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Epi Project case study cyclo s (2)

Epi Project case study cyclo s (2)

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A Multistate Outbreak of Cyclosporiasis

Original investigators:

Barbara L. Herwaldt, MD, MPH

, Marta-Louise Ackers, MD

, Michael J. Beach, PhD

, and the

Cyclospora Working Group

Centers for Disease Control and Prevention

Case study and instructor’s guide created by: Jeanette K. Stehr-Green, MD

Reviewed by: Charles Haddad, Robert Tauxe, MD, MPH, Roderick C. Jones, MPH

NOTE: This case study is based on real-life investigations undertaken in 1996 and 1997 in

the United States and abroad that were published in the Morbidity and Mortality Weekly

Report, the New England Journal of Medicine, and the Annals of Internal Medicine. The

case study, however, is not a factual accounting of the details from these investigations.

Some aspects of the investigations (and the circumstances leading up to them) have been

altered to assist in meeting the desired teaching objectives. Some details have been

fabricated to provide continuity to the storyline.

Time required: approximately 3 hours

Project Requirements:

1. A fact sheet on Cyclosporiasis is provided in Appendix 1 of this document. You should read that

before starting this project since that information will be helpful in answering the questions in the

case study.

2. Enter your answers to the questions directly in this document. Save your work as either

a .doc, .docx or .pdf then upload the file to the appropriate assignment link on canvas.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

Atlanta, Georgia 30333

A Multistate Outbreak of Cyclosporiasis

Part I – Background

On May 20, 1996, the following article appeared on the front page of the Toronto Sun:

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Exotic

Parasite

Sickens

Canadian

Businessmen

By Xavier Onnasis

TORONTO – Public health

officials today confirmed

that three Canadian

businessmen, two from

Toronto and one from

Ottawa, were diagnosed

with cyclosporiasis, a

parasitic disease seen

only in tropical

countries and overseas

travelers. The three men,

who had recently traveled

to the United States,

became seriously ill with

diarrhea over the weekend

(May 16-18). One of the

men was hospitalized at

Princess Margaret Hospital

when he

collapsed due to severe

dehydration.

Dr. Richard Schabas,

Ontario’s Chief Medical

Officer, reported that

cyclosporiasis was

exceedingly rare in North

American and that much was

still unknown about this

disease. Cyclosporiasis is

caused by the

microorganism Cyclospora

cayetanensis. Cyclospora

infects the small bowel and

usually causes watery diarrhea,

with frequent, sometimes

explosive, bowel

movements. Symptoms can include

bloating, increased gas, stomach

cramps, nausea, loss of

appetite, and profound weight

loss. The illness is diagnosed

by examining stool specimens in

the laboratory.

Dr. Schabas declined to identify

a source of infection for the

three businessmen but indicated

that the parasite is transmitted

through

contaminated food or water but

not by direct person-to-person

spread.

The time between exposure to

the parasite and becoming

sick is usually about 7 days.

Dr. Schabas reported that all

three men had attended a

meeting in Texas on May 9-10.

He said Ontario Health

Department staff would be

investigating leads locally

and in Texas.

Question 1: What is the incubation period for cyclosporiasis? How will it be used in the investigation?

Question 2: On what sources of infection should public health officials focus for the three cases of

cyclosporiasis? Is it possible that one of the men was the source of infection for the others? Do you think

that it is likely that the businessmen became infected with cyclosporiasis in Texas?

Part II – Outbreaks in Texas

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A Multistate Outbreak of Cyclosporiasis Original investigators: Barbara L. Herwaldt, MD, MPH1, Marta-Louise Ackers, MD1, Michael J. Beach, PhD1, and the Cyclospora Working Group 1 Centers for Disease Control and Prevention Case study and instructor’s guide created by: Jeanette K. Stehr-Green, MD Reviewed by: Charles Haddad, Robert Tauxe, MD, MPH, Roderick C. Jones, MPH NOTE: This case study is based on real-life investigations undertaken in 1996 and 1997 in the United States and abroad that were published in the Morbidity and Mortality Weekly Report, the New England Journal of Medicine, and the Annals of Internal Medicine. The case study, however, is not a factual accounting of the details from these investigations. Some aspects of the investigations (and the circumstances leading up to them) have been altered to assist in meeting the desired teaching objectives. Some details have been fabricated to provide continuity to the storyline. Time required: approximately 3 hours Project Requirements: 1. A fact sheet on Cyclosporiasis is provided in Appendix 1 of this document. You should read that before starting this project since that information will be helpful in answering the questions in the case study. 2. Enter your answers to the questions directly in this document. Save your work as either a .doc, .docx or .pdf then upload the file to the appropriate assignment link on canvas. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Cont ...
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