WEBVTT - Ep 216 Cyclospora: Explosive Diarrhea Everywhere 0:00:20.200 --> 0:00:46.840 Hi, I'm erin Welsh and I'm erin on an updike 0:00:47.040 --> 0:00:49.159 and this is this podcast will kill you. 0:00:49.640 --> 0:00:54.440 We're coming to you with a very rapid fire episode, rapid. 0:00:54.120 --> 0:00:59.800 Fire episode on cyclospora because it's better the news you've 0:00:59.800 --> 0:01:02.160 seen in the news. Many of you have asked us 0:01:02.320 --> 0:01:07.440 about it and we had not yet covered it. So, yeah, 0:01:07.480 --> 0:01:10.600 we wanted to kind of like put some stuff together 0:01:10.640 --> 0:01:13.600 really quickly to get information out to you about what 0:01:13.640 --> 0:01:16.119 this thing is, where it came from, and what's going 0:01:16.120 --> 0:01:18.000 on with the current outbreak a little bit of that. 0:01:19.400 --> 0:01:20.640 We will note. 0:01:20.400 --> 0:01:24.120 That we are recording this on Sunday, July twelfth, and 0:01:24.160 --> 0:01:26.400 so this will come out, you know, in a week 0:01:26.440 --> 0:01:29.920 and a few days and things. The numbers will probably 0:01:29.920 --> 0:01:30.880 have shifted by then. 0:01:31.040 --> 0:01:31.639 Maybe one. 0:01:33.040 --> 0:01:34.160 We will be different. 0:01:34.240 --> 0:01:35.000 It will be different. 0:01:35.480 --> 0:01:38.840 We might know more about like what foods are linked 0:01:38.880 --> 0:01:39.600 to this outbreak. 0:01:39.640 --> 0:01:42.960 Potentially I doubt it, maybe. 0:01:42.520 --> 0:01:45.280 But you know, we will be giving you some information 0:01:45.360 --> 0:01:47.680 that is sort of evergreen in terms of what this 0:01:47.800 --> 0:01:51.880 parasite is and why it's a food borne illness that 0:01:51.920 --> 0:01:54.240 we have been looking out for for a number of 0:01:54.280 --> 0:01:57.559 years and then stopped looking out for kind of kind 0:01:57.560 --> 0:01:58.200 of yeah. 0:01:58.080 --> 0:01:59.160 We'll get to all of that. 0:02:01.480 --> 0:02:03.480 First. It's quarantine any time. 0:02:03.480 --> 0:02:05.680 It is, you know, we're still going to do one. 0:02:05.800 --> 0:02:10.040 Even for this, I think we ended up we landed 0:02:10.120 --> 0:02:13.440 on This stinks. This stinks. 0:02:13.320 --> 0:02:13.880 The stinks. 0:02:15.680 --> 0:02:18.280 It's so accurate on so many levels. 0:02:18.400 --> 0:02:22.799 Arin Yep, it really stinks. And it's basically like, honestly, 0:02:23.000 --> 0:02:26.400 it's water plus your favorite electrolytes. 0:02:26.120 --> 0:02:29.160 Non branded, non proprietary, and I want everyone to know 0:02:29.200 --> 0:02:32.919 you probably don't actually need electrolytes in your life unless 0:02:32.919 --> 0:02:37.679 you are actually having profuse watery diarrhea or working out 0:02:37.720 --> 0:02:39.960 way more than most of us actually work out. 0:02:40.000 --> 0:02:44.160 So we do not supplements and branded supplements. 0:02:44.400 --> 0:02:48.440 So it's just quarantiny time, quarantiny time. 0:02:51.000 --> 0:02:53.880 We'll post the full recipe, not that you need one 0:02:53.919 --> 0:02:57.040 for this honestly, on our website and on our social media. 0:02:57.240 --> 0:02:58.960 Make sure you're following us there if you're not. 0:02:58.919 --> 0:03:01.760 Already on our website. There's all sorts of things. 