Cyclosporiasis: An Emerging Potential Threat for Water Contamination



According to the World Health Organization (WHO), 3.4 million people die every year from water-related diseases. Almost half the world’s population have no acceptable means of sanitation and availability of potable drinking water. Lack of improved domestic water supply leads to various waterborne diseases, such as cholera, diarrhea, viral hepatitis A, dysentery and typhoid, which are transmitted by contaminated drinking water. Hence, improved water quality, sanitation and personal hygiene can significantly reduce the spread of water-related diseases. Diarrhea is the major illness caused due to the consumption of unhygienic water. It can be of bacterial, viral or parasitic origin. Most of the bacterial and viral agents like coliforms, Salmonella, Shigella, caliciviruses that contaminating water are killed by routine chlorination, but the parasitic forms (dormant/resistant cysts and oocysts) are difficult to remove and need special treatment. According to the World Health Organization (WHO), Cryptosporidium parvum oocysts and Giardia lamblia cysts are introduced to waters all over the world by fecal pollution. Although chlorine is the primary disinfectant of choice in water treatment practice, parasites like Cryptosporidium and Cyclospora are resistant to chlorine treatment and hence pose a formidable threat to water health. Cyclospora cayetanensis is an emerging protozoan parasite and causes small intestine gastroenteritis. The disease has been implicated in many foodborne outbreaks worldwide, especially contaminated products (raspberries, basil and lettuce) imported from developing nations. After washing these products, Cyclospora oocysts were found in water. This intrigued researchers to define the epidemiological link of Cyclospora to water. In the USA, Cyclospora has been detected in several sporadic cases associated with exposure to drinking or recreational sewage and water sources. There is apparently a worldwide distribution, including regions of endemicity, for example, Nepal, Haiti and Peru. Thus, there is an increased risk to travelers visiting these endemic areas. Moreover, because of the recent developments in the detection of protozoal parasites using acid-fast staining, the detection of Cyclospora cases has been raised worldwide. Due to the lack of a quantification technique, there is limited information on the prevalence of Cyclospora in water environments, necessitating the need for further research on pathways and transmission dynamics of cyclosporiasis and encouraging innovative research in water treatment for improving sanitation and public health.


