Cystoisospora, Cyclospora, and Sarcocystis*

David S. Lindsay; Louis M. Weiss

doi:10.1128/9781555817381.ch141

Chapter 141 : Cystoisospora, Cyclospora, and Sarcocystis*

Authors: David S. Lindsay, Louis M. Weiss

Content Type: Reference

Publication Year: 2015

Category: Clinical Microbiology

Book DOI: 10.1128/9781555817381

Chapter DOI: 10.1128/9781555817381.ch141

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Cystoisospora, Cyclospora, and Sarcocystis*, Page 1 of 2

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Abstract:

“Cystoisospora, Cyclospora, and Sarcocystis” provides an overview of the life cycles, pathogenesis, diagnosis, and treatment of these important parasites. These coccidial parasites have an environmentally resistant oocyst stage in their life cycles. They remain an important cause of diarrhea in patients in developing countries, and foodborne outbreaks still occur in developed countries. Humans are the only definitive hosts for Cystoisospora belli and Cyclospora cayetanensis and pass unsporulated oocysts in their stools. Sarcocystis requires two hosts. Humans are definitive hosts for S. hominis and S. suihominis and become infected after ingesting undercooked meat of bovids (cattle, buffalo) and pigs, respectively. Humans pass sporulated oocysts and sporocysts in their stools. Humans are also accidental intermediate hosts for one or more Sarcocystis species, and most cases are observed in Southeast Asia. Muscle sarcocysts are associated with fever and muscle pain. Diagnosis of Cystoisospora, Cyclospora, and Sarcocystis is based on microscopic examination of stool samples using acid-fast-stained slides or with UV microscopy. PCR-based methods of stool examination for oocysts have been developed. There are currently no serologic tests available to detect antibodies to these parasites and aid in their diagnosis. Combination antiretroviral therapy (cART) is associated with a better prognosis in AIDS patients, but clinical episodes still occur even in some patients on cART. Treatments for acute Cystoisospora and Cyclospora infections are available and effective. Apparent drug failures are most likely related to poor drug absorption or distribution rather than to true drug resistance.

Citation: Lindsay D, Weiss L. 2015. Cystoisospora, Cyclospora, and Sarcocystis*, p 2425-2434. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch141

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Cystoisospora, Cyclospora, and Sarcocystis*

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FIGURE 1

Line drawings of unsporulated and sporulated oocysts of Cyclospora cayetanensis (A and B) and Cystoisospora belli (C and D) and a sporulated oocyst (E) and sporocyst (F) of a Sarcocystis species from humans. Bar, 10 μm. doi:10.1128/9781555817381.ch141.f1

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FIGURE 1

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FIGURE 2

Modified Kinyoun’s acid-fast-stained smears demonstrating a Cystoisospora belli oocyst with a sporont (A), a C. belli oocyst with two sporoblasts (B), and a Cyclospora cayetanensis oocyst with a sporont (C). Bar, 1µm. doi:10.1128/9781555817381.ch142.f2

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FIGURE 2

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FIGURE 3

Sporocyst of a Sarcocystis species in a stool sample viewed using differential interference contrast microscopy (A) and autofluorescence using UV light (B). Bar, 10 μm. Courtesy of Alice E. Houk, Department of Biomedical Sciences and Pathobiology, Virginia Tech, Blacksburg, VA. doi:10.1128/9781555817381.ch141.f3

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FIGURE 3

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FIGURE 4

Hematoxylin and eosin-stained tissue section demonstrating several monozoic tissue cysts (arrows) of Cystoisospora belli. Note the thick wall that surrounds each single zoite. Bar, 10 μm. doi:10.1128/9781555817381.ch141.f4

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FIGURE 4

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FIGURE 5

Sarcocyst (arrow) of a Sarcocystis species in a skeletal muscle biopsy specimen from a male Dutch patient obtained during an outbreak of muscular sarcocystosis ( 49 ) among visitors to Tioman Island off the east coast of Malaysia. A sarcocyst wall (arrowhead) surrounds hundreds of bradyzoites. Note the lack of inflammatory response. The patient’s traveling partner was also confirmed to be positive by muscle biopsy. Bar, 10 μm. Courtesy of Douglas H. Esposito and Clifton Drew, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA. doi:10.1128/9781555817381.ch141.f5

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FIGURE 5

References

/content/book/10.1128/9781555817381.mcm11.ch141

1. Frenkel JK. 1977. Besnoitia wallacei of cats and rodents: with a reclassification of other cyst-forming isosporid coccidia. J Parasitol 63: 611– 628.