0:03:01.800 --> 0:03:03.400 I don't think we'd really need to get into it 0:03:03.440 --> 0:03:06.400 for this rapid fire episode. I think people want the information, 0:03:06.600 --> 0:03:09.200 so let's hit a break and begin. 0:03:35.320 --> 0:03:38.040 So the disorder, the disease we're talking about today, is 0:03:38.120 --> 0:03:44.680 known as cyclosporiasis if caused by a parasite called Cyclospora caiatenensis. 0:03:44.920 --> 0:03:48.080 I think I'm saying that right. There are a number 0:03:48.080 --> 0:03:51.280 of other species of this passogen that infect snakes and 0:03:51.680 --> 0:03:55.880 insectivorous animals, some that infect monkeys, but it's only this 0:03:56.040 --> 0:03:59.680 one species that seems to be important for humans and 0:04:00.040 --> 0:04:04.160 which infects only humans as far as we know. It's 0:04:04.160 --> 0:04:09.000 a type of parasite called an apicomplexin okay, which I 0:04:09.080 --> 0:04:12.160 know that we've talked about parasites in this in this 0:04:12.240 --> 0:04:15.480 phylum before, but I don't know that we've actually said 0:04:15.480 --> 0:04:22.839 that word. But it's the same group that includes malaria parasites, toxoplasmosis, cryptosperdium, 0:04:22.839 --> 0:04:24.400 which we have not done yet. 0:04:24.560 --> 0:04:24.800 Nope. 0:04:25.279 --> 0:04:27.840 And of course there are lots of other protozoan parasite 0:04:27.839 --> 0:04:30.000 friends that we've covered on this podcast, like shaugust disease 0:04:30.040 --> 0:04:32.960 you're already at, et cetera. Those are just sort of 0:04:33.000 --> 0:04:37.839 slightly different vibes, right, Yeah, So we get exposed to 0:04:38.000 --> 0:04:42.560 the infectious stage of this parasite from either food or 0:04:42.720 --> 0:04:48.599 water in our mouths that has been contaminated with old poop. 0:04:50.240 --> 0:04:51.560 Tell me about old. 0:04:51.560 --> 0:04:54.080 We'll get there erin Okay, but I wanted you to 0:04:54.120 --> 0:04:57.680 ask that because it's an important part. Okay, old poop, 0:04:58.360 --> 0:04:59.440 not just any poop. 0:05:00.080 --> 0:05:00.600 Set me up. 0:05:00.720 --> 0:05:04.839 I did so. The infectious stage of this parasite, these 0:05:04.880 --> 0:05:07.520 are single cell parasites, by the way, like, yeah, okay, 0:05:07.800 --> 0:05:11.880 And the infectious stage are these teeny tiny little balls, 0:05:11.920 --> 0:05:14.360 little spherical balls. And by teeny tiny, I mean they're 0:05:14.400 --> 0:05:17.719 like eight to ten microns. They're very small. You cannot 0:05:17.720 --> 0:05:20.800 see them with your eyes, okay. And these balls are 0:05:20.920 --> 0:05:27.080 filled with these two bunches of bananas, like they these 0:05:27.120 --> 0:05:30.160 little critters that are shaped like bananas. We eat these 0:05:30.200 --> 0:05:35.480 little little tiny balls filled with four bananas total. Okay, Okay. 0:05:35.760 --> 0:05:39.240 Once these banana filled balls pass through our stomach and 0:05:39.279 --> 0:05:42.640 get to our small intestine, they punch their way out 0:05:42.760 --> 0:05:46.719 of the ball, and these bananas, these borozoites invade the 0:05:46.800 --> 0:05:49.280 cells that line are small intestine. 0:05:49.480 --> 0:05:50.680 Okay, question real quick. 0:05:50.760 --> 0:05:54.280 So within the ball once once it lands safely, these 0:05:55.120 --> 0:05:58.039 bunches of four bananas, that's still one individual like is 0:05:58.040 --> 0:05:59.240 that still one individual thing? 0:05:59.320 --> 0:05:59.920 Or is it multiple? 