Clinical and Epidemiologic Characteristics With Molecular Confirmation of Cyclosporiasis in Pediatric Patients Presenting to the Emergency Department With Acute Diarrheal Disease in Quindio, Colombia

BACKGROUND: No analyses have explored the differential clinical characteristics of cyclosporiasis compared with other diarrheal etiologies. METHODS: We conducted a prospective study of 118 children with diarrheal illnesses. Stool samples were analyzed using Ziehl-Neelsen (ZN) staining and polymerase chain reaction (PCR) targeting the ssu rRNA gene. Positive PCR samples were sequenced to identify phylogroups (A, B and C). Quantitative variables were compared using the Mann-Whitney U test. Qualitative associations were analyzed using odds ratios (ORs) and Fisher exact or χ2 tests. A parsimonious multivariate logistic regression identified independent predictors while controlling for sample size effects. RESULTS: Cyclosporiasis was identified in 18.6% (n = 22) by ZN and 19.5% (n = 23) by PCR. Diagnostic agreement was substantial (kappa = 0.81). Stool pH was significantly more alkaline in the ZN-positive group (median: 7.5, range: 4.0-9.0) than in the negative group (median: 6.0, range: 4.0-9.0; P = 0.0206). High-output diarrhea (OR = 3.58; 95% confidence interval: 1.29-9.94; P = 0.011) and abdominal pain (OR = 3.05; 95% confidence interval: 1.16-7.99; P = 0.020) were the primary clinical hallmarks of cyclosporiasis. Lineage B was the endemic strain, causing most acute, high-output secretory diarrhea cases. The parasite was found in domestic water and food (coriander) with 100% identity with lineage B. CONCLUSIONS: Pediatric Cyclospora infection presents with a distinct clinical triad: high-volume watery diarrhea, abdominal pain and alkaline stool Ph. Lineage B is the drive core of cases with waterborne transmission as a primary pathway.