2. Samarasinghe B,, Johnson J,, Ryan U. 2008. Phylogenetic analysis of Cystoisospora species at the RNA ITS1 locus and development of a RFLP assay. Exp Parasitol 118: 592– 595.

3. Jongwutiwes S,, Putaporntip C,, Charoenkorn M,, Iwasaki T,, Endo T. 2007. Morphologic and molecular characterization of Isospora belli oocysts from patients in Thailand. Am J Trop Med Hyg 77: 107– 112.

4. Ferreira LF,, Coutinho SG,, Argento CA,, da Silva JR. 1962. Experimental human coccidial enteritis by Isospora belli Wenyon, 1923. A study based on the infection of 5 volunteers. Hospital (Rio J) 62: 795– 804.

5. Mughal TI,, Khan MY. 1991. Isospora belli diarrhea as a presenting feature of AIDS. Saudi Med J 12: 433– 434.

6. Brandborg LL,, Goldberg SB,, Breidenbach WC. 1970. Human coccidiosis—a possible cause of malabsorption. N Engl J Med 283: 1306– 1313.

7. Lindsay DS,, Dubey JP,, Toivio-Kinnucan MA,, Michiels JF,, Blagburn BL. 1997. Examination of extraintestinal tissue cysts of Isospora belli. J Parasitol 83: 620– 625.

8. Michiels JF,, Hofman P,, Bernard E,, St. Paul MC,, Boissy C,, Mondain V,, LeFichoux Y,, Loubiere R. 1994. Intestinal and extraintestinal Isospora belli infection in an AIDS patient. Pathol Res Pract 190: 1089– 1093.

9. Velásquez JN,, Carnevale S,, Mariano M,, Kuo LH,, Caballero A,, Chertcoff A,, Ibáñez C,, Bozzini JP. 2001. Isosporosis and unizoite tissue cysts in patients with acquired immunodeficiency syndrome. Hum Pathol 32: 500– 505.

10. Elsdon-Dew R. 1953. Isospora natalensis (sp. nov.) in man. J Trop Med Hyg 56: 149– 150.

11. Dodds SE,, Elsdon-Dew R. 1955. Further observations on human coccidiosis in Natal. S Afr J Lab Clin Med 1: 104– 109.

12. Smith HV,, Paton CA,, Mtambo MM,, Girdwood RW. 1997. Sporulation of Cyclospora sp. oocysts. Appl Environ Microbiol 63: 1631– 1632.

13. Milord F,, Lampron-Goulet L,, St-Amour M,, Levac E,, Ramsay D. 2012. Cyclospora cayetanensis: a description of clinical aspects of an outbreak in Quebec, Canada. Epidemiol Infect 140: 626– 632.

14. Bendall RP,, Lucas S,, Moody A,, Tovey G,, Chiodini PL. 1993. Diarrhoea associated with cyanobacterium-like bodies: a new coccidian enteritis of man. Lancet 341: 590– 592.

15. Ortega YR,, Nagle R,, Gilman RH,, Watanabe J,, Miyagui J,, Quispe H,, Kanagusuku P,, Roxas C,, Sterling CR. 1997. Pathologic and clinical findings in patients with cyclosporiasis and a description of intracellular parasite life-cycle stages. J Infect Dis 176: 1584– 1589.

16. Sun T,, Ilardi CF,, Asnis D,, Bresciani AR,, Goldenberg S,, Roberts B,, Teichberg S. 1996. Light and electron microscopic identification of Cyclospora species in the small intestine. Evidence of the presence of asexual life cycle in human host. Am J Clin Pathol 105: 216– 220.

17. Alfano-Sobsey EM,, Eberhard ML,, Seed JR,, Weber DJ,, Won KY,, Nace EK,, Moe CL. 2004. Human challenge pilot study with Cyclospora cayetanensis. Emerg Infect Dis 10: 726– 728.

18. Beaver PC,, Gadgil K,, Morera P. 1979. Sarcocystis in man: a review and report of five cases. Am J Trop Med Hyg 28: 819– 844.