0:06:00.240 --> 0:06:04.320 It's four sporozoites okay, yeah, in each one of these. 0:06:05.160 --> 0:06:07.120 How interesting? I know? 0:06:07.279 --> 0:06:10.560 It gets better erin Okay, this is a really interesting parasite. 0:06:11.080 --> 0:06:14.520 Once they are inside the cells, So these are intracellular parasites. 0:06:14.520 --> 0:06:18.280 They're invading the cells inside our small intestine, and there 0:06:18.320 --> 0:06:21.760 they start to reproduce asexually. So they're making a bunch 0:06:21.839 --> 0:06:24.320 more of these banana shaped critters. They now have a 0:06:24.320 --> 0:06:30.279 different name. Again why because they're different. And then at 0:06:30.320 --> 0:06:34.960 some point, some of these bananas that are invading our 0:06:35.000 --> 0:06:37.760 cells replicating and then going out to invade more and 0:06:37.880 --> 0:06:41.839 more of the cells in our small intestine. At some 0:06:42.000 --> 0:06:46.960 point some will differentiate into a form that actually undergoes 0:06:47.240 --> 0:06:48.600 sexual reproduction. 0:06:49.839 --> 0:06:50.480 What proportion? 0:06:51.120 --> 0:06:54.320 Oh, I have no idea Aron, it doesn't, not a clue. 0:06:54.800 --> 0:06:56.719 Yeah, but some of them do. 0:06:56.800 --> 0:06:59.520 And so they form these basically like micro and macro 0:06:59.640 --> 0:07:03.120 gamma eats, and then they fertilize each other to form 0:07:03.360 --> 0:07:05.440 a zygoat the same way that we think of a 0:07:05.520 --> 0:07:08.280 zygoat in humans, except completely different because it's a single 0:07:08.320 --> 0:07:13.640 celled parasite. And then these zygoats become oocysts. These are 0:07:13.680 --> 0:07:17.760 what will pop out of our small intestine cells, travel 0:07:17.880 --> 0:07:20.400 the rest of the way through our guts, and be 0:07:20.480 --> 0:07:28.040 pooped out in an explosive fashion. Yea and then these balls, 0:07:28.080 --> 0:07:33.560 these oocysts have to live in the environment for at 0:07:33.640 --> 0:07:38.960 least a week before they grow those banana things inside 0:07:38.960 --> 0:07:42.840 of them and actually become infectious. That's why I said, 0:07:42.960 --> 0:07:43.600 old poop. 0:07:43.760 --> 0:07:46.760 Yeah, okay, so just so I understand. 0:07:46.760 --> 0:07:49.680 So what happened is you consume these little these little 0:07:49.720 --> 0:07:54.120 banana banana filled balls. Yep, those then invade Once they're 0:07:54.280 --> 0:07:57.520 safely in your gut, they invade your cells. There they 0:07:57.880 --> 0:08:03.800 replicate asexually until a certain point point they begin to 0:08:04.880 --> 0:08:08.280 some will differentiate so that they can undergo sexual reproduction 0:08:08.640 --> 0:08:12.520 correct and then those the offspring produced by those are 0:08:12.520 --> 0:08:15.120 the ones that make it into the environment for to 0:08:15.200 --> 0:08:18.800 then mature and infect other potentially other people. 0:08:19.200 --> 0:08:19.680 Nailed it. 0:08:20.040 --> 0:08:21.680 You've pooped out these parasites. 0:08:21.840 --> 0:08:22.480 Pooped them out. 0:08:23.280 --> 0:08:29.040 They then will in the environment in water like what, 0:08:29.280 --> 0:08:30.560 the environment. 