Case Report

By Dr. Ulku Karaman , Mr. Erdal Karci , Mr. Mesut Karadan , Dr. Basak Karbek
Corresponding Author Dr. Ulku Karaman
Ordu University, - Turkey 52100
Submitting Author Dr. Ulku Karaman
Other Authors Mr. Erdal Karci
Parasitology, - Turkey

Mr. Mesut Karadan
Parasitology, - Turkey

Dr. Basak Karbek
Internal Medicine, - Turkey


Cyclospora Cayetanensis, Chronic Thyroiditis, Non-Immune Deficiency

Karaman U, Karci E, Karadan M, Karbek B. An Infection Case of Cyclospora Cayetanensis in a Patient with Chronic Thyroiditis. WebmedCentral PARASITOLOGY 2011;2(4):WMC001899
doi: 10.9754/journal.wmc.2011.001899
Submitted on: 25 Apr 2011 01:31:20 PM GMT
Published on: 26 Apr 2011 07:35:05 PM GMT


Cyclospora cayetanensis, which is a protozoon, falls into the coccidia subclass of Apicomplexa branch. It has been reported that this parasite can infect all age groups and cause diarrhea among patients with non-immune deficiency and immune deficiency. Moreover, it is known that the prevalence of C. cayetanensis increased in tropical and subtropical regions. In the present case, a 45 year-old female patient having L-tyrosine treatment for chronic thyroiditis and traced as eutiroid visits the interior disease polyclinic with complaint about severe diarrhea for one week. Following examination for parasite using Kinyoun's acid-fast staining method revealed C. cayetanensis oocysts. The parasite in the present case can be an agent of persistent diarrhea especially among patients with suppressed immune system. Moreover, this case is also presented to note that it can be a cause of diarrhea among non-immune deficiency patients based on the case stories reported.


It has been reported that Cyclospora cayetanensis is an agent of diarrhea among patients of all ages, who are either healthy or with immune deficiency1. Cyclospora infection is reported to be common in tropical and subtropical regions2,3. The parasite oocysts discharged with human feces are round and about 10 µm. They are stained with acid-fast method and they are not mature when discharged4. Sporulation is needed for this oocysts to become infective after they get mature outside, which affects the epidemiology of this parasite 2.
Due to the difficulty of the identification of the Cyclospora oocysts, it is recommended to examine the feces samples after they are concentrated to facilitate the diagnosis5. It has been reported that it is useful to examine the fresh feces samples under ultraviolet fluoresanmicroscope thanks to the ability of cyclospora oocysts to give otofluoresan and that oocysts give green fluoresan under 450-490 nm excitation filter 6.
The present parasite case is presented in order to note that it can cause diarrhea among non-immune deficiency patients since it can cause persistent diarrhea among patients with suppressed immune system and also it has been generally reported in cases.

Case Description

A 45 year-old female patient having L-Tyrosine treatment for Cronic Tirioditis and traced as euthyroid visits the interior disease polyclinic and complaints about severe diarrhea which started one week ago. Routine examinations were demanded and the patient was forwarded to parasitology laboratory due to diarrhea complaint. The anamnesis of the patient revealed diarrhea of excessively watery and in gushing nature, stomachache, and exhaustion. After the blood examination and thyroid functions tests revealed normal, the patient’s feces sample was examined, and as some dubious structures thought to belong to Coccidias were found using native-lughole (Figure 1), C. cayetanensis oocysts were detected using Kinyoun's acid-fast staining method (Figure 2,3).
Native preparates were examined via fluoresan microscope under 40X objective with 380-420 nm wave length filter, and it was determined that mentioned structures gave autofluoresan. The patient began to receive a two-week 2X160/240 mg trimetoprimsulphametoksazol treatment, after which patient stated that her complaints ceased and no parasite were found in her feces examination.