19. Karanis P,, Kourenti C,, Smith H. 2007. Waterborne transmission of protozoan parasites: a worldwide review of outbreaks and lessons learnt. J Water Health 5: 1– 38.

20. Chacín-Bonilla L. 2008. Transmission of Cyclospora cayetanensis infection: a review focusing on soil-borne cyclosporiasis. Trans R Soc Trop Med Hyg 102: 215– 216.

21. Dowd SE,, John D,, Eliopolus J,, Gerba CP,, Naranjo J,, Klein R,, López B,, de Mejía M,, Mendoza CE,, Pepper IL. 2003. Confirmed detection of Cyclospora cayetanesis, Encephalitozoon intestinalis and Cryptosporidium parvum in water used for drinking. J Water Health 1: 117– 123.

22. Baldursson S,, Karanis P. 2011. Waterborne transmission of protozoan parasites: review of worldwide outbreaks—an update 2004–2010. Water Res 45: 6603– 6614.

23. Lindsay DS,, Holliman D,, Flick GJ,, Goodwin DG,, Mitchell SM,, Dubey JP. 2008. Effects of high pressure processing on Toxoplasma gondii oocysts on raspberries. J Parasitol 94: 757– 758.

24. Dubey JP,, Kotula AW,, Sharar A,, Andrews CD,, Lindsay DS. 1990. Effect of high temperature on infectivity of Toxoplasma gondii tissue cysts in pork. J Parasitol 76: 201– 204.

25. Arness MK,, Brown JD,, Dubey JP,, Neafie RC,, Granstrom DE. 1999. An outbreak of acute eosinophilic myositis attributed to human Sarcocystis parasitism. Am J Trop Med Hyg 61: 548– 553.

26. Centers for Disease Control and Prevention (CDC) . 2012. Notes from the field: acute muscular sarcocystosis among returning travelers—Tioman Island, Malaysia, 2011. MMWR Morb Mortal Wkly Rep 61: 37– 38.

27. Wong KT,, Pathmanathan R. 1992. High prevalence of human muscular skeletal muscle sarcocystosis in South-east Asia. Trans R Soc Trop Med Hyg 86: 631– 632.

28. Sasaki M,, Tanaka A,, Nishimura T,, Tsujikawa T,, Andoh A,, Ishizuka I,, Koyama S,, Fujiyama Y,, Kushima R. 2004. A case of malabsorption syndrome caused by isosporiasis in an immunocompetent patient. J Gastroenterol 39: 88– 89.

29. Trier JS,, Moxey PC,, Schimmel EM,, Robles E. 1974. Chronic intestinal coccidiosis in man: intestinal morphology and response to treatment. Gastroenterology 66: 923– 935.

30. Certad G,, Arenas-Pinto A,, Pocaterra L,, Ferrara G,, Castro J,, Bello A,, Núñez L. 2003. Isosporiasis in Venezuelan adults infected with human immunodeficiency virus: clinical characterization. Am J Trop Med Hyg 69: 217– 222.

31. Navaneethan U,, Venkatesh PG,, Downs-Kelly E,, Shen B. 2012. Isospora belli superinfection in a patient with eosinophilic gastroenteritis—a diagnostic challenge. J Crohns Colitis 6: 236– 239.

32. Jongwutiwes S,, Sampatanukul P,, Putaporntip C. 2002. Recurrent isosporiasis over a decade in an immunocompetent host successfully treated with pyrimethamine. Scand J Infect Dis 34: 859– 862.

33. Koru O,, Araz RE,, Yilmaz YA,, Ergüven S,, Yenicesu M,, Pektas¸ B,, Tanyüksel M. 2007. Case report: Isospora belli infection in a renal transplant recipient. Turkiye Parazitol Derg 31: 98– 100.

34. Atambay M,, Bayraktar MR,, Kayabas U,, Yilmaz S,, Bayindir Y. 2007. A rare diarrheic parasite in a liver transplant patient: Isospora belli. Transplant Proc 39: 1693– 1695.

35. Hallak A,, Yust I,, Ratan Y,, Adar U. 1982. Malabsorption syndrome, coccidiosis, combined immune deficiency, and fulminant lymphoproliferative disease. Arch Intern Med 142: 196– 197.