0:08:30.240 --> 0:08:36.640 Wherever wherever they land. These are incredibly hardy parasites, so 0:08:36.760 --> 0:08:39.960 the osis which take a week to become infectious. But 0:08:40.080 --> 0:08:42.800 during that week and after once they are what they 0:08:42.840 --> 0:08:46.560 call spoulated and infectious, they I tried to get a 0:08:46.720 --> 0:08:48.960 number on exactly how long they can live, and I 0:08:49.040 --> 0:08:51.640 could not find that in the literature. Maybe I was 0:08:51.720 --> 0:08:55.960 not looking at the right terms. But I can assume 0:08:56.240 --> 0:08:59.000 based on the studies that I did read that it's 0:08:59.080 --> 0:09:01.960 a long time that they're able to persist in the environment. 0:09:02.360 --> 0:09:06.040 They also can withstand freezing to a certain degree. Freezing 0:09:06.080 --> 0:09:09.240 is not guaranteed to kill them. They also withstand most 0:09:09.400 --> 0:09:14.240 of the disinfection techniques that we use, including chlorination. So 0:09:14.480 --> 0:09:17.400 the only way to actually rid them of let's say 0:09:17.400 --> 0:09:21.040 our water sources, if you know poop is contaminating water sources, 0:09:21.480 --> 0:09:25.200 is with physical filtration to literally remove them, get them 0:09:25.240 --> 0:09:28.199 stuck on a filter, or with like UV filtration. 0:09:28.600 --> 0:09:29.640 What about like boiling? 0:09:30.200 --> 0:09:32.560 Boiling will do it? Yees, So heat does kill them. 0:09:32.800 --> 0:09:35.120 Same thing with cooking your foods if your foods and 0:09:35.240 --> 0:09:38.679 food can get contaminated, both because the soil can be contaminated. 0:09:39.400 --> 0:09:42.880 If you're using reclaimed water or you know, unfiltered water 0:09:43.040 --> 0:09:46.240 to irrigate your crops, then they can get contaminated that way. 0:09:46.679 --> 0:09:51.760 And apparently they're quite sticky, the oocysts, and so they 0:09:51.800 --> 0:09:55.560 really glom on to let's say the tiny bumps and 0:09:55.640 --> 0:09:57.760 hairs covering a rasp berry cerious. 0:09:57.920 --> 0:10:02.800 Ye, yeah, raspberries are culprits. 0:10:03.160 --> 0:10:09.559 Often speaking of timeline from ingestion of these parasites to 0:10:10.000 --> 0:10:13.200 symptoms to the diarrhea. How long is that taking? And 0:10:13.240 --> 0:10:16.160 then how long does it take for symptoms to resolve? 0:10:16.200 --> 0:10:18.400 How do all the rest of that stuff? 0:10:18.520 --> 0:10:20.040 So glad you asked, that's the next thing I have 0:10:20.080 --> 0:10:23.800 written there. And so the incubation period usually it's about 0:10:23.840 --> 0:10:26.680 a week, but it could be as short as two days. 0:10:26.720 --> 0:10:29.240 It could be as long as two weeks, but on 0:10:29.400 --> 0:10:32.679 average it's a week, which for a food born infection 0:10:32.920 --> 0:10:36.560 is a very long time. And we'll talk about the 0:10:36.559 --> 0:10:38.839 importance of that when we try it, when we talk 0:10:38.840 --> 0:10:42.680 about like tracing what was the source of this outbreak? Right, 0:10:43.280 --> 0:10:46.960 it's also very possible and very probably more common than 0:10:47.000 --> 0:10:51.080 we know that people have asymptomatic infections. So they're not 0:10:51.120 --> 0:10:53.600 getting sick at all, does not mean that they're not 0:10:53.800 --> 0:10:58.600 infecting others, because they can still be excreting oocysts in 0:10:58.640 --> 0:11:01.720 their stool. And again we do not have great numbers 0:11:01.760 --> 0:11:04.520 on like how often are we having asymptomatic versus symtomatic 0:11:04.559 --> 0:11:10.160 infections the symptoms themselves. So after that week, in the literature, 0:11:11.080 --> 0:11:15.880 never so often have I seen the words explosive, foul 0:11:15.920 --> 0:11:18.120 smelling diarrhea. 