cayetanensis was introduced in 1992. The complete morphological description was published only in 1994. Cyclospora presents in faeces as spherical oocysts with a diameter of 8-10 Ám. The cell wall is clearly delineated with a double membrane enveloping several round refractile granules. Cyclospora is distributed worldwide. Some outbreaks were described in the US, linked to consumption of raspberries from Guatemala, consumption of lettuce, and drinking of contaminated water. The parasite appears to be endemic in Nepal, Ha´ti, and Peru. In the period between January and June 15 Cyclospora infections were reported in Belgium, all of which were probably imported. The geographical origin of the infections was obtained for 10 patients: 5 patients had travelled to lndonesia, 3 to Turkey, 1 to Mexico, and 1 to Tibet. The lnstitute for Tropical Medicine in Antwerp registered in 1997 13 cases of Cyclospora infection. Most of these infections were contracted in Indonesia, Central America, Africa, and Turkey. Many laboratories were not aware of the newparasite. They needed to be informed and instructed about the clinical and diagnostic features of Cyclospora. Therefore a stool specimen with Cyclospora was included twice in the National External Quality Control scheme (January 1997 and 1998). The detection rate improved significantly, approximately by 30%, for the second scheme. In June 1998 the participants were invited to fill in a questionnaire about the detection of Cyclospora. The questionnaire revealed the following: half of the participants were unaware of the existence of Cyclospora before their participation to the External Ouality Control scheme in January 1997. Approximately two thirds of the participants detected a Cyclospora oocyste for the first time in the sample during the first EOC round. Only half of the faboratories will routinely search for Cyclospora. In conclusion, to improve the detection capability of parasites by the laboratories and to ensure that Cyclospora will be detected even in routine samples further training is stillt needed.