36. Greenberg SJ,, Davey MP,, Zierdt WS,, Waldmann TA. 1988. Isospora belli infection in patients with human T-cell leukemia virus type I-associated adult T-cell leukemia. Am J Med 85: 435– 438.

37. Ud Din N,, Torka P,, Hutchison RE,, Riddell SW,, Wright J,, Gajra A. 2012. Severe Isospora (Cystoisospora) belli diarrhea preceding the diagnosis of human T-cell-leukemia-virus-1-associated T-cell lymphoma. Case Rep Infect Dis 2012: 640104. 10.1155/2012/640104.

38. Benator DA,, French AL,, Beaudet LM,, Levy CS,, Orenstein JM. 1994. Isospora belli infection associated with acalculous cholecystitis in a patient with AIDS. Ann Intern Med 121: 663– 664.

39. French AL,, Beaudet LM,, Benator DA,, Levy CS,, Kass M,, Orenstein JM. 1995. Cholecystectomy in patients with AIDS: clinicopathologic correlations in 107 cases. Clin Infect Dis 21: 852– 858.

40. Walther Z,, Topazian MD. 2009. Isospora cholangiopathy: case study with histologic characterization and molecular confirmation. Hum Pathol 40: 1342– 1346.

41. de Otazu RD,, García-Nieto L,, Izaguirre-Gondra E,, Mayayo E,, Ciani S,, Nogales FF. 2004. Endometrial coccidiosis. J Clin Pathol 57: 1104– 1105.

42. Bialek R,, Binder N,, Dietz K,, Knobloch J,, Zelck UE. 2002. Comparison of autofluorescence and iodine staining for detection of Isospora belli in feces. Am J Trop Med Hyg 67: 304– 305.

43. Sifuentes-Osornio J,, Porras-Cortés G,, Bendall RP,, Morales-Villarreal F,, Reyes-Terán G,, Ruiz-Palacios GM. 1995. Cyclospora cayetanensis infection in patients with and without AIDS: biliary disease as another clinical manifestation. Clin Infect Dis 21: 1092– 1097.

44. Zar FA,, El-Bayoumi E,, Yungbluth MM. 2001. Histologic proof of acalculous cholecystitis due to Cyclospora cayetanensis. Clin Infect Dis 33: E140– E141.

45. Fayer R. 2004. Sarcocystis spp. in humans. Clin Microbiol Rev 17: 894– 902.

46. Bunyaratvej S,, Bunyawongwiroj P,, Nitiyanant P. 1982. Human intestinal sarcosporidiosis: report of six cases. Am J Trop Med Hyg 31: 36– 41.

47. Mehrotra R,, Bisht D,, Singh PA,, Gupta SC,, Gupta RK. 1996. Diagnosis of human Sarcocystis infection from biopsies of the skeletal muscle. Pathology 28: 281– 282.

48. Van den Enden E,, Praet M,, Joos R,, Van Gompel A,, Gigasse P. 1995. Eosinophilic myositis resulting from sarcocystosis. J Trop Med Hyg 98: 273– 276.

49. Esposito DH,, Freedman DO,, Neumayr A,, Parola P. 2012. Ongoing outbreak of an acute muscular Sarcocystis-like illness among travellers returning from Tioman Island, Malaysia, 2011–2012. Euro Surveill 17: pii= 20310.

50. Goodman ML,, Maher E. 1966. Four uncommon infections in Hodgkin’s disease. JAMA 198: 1129.

51. Larbcharoensub N,, Cheewaruangroj W,, Nitiyanant P. 2012. Laryngeal sarcocystosis accompanying laryngeal squamous cell carcinoma: case report and literature review. Southeast Asian J Trop Med Public Health 42: 1072– 1076.

52. Garcia LS,, Bruckner DA. 1997. Diagnostic Medical Parasitology, 3rd ed, p 593– 607. ASM Press, Washington, DC.

53. Eberhard ML,, Pieniazek NJ,, Arrowood MJ. 1997. Laboratory diagnosis of Cyclospora infections. Arch Pathol Lab Med 121: 792– 797.

54. Lindquist HD,, Bennett JW,, Hester JD,, Ware MW,, Dubey JP,, Everson WV. 2003. Autofluorescence of Toxoplasma gondii and related coccidian oocysts. J Parasitol 89: 865– 867.