0:11:17.480 --> 0:11:19.600 Not even with sediff or Nora. 0:11:19.760 --> 0:11:25.600 I don't remember seeing specifically the words explosive quite as 0:11:25.640 --> 0:11:28.680 often as I do with this parasite in particular. Okay, 0:11:29.000 --> 0:11:31.120 we can get a little bit more into the symptoms. 0:11:31.160 --> 0:11:35.760 It's a very watery diarrhea, hence the explosiveness. We talked 0:11:35.800 --> 0:11:38.800 in our poop episode about how our anal canal has 0:11:38.840 --> 0:11:41.640 sensors to detect between a poop and a fart, and 0:11:41.679 --> 0:11:44.000 they're really not good at detecting liquid. So when we 0:11:44.080 --> 0:11:46.400 have like very watery stools. 0:11:46.200 --> 0:11:49.120 This is when that's part trusting a fart is not 0:11:49.240 --> 0:11:51.160 the way to go the wrong way. 0:11:51.280 --> 0:11:55.040 Yep. We also see a lot of abdominal cramping, bloating, 0:11:55.400 --> 0:11:59.440 People can have nausea or like a headache. Not often 0:11:59.480 --> 0:12:02.320 do we see vomiting, but sometimes people might have vomiting, 0:12:02.440 --> 0:12:04.760 and sometimes people might have a fever. But it's not 0:12:04.920 --> 0:12:08.040 super common that you get a fever with this particular parasite. 0:12:08.640 --> 0:12:11.200 But it can last for quite a long time. So 0:12:11.240 --> 0:12:13.960 we can see like weight loss because of how just 0:12:14.000 --> 0:12:16.600 like yucky people are feeling and that they're not really eating. 0:12:16.640 --> 0:12:19.440 Their appetite is down. And when I say it can 0:12:19.480 --> 0:12:22.280 go on for a long time, I mean this can 0:12:22.320 --> 0:12:26.880 go on for weeks to a month to six weeks 0:12:27.120 --> 0:12:32.040 if it's untreated. WHOA, yes, So it's usually at least 0:12:32.160 --> 0:12:36.000 two weeks of illness and like five to fifteen explosive 0:12:36.000 --> 0:12:41.440 liquidity stools a day, not minor. That can go on 0:12:41.520 --> 0:12:44.199 for at least two weeks if it's untreated, but often 0:12:44.240 --> 0:12:46.680 it's lasting longer than two weeks, right, like a month, 0:12:46.840 --> 0:12:47.680 five six weeks. 0:12:50.200 --> 0:12:52.640 I have two questions about numbers. Give it to me 0:12:53.000 --> 0:12:57.320 how much how many parasites does it take to get sick? 0:12:57.440 --> 0:13:01.000 And then how much are you pooping out during this process? 0:13:01.080 --> 0:13:03.000 I love that you asked me this question. I don't know. 0:13:03.840 --> 0:13:06.720 The only thing I saw in the literature of how 0:13:06.800 --> 0:13:10.440 many parasites does it take is that we think I 0:13:10.440 --> 0:13:12.200 wish I had written the exact quote, but it was like, 0:13:12.280 --> 0:13:15.880 we think that it's quite low. So we don't really know. 0:13:16.040 --> 0:13:20.719 But it's probably just a handful of these individual oocysts, right, 0:13:20.760 --> 0:13:24.080 each one has four sporozoites that are causing infection. Then 0:13:24.080 --> 0:13:27.680 they're replicating asexually before doing the sexual reproduction things. So 0:13:28.000 --> 0:13:31.600 I couldn't find a specific infectious dose. And similarly, I 0:13:31.600 --> 0:13:34