Cyclosporiasis: an emerging public health concern around the world and in Africa

R M Karanja, W Gatei, N Wamae

Abstract

Background: Cyclosporiasis is an emerging gastro-enteric disease caused by the coccidia protozoan Cyclospora cayetanensis . It isassociated with diarrhoea among children in developing countries, in the Americas where C. cayetanensis is endemic, traveller’s diarrhoeaand/or food and waterborne outbreaks in the developed countries.

Objectives:The aim of this review is to highlight cyclosporiasis and its relevance to public health in East Africa and Africa at large.
Methods: All literature on Cyclospora, C. cayetanensis,cyclosporiasis in Africa, and endemic cyclosporiasis was searched from libraries,colleagues and internet but only literature on its history, clinical presentation, epidemiology in endemic settings, and occurrence inAfrica were scrutinised.

Results: In Sub Saharan Africa, cyclosporiasis has been reported in at least 3 countries, including Tanzania, in East Africa, occurring inboth immunocompromised and immunocompetent patients. Zoonotic species of Cyclospora have also been identified in East Africanprimates, indicating likely endemicity of this little reported disease in the region. This can be attributed to lack of awareness in thepublic and medical profession concerning the disease, and therefore not routinely checked at the health centres. Cyclosporiasis ischaracterized by intermittent diarrhoea, and secondary conditions or sequelae such as reactive arthritis syndrome (Reiter’s syndrome),have been associated with progression of the disease. Its management is based on antibiotics, an unusual scenario for a protozoa.

Conclusions: Although many aspects of this disease and its transmission remain an enigma, the situation has been rapidly changing since the disease first came to medical attention in the 1970s.