55. Kimura K,, Kumar Rai S,, Takemasa K,, Ishibashi Y,, Kawabata M,, Belosevic M,, Uga S. 2004. Comparison of three microscopic techniques for diagnosis of Cyclospora cayetanensis. FEMS Microbiol Lett 238: 263– 266.

56. Parija SC,, Shivaprakash MR,, Jayakeerthi SR. 2003. Evaluation of lacto-phenol cotton blue (LPCB) for detection of Cryptosporidium, Cyclospora and Isospora in the wet mount preparation of stool. Acta Trop 85: 349– 354.

57. Visvesvara GS,, Moura H,, Kovacs-Nace E,, Wallace S,, Eberhard ML. 1997. Uniform staining of Cyclospora oocysts in fecal smears by a modified safranin technique with microwave heating. J Clin Microbiol 35: 730– 733.

58. Dixon BR,, Bussey JM,, Parrington LJ,, Parenteau M. 2005. Detection of Cyclospora cayetanensis oocysts in human fecal specimens by flow cytometry. J Clin Microbiol 43: 2375– 2379.

59. Oliveira-Silva MB,, Lages-Silva E,, Resende DV,, Prata A,, Ramirez LE,, Frenkel JK. 2006. Cystoisospora belli: in vitro multiplication in mammalian cells. Exp Parasitol 114: 189– 192.

60. Mehlhorn H,, Heydorn AO. 1979. Electron microscopical study on gamogony of Sarcocystis suihominis in human tissue cultures. Z Parasitenkd 58: 97– 113.

61. ten Hove RJ,, van Lieshout L,, Brienen EA,, Perezn MA,, Verweij JJ. 2008. Real-time polymerase chain reaction for detection of Isospora belli in stool samples. Diagn Microbiol Infect Dis 61: 280– 283.

62. Resende DV,, Pedrosa AL,, Correia D,, Cabrine-Santos M,, Lages-Silva E,, Meira WSF,, Oliveira-Silva MB. 2011. Polymorphisms in the 18S rDNA gene of Cystoisospora belli and clinical features of cystoisosporosis in HIV-infected patients. Parasitol Res 108: 679– 685.

63. Murphy SC,, Hoogestraat DR,, SenGupta DJ,, Prentice J,, Chakrapani A,, Cookson BT. 2011. Molecular diagnosis of cystoisosporiasis using extended-range PCR screening. J Mol Diagn 13: 359– 362.

64. Lalonde LF,, Gajadhar AA. 2008. Highly sensitive and specific PCR assay for reliable detection of Cyclospora cayetanensis oocysts. Appl Environ Microbiol 74: 4354– 4358.

65. Relman DA,, Schmidt TM,, Gajadhar AA,, Sogin M,, Cross J,, Yoder JK,, Sethabutr O,, Echeverria P. 1996. Molecular phylogenetic analysis of Cyclospora, the human intestinal pathogen, suggests that it is closely related to Eimeria species. J Infect Dis 73: 440– 445.

66. Jinneman KC,, Wetherington JH,, Hill WE,, Adams AM,, Johnson JM,, Tenge BJ,, Dang NL,, Manger RL,, Wekell MM. 1998. Template preparation for PCR and RFLP of amplification products for the detection and identification of Cyclospora sp. and Eimeria spp. oocysts directly from raspberries. J Food Prot 61: 1497– 1503.

67. Varma M,, Hester JD,, Schaefer FW, III,, Ware MW,, Lindquist HD. 2003. Detection of Cyclospora cayetanensis using a quantitative real-time PCR assay. J Microbiol Methods 53: 27– 36.

68. Taniuchia M,, Verweij JJ,, Sethabutr O,, Bodhidatta L,, Garcia L,, Maro A,, Kumburu H,, Gratz J,, Kibiki G,, Houpt ER. 2011. Multiplex polymerase chain reaction method to detect Cyclospora, Cystoisospora, and microsporidia in stool samples. Diagn Microbiol Infect Dis 71: 386– 390.

69. Wang KX,, Li CP,, Wang J,, Tian Y. 2002. Cyclospora cayetanensis in Anhui, China. World J Gastroenterol 8: 1144– 1148.

