The US is experiencing an alarming increase in Cyclospora cases.

A total of 1,957 laboratory-confirmed cases of cyclosporiasis have been reported in the United States so far this year. That is already surpassing the 1,129 cases reported in all of 2022. (1) The investigation of this outbreak is ongoing with no specific food item being identified as the source of most of these illnesses, although the outbreak count does include 20 patients in Georgia and Alabama whose infections were found to be linked to raw imported broccoli. The broccoli outbreak appears to be over and there is no indication that broccoli continues to be a source of illness for the other cyclosporiasis cases. (1) Other common sources would include cilantro, raspberries, and basil. Sick people range in age from 2 to 96 years with a median age of 50 and 58% are female. 153 hospitalizations and zero deaths have been recorded.

Cyclospora cayetanensis is a parasite that causes intestinal infection. The parasite is spread by consuming food or water that was contaminated with feces containing the sporulated oocysts of the parasite. It can only be spread through human waste and not directly from person to person. (2) This is because an infected person sheds unsporulated oocysts (which is not infective) and it takes 1-2 weeks in a favorable environment outside of the body for the oocysts to sporulate and become infective. The black and white photo above shows a sporulating oocyst containing two immature sporocysts. No animal reservoirs of Cyclospora cayetanensis have been identified.

The incubation time is usually about one week and symptoms include watery diarrhea with frequent bowel movements, loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, and fatigue. (3) Symptoms can be severe enough to require hospitalization but death from cyclosporiasis is rare.

Laboratory diagnosis is done through microscopy using a modified acid fast stain (organisms will stain pink to deep red or purple, see color photo above) or PCR. The organisms will auto-fluoresce under a UV fluorescent microscope. Cyclospora infections are treated with trimethoprim-sulfamethoxazole (brand name: Bactrim, Septra, Cotrim).

Cyclosporiasis occurs in many countries and seems to be most common in tropical and subtropical regions. The risk for infection is typically seasonal but no consistent pattern has been identified regarding time of year or environmental conditions. In the United States, outbreaks have been linked to various types of imported fresh produce. Other cases have occurred in persons who traveled to Cyclospora-endemic areas. (4)

The best way to prevent Cyclospora infections is to follow safe fruit and vegetable handling recommendations and to avoid food or water that may have been contaminated with feces. Travelers to cyclosporiasis-endemic areas should be aware that treatment of water or food by routine chemical disinfection or sanitizing methods is unlikely to kill Cyclospora. No vaccine for cyclosporiasis is available (5).

By Alani Vasquez

R&D Manager, Hardy Diagnostics

References: 1, 2, 3, 4, 5

Health officials are on high alert over the alarming increase in infectious and congenital syphilis throughout the United States and Canada. Syphilis cases fell to an all-time low in the early 2000s, but have increased nearly every year since then. In the United States, cases of both infectious and congenital syphilis increased by 28.6% in just one year alone from 2020 to 2021.(1) In Canada, cases of infectious syphilis have increased by 166% from 2017 to 2021.(4)

Public health experts believe that a lack of surveillance, prevention, and testing have contributed to the increase in syphilis cases. General distrust of the medical system by marginalized people or the high cost of medical treatment may also prevent infected individuals from seeking treatment.(3) Syphilis cases are most prevalent in men but cases are rising quickly in women. Canada saw a 729% increase in infected women from 2017 to 2021.(4)

Syphilis is a bacterial infection caused by the spirochete organism Treponema pallidum. The infection causes syphilitic sores, called chancres, which may initially appear as painless lesions on the genitals, rectum, or mouth. With treatment, early stage syphilis can generally be cleared with one injection of penicillin. If syphilis progresses to a later stage, symptoms may advance to itchy painful rashes, wart-like sores, fever, weight loss, and/or fatigue, requiring treatment that is more intensive. Untreated Syphilis can eventually lead to life threatening complications as the infection spreads to the organs and nervous system.(1) 

Treponema pallidum can enter the body through minor cuts or scrapes in the skin or through the mucous membranes of the body. Syphilis is commonly spread from person to person through direct contact with chancres during sexual activity. While sexual contact accounts for many syphilis cases, congenital transmission is also a major mechanism of infection.(2)

Health officials urge at-risk individuals to seek STI testing, which is offered at many STD clinics free of charge. Pregnant women should also be tested throughout their pregnancy to ensure no risk of congenital syphilis. Prevention of syphilis includes practicing safe sex, using latex condoms, and finishing all treatment regimens for any infection. Avoiding unprotected vaginal, anal, or oral sex is key to minimizing the spread of syphilis.(2) Those who suspect they may be infected with syphilis or those who have come into direct contact with an infected individual should seek out testing. Collaborative efforts among public health officials, healthcare providers, and informed individuals are essential in controlling the increase in syphilis cases.

By Alexandra Lopez

Business intelligence associate, Hardy Diagnostics

References: 1, 2, 3, 4

New Therapies for Difficult-to-Treat Pathogens:

Sulbactam-Durlobactam

and Rezafungin

Healthcare professionals face a constant challenge with ever-evolving bacterial and fungal infections. Multidrug-resistant pathogens threaten the efficacy of existing treatments and highlight the need for new antimicrobial therapies. These microorganisms are typically resistant to the majority of antimicrobial agents, including carbapenems, making them difficult to treat. The Centers for Disease Control and Prevention (CDC) has identified carbapenem-resistant Acinetobacter baumannii (CRAB) as an urgent public health threat.

Sulbactam-Durlobactam (Xacduro) was FDA approved in May to treat hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) caused by Acinetobacter baumannii-calcoaceticus complex. HardyDisk™ AST Sulbactam-Durlobactam was subsequently FDA cleared 44 days later. The intravenous drug developed by Entasis Therapeutics Inc., provides a promising solution to treatment of CRAB.

Rezafungin (Rezzayo) is a new antifungal agent that gained FDA approval in March. HardyDisk™ AST Rezafungin was subsequently FDA cleared 71 days later. Cidara Therapeutics developed this echinocandin antifungal agent to combat invasive fungal infections. This marks the first new treatment option approved for individuals with candidemia and invasive candidiasis in over 10 years.

Drug-resistant fungal infections are becoming more common, especially in patients with weakened immune systems. Serious fungal infections are often life-threatening with a mortality rate of up to 60%. Candida is part of the normal human microflora and invasive infections can occur if the organism is introduced into the bloodstream via catheter insertions, injections, endocarditis, or peritonitis. Candidemia and invasive candidiasis are often treated with antifungal agents such as fluconazole, caspofungin, and amphotericin B. However, the emergence of antimicrobial resistance in Candida species has complicated treatment strategies.

The introduction of Sulbactam-Durlobactam and Rezafungin expands the armamentarium of healthcare professionals. These new therapies provide hope for improved patient outcomes when drug-resistant microorganisms are encountered.

HardyDisk™ AST Sulbactam-durlobactam and HardyDisk™ AST Rezafungin will allow clinicians to make informed treatment decisions, ultimately improving patient care, and contributing to the global fight against antimicrobial resistance. Click here to see Hardy's complete selection of products for Antimicrobial Susceptibility Testing.

By Anna Klavins and Lauren Hamilton

Sulbactam-Durlobactam (Xanduro)

   Catalog# Z9461 - Single Pack

   Catalog# Z9465 - 5 Pack

Rezafungin (Rezzayo)

   Catalog# Z9471 - Single Pack

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