It was emphasized that C.cayetanensis, which was first found to infect man in Papua New Gina in 1979, is a significant reason of chronic diarrhea among patients with immune deficiencies including those with AIDS7. The infection of the parasite show watery diarrhea, stomachache, nausea and loss of weigh8,9. Similarly in the present case, severe stomachache and watery diarrhea for one week were observed.
It was also reported that the parasite was seen among British troops in 1994, that a tab-water-related cyclospora epidemic broke out in a small military troop in Pokhara/Nepal and parasite was isolated from the tab water. It was understood that some water-related epidemics, the causes of which not explained adequately before, were caused by C. cayetanensis10. Recently some diarrhea epidemics have been reported about C. cayetanensis, which shows a cosmopolite distribution around the world8-10. In the present case, it was found that the patient had a vegetable-rich diet and consumed tab water.
The first case in our country was detected by Koç et al.9 while a HIV positive patient’s chronic diarrhea etiology was examined. Next, Turgay et al.8 and Yazar et al.2,3 also reported cases. In Malatya, Çelik et al.11 reported the parasite in a boy. In this case study, it was intended to note that C. cayetanensis can be a cause of diarrhea among non-immune deficiency patients and it must be examined in unclear diarrhea.


1.Long EG, Ebrahimzadeh A, White EH, Swisher BL, Callaway CS. Alga associated with diarrhea in patients with acquired immunodeficiency syndrome and in travelers. J Clin Microbiol 1990;28: 1101-1104. 
2.Yazar S, Yalç?n ?, ?ahin ?. Cyclospora cayetanensis. Türkiye Parazitol Derg 2003;27 (1): 56-63.
3.Yazar S, M?st?k S, Yaman O, Y?ld?z O, Özcan H, ?ahin ?. Kayseri'de Cyclospora cayetanensis Kaynakl? Üç ?shal Olgusu. Türkiye Parazitol Derg 2009;33(1) :085-088.
4.Albert MJ, Kabir I, Azim T, Hossain A, Ansaruzzaman M, Unicomb L. Diarrhea associated with Cyclospora sp. in Bangladesh. Diagn Microbiol Infect Dis 1994;19: 47-49.
5.Eberhard ML, Pieniazek NJ, Arrowood MJ. Laboratory diagnosis of Cyclospora infections. Arch Pathol Lab Med 1997;121: 792-797.
6.Garcia SL, Bruckner AD. Intestinal protozoa: Coccidia and Microsporidia in Diagnostic edical parasitology. American Society for Microbiology, Washington, D.C., 1997;54-89.
7.Ashfort RW. Occurrence of a undescript coccidian in man in Papua New Guinea. Ann Trop Med Par 1979 ;73: 497-500.
8.Turgay N, Yolasigmaz A, Erdogan DD, Zeyrek FY, Uner A. Incidence of cyclosporiasis in patients with gastrointestinal symptoms in western Turkey. Med Sci Monit 2007;13(1): CR34-39.
9.Koç AN, Aygen B, ?ahin ?, Kayaba? Ü. Cyclospora sp. associated with diarrhea in a patient with AIDS in Turkey. Tr J Med Sciences 1998;28:557-558.
10.Rabold JG, Hoge CW, Shlim DR, Kefford C, Rajah R, Echeverria  P. Cyclospora outbreak associated with chlorinated drinking water. Lancet 1994;344: 1360-1361.
11.Celik T, Karincao?lu Y, Karaman U, Daldal NÜ. Co-infection of cyclospora cayetanensis and cryptosporidium parvum in an immunocompetent patient with urticaria without diarrhea: case report. The American Journal of Case Report 2008;9:163-166.

Source(s) of Funding


This study was presented as an abstract at the XVI th National Parasitology Congress on 1-7 Nov. 2009.

Competing Interests



This article has been downloaded from WebmedCentral. With our unique author driven post publication peer review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before submitting any information that requires obtaining a consent or approval from a third party. Authors should also ensure not to submit any information which they do not have the copyright of or of which they have transferred the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm that you may suffer or inflict on a third person by following the contents of this website.

0 comments posted so far

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.


Author Comments
0 comments posted so far


What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)