70. Eberhard ML,, Ortega YR,, Hanes DE,, Nace EK,, Do RQ,, Robl MG,, Won KY,, Gavidia C,, Sass NL,, Mansfield K,, Gozalo A,, Griffiths J,, Gilman R,, Sterling CR,, Arrowood MJ. 2000. Attempts to establish experimental Cyclospora cayetanensis infection in laboratory animals. J Parasitol 86: 577– 582.

71. Clarke SC,, McIntyre M. 1997. An attempt to demonstrate a serological immune response in patients infected with Cyclospora cayetanensis. Br J Biomed Sci 54: 73– 74.

72. Pape JW,, Verdier RI,, Johnson WD, Jr. 1989. Treatment and prophylaxis of Isospora belli infections in patients with the acquired immunodeficiency syndrome. N Engl J Med 320: 1044– 1047.

73. Boyles TH,, Black J,, Meintjes G,, Mendelson M. 2012. Failure to eradicate Isospora belli diarrhoea despite immune reconstitution in adults with HIV—a case series. PLoS One 7: e42844. 10.1371/journal.pone.0042844.

74. Weiss LM,, Perlman DC,, Sherman J,, Tanowitz H,, Wittner M. 1988. Isospora belli infection: treatment with pyrimethamine. Ann Intern Med 109: 474– 475.

75. Verdier RI,, Fitzgerald DW,, Johnson DW,, Pape JW. 2000. Trimethoprim-sulfamethoxazole compared with ciprofloxacin for treatment and prophylaxis of Isospora belli and Cyclospora cayetanensis infection in HIV-infected patients—a randomized, controlled trial. Ann Intern Med 132: 885– 888.

76. Doumbo O,, Rossignol JF,, Pichard E,, Traore HA,, Dembele TM,, Diakite M,, Traore F,, Diallo DA. 1997. Nitazoxanide in the treatment of cryptosporidial diarrhea and other intestinal parasitic infections associated with acquired immunodeficiency syndrome in tropical Africa. Am J Trop Med Hyg 56: 637– 639.

77. Cabello RR,, Guerrero LR,, Garcia MR,, Cruz AG. 1997. Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico. Trans R Soc Trop Med Hyg 91: 701– 703.

78. Bialek R,, Overkamp D,, Rettig I,, Knobloch J. 2001. Case report: Nitazoxanide treatment failure in chronic isosporiasis. Am J Trop Med Hyg 65: 94– 95.

79. Kayembe K,, Desmet P,, Henery MC,, Stoffels P. 1989. Diclazuril for Isospora belli infection in AIDS. Lancet 1: 1397– 1398.

80. Limson-Pobre RN,, Merrick S,, Gruen D,, Soave R. 1995. Use of diclazuril for the treatment of isosporiasis in patients with AIDS. Clin Infect Dis 20: 201– 202.

81. Madico G,, McDonald J,, Gilman RH,, Cabera L,, Sterling CR. 1997. Epidemiology and treatment of Cyclospora cayetanensis infection in Peruvian children. Clin Infect Dis 24: 977– 981.

82. Pape JW,, Verdier RI,, Boncy M,, Boncy J,, Johnson WD. 1994. Cyclospora infection in adults infected with HIV. Clinical manifestations, treatment, and prophylaxis. Ann Intern Med 121: 654– 657.

83. Diaz E,, Mondragon J,, Ramirez E,, Bernal R. 2003. Epidemiology and control of intestinal parasites with nitazoxanide in children in Mexico. Am J Trop Med Hyg 69: 384– 385.

84. Fox LM,, Saravolatz LD. 2005. Nitazoxanide: a new thiazolide antiparasitic agent. Clin Infect Dis 40: 1173– 1180.

85. Centers for Disease Control and Prevention (CDC). 2013. Outbreaks of cyclosporiasis—United States, June–August 2013. MMWR Morb Mortal Wkly Rep 62: 862.

Tables

Cystoisospora, Cyclospora, and Sarcocystis*

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TABLE 1

Structural data for Cystoisospora, Cyclospora, and Sarcocystis oocysts and sporocysts found in stool samples from humans

TABLE 1

Structural data for Cystoisospora, Cyclospora, and Sarcocystis oocysts and sporocysts found in stool samples from humans