First Cyclospora cayetanensis outbreak reported in Brazil occurred in 2000, in the General Salgado city (SP), and control measures

Abstract

 Cyclospora cayetanensis, an emerging coccidian parasite, acquired importance due to   cause diarrhea outbreaks and sporadic cases worldwide associated with food. In Brazil,   until 1999, no cyclosporiasis outbreak was registered. We summarize the findings of the Cyclospora cayetanensis outbreak investigation occurred from September to December   2000, in the city of General Salgado, SP, associated with the public drinking water system. A   descriptive study was conducted to identify the source of transmission, including interviews   with patients, data analysis of local diarrhea trends, sanitary inspections in water and sewer   systems, as well as laboratorial tests of patients stool, suspected food and public drinking   water samples. Compatible clinical case was defined as the person with liquid diarrhea and,   at least, three other gastrointestinal symptoms such as nausea, vomit, flatulence, abdominal   pain, weight loss or prolonged diarrhea, resident in General Salgado, during the period of the   outbreak. Confirmed laboratorial cases were defined as those with typical oocysts in the stool   sample. Clinical samples and food were analyzed by Adolfo Lutz Institute. Water samples   were tested at the CDC/Atlanta, by PCR analysis. A total of 350 cases were identified as   involved in this outbreak (incidence rate = 32.3 cases/1,000 inhabitants) and children under 4   years old were the group more affected (incidence rate = 49.1 cases/1,000 inhabitants).   Among 40 cases tested for bacteria, virus and parasite, 10 were positive for Cyclospora   cayetanensis. The water system was compound by 15 artesian wells with infiltration of pluvial   water and sewer. The water from one of them (well # 7) was positive for Cyclospora   cayetanensis. Control of this outbreak required important changes in public drinking water   and sewer systems of the city. Educational measures, monitoring of acute diarrhea,   laboratorial tests of all new cases of diarrhea, water quality control, during and after the   reconstruction of the systems, contributed to eliminate the Cyclospora cayetanensis source   of transmission. Six new sporadic cases were also reported during 2001. From 2002 to   December 2007 no cases were identified.