Cyclospora cayetanensis Diarrhea Water contaminant 


  1. Aksoy U, Akisu C, Sahin S, Usluca S, Yalcin G, Kuralay F, Oral AM (2007) First reported waterborne outbreak of cryptosporidiosis with Cyclospora co-infection in Turkey. Europe Surveillance 12:E070215Google Scholar
  2. Ashford RW (1979) Occurrence of an undescribed coccidian in man in Papua New Guinea. Ann Trop Med Parasitol 73:497–500Google Scholar
  3. Babcock D, Houston R, Kumaki D, Shlim D (1985) Blastocystis hominis in Kathmandu, Nepal [letter]. N Engl J Med 313:1419Google Scholar
  4. CIWEC Clinic. (1991) Travel Medicine Center in Katmandu, Nepal (
  5. Bendall RP, Moody A, Chiodini PL, Lucas S, Tovey G (1993) Diarrhoea associated with cyanobacterium-like bodies: a new coccidian enteritis of man. Lancet 341(8845):590–592CrossRefGoogle Scholar
  6. Dixon BR, Bussey JM, Parrington LJ, Parenteau M (2005) Detection of Cyclospora cayetanensis oocysts in human fecal specimens by flowcytometry. J Clin Microbiol 43:2375–2379CrossRefGoogle Scholar
  7. Dowd SE (2003) Confirmed detection of Cyclospora cayetanensis, Encephalitozoon intestinalis and Cryptosporidium parvum in water used for drinking. J Water Health 1:117–123Google Scholar
  8. El-Karamany EM, Zaher TI, el-Bahnasawy MM (2005) Role of water in the transmission of cyclosporiasis in Sharkia Governorate, Egypt. J Egypt Soc Parasitol 35:953–962Google Scholar
  9. Elshazly AM, Elsheikha HM, Soltan DM, Mohammad KA, Morsy TA (2007) Protozoal pollution of surface water sources in Dakahlia Governorate, Egypt. J Egypt Soc Parasitol 37:51–64Google Scholar
  10. Goodgame R (2003) Emerging causes of traveller’s diarrhea: Cryptosporidium, Cyclospora, Isospora and microsporidia. Curr Infect Dis Rep 5:66–73CrossRefGoogle Scholar
  11. Graczyk TK, Ortega YR, Conn DB (1998) Recovery of waterborne oocysts of Cyclospora cayetanensis by Asian freshwater clams (Corbicula fluminea). Am J Trop Med Hyg 59:928–932Google Scholar
  12. Hale D, Aldeen W, Carroll K (1994) Diarrhea associated with cyanobacteria like bodies in an immunocompetent host. JAMA 271:144–145CrossRefGoogle Scholar
  13. Huang P, Weber JT, Sosin DM et al (1995) The first reported outbreak of diarrheal illness associated with Cyclospora in the United States. Ann Intern Med 123:409–414CrossRefGoogle Scholar
  14. Kwakye-Nuako G, Borketey P, Mensah-Attipoe I, Asmah R, yeh-Kumi P (2007) Sachet drinking water in Accra: the potential threats of transmission of enteric pathogenic protozoan organisms. Ghana Med J 41:62–67Google Scholar
  15. Miegeville M, Koubi V, Dan LC, Barbier JP, Cam PD (2003) Cyclospora cayetanensis presence in aquatic surroundings in Hanoi (Vietnam). Environmental study (well water, lakes and rivers). Bull Soc Pathol Exot 96:149–152Google Scholar
  16. Pape JW, Verdier RI, Boncy M, Boncy J, Johnson WD Jr (1994) Cyclospora infection in adults infected with HIV. Clinical manifestations, treatment, and prophylaxis. Ann Intern Med 121:654–657CrossRefGoogle Scholar
  17. Soave R (1996) Cyclospora an overview. Clin Infect Dis 23(3):429–435CrossRefGoogle Scholar
  18. Soave R, Johnson WD Jr (1995) Cyclospora: conquest of an emerging pathogen. Lancet 345:667–668CrossRefGoogle Scholar
  19. Ooi WW, Zimmerman SK, Needham CA (1995) Cyclospora species as a gastrointestinal pathogen in immunocompetent hosts. J Clin Microbiol 33:1267–1269Google Scholar
  20. Ortega Y, Sterling C, Oilman R, Cama V, Díaz F (1993) Cyclospora species-a new protozoan pathogen of humans. N Engl J Med 328:1308–1312CrossRefGoogle Scholar
  21. Ortega YR, Gilman RH, Sterling CR (1994) A new coccidian parasite (Apicomplexa: Eimeriidae) from humans. J Parasitol 80:625–629CrossRefGoogle Scholar
  22. Ortega YR, Sanchez R (2010) Update on Cyclospora cayetanensis, a Food-Borne and Waterborne Parasite. Clin Microbiol Rev 2010(23):218–234CrossRefGoogle Scholar
  23. Ozdamar M, Hakko E, Turkoglu S (2010) High occurrence of cyclosporiasis in Istanbul, Turkey, during a dry and warm summer. Parasites Vectors 3:39.
  24. Percival SL, Chalmers RM, Embrey M, Hunters PR, Sellwood J, Wyn-Jones P (2004) Microbiology of waterborne diseases. Elsevier academic press, California, pp 267–290CrossRefGoogle Scholar
  25. Rabold JG (1994) Cyclospora outbreak associated with chlorinated drinking water [letter]. Lancet 344:1360–1361CrossRefGoogle Scholar
  26. Shlim DR, Cohen MT, Eaton M, Rajah R, Long EG, Ungar BL (1991) An alga-like organism associated with an outbreak of prolonged diarrhea among foreigners in Nepal. Am J Trop Med Hyg 45:383–389Google Scholar
  27. Sturbaum GD, Ortega YR, Gilman RH, Sterling CR, Cabrera L, Klein DA (1998) Detection of Cyclospora cayetanensis in wastewater. Appl Environ Microbiol 64:2284–2286Google Scholar
  28. Wurtz RM, Kocka FE, Peters CS, Weldon-Linne CM, Kuritza A, Yungbluth P (1993) Clinical characteristics of seven cases of diarrhea associated with a novel acid-fast organism in the stool. Clin Infect Dis 16:136–138CrossRefGoogle Scholar

Copyright information

© Springer India 2014

Authors and Affiliations

  1. 1.Department of MedicineAll India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations