March, 2024

Year

A 33 year old female presented with a history of persistent diarrhoea and abdominal cramps for the last 5 days. She is a renal allograft recipient and on Prednisolone, Tacrolimus and Mycophenolate mofetil. CBC was within normal range. A stool sample was sent to screen for parasites.

  1. What is the diagnosis?
  2. How is this infection acquired
  3. What is the treatment required?

Case answer – Posted on: 18-March-2024

  1. What is the diagnosis?
    Cyclospora cayetanensis
    Cyclospora cayetanensis is a coccidian protist with spherical oocysts, 8-10 µm in size with a thick outer wall. Unsporulated, refractile, weakly acid-fast oocysts(seen in stool) develop into sporulated, infective oocysts (contains two sporocysts with two sporozoites each) in the environment.
  2. How is this infection acquired?
    The primary mode of acquisition is through the consumption of food and water contaminated with sporulated oocysts of Cyclospora cayetanensis. This parasite causes food-borne outbreaks associated with contaminated fruit and leafy vegetables. It causes opportunistic infections with prolonged diarrhea and relapses in immunocompromised hosts.
  3. What is the treatment?
    The recommended treatment regimen is Cotrimoxazole (trimethoprim 160mg/sulfamethoxazole 800mg) administered twice daily for a duration of 7 days. Prolonged treatment will be required for HIV-infected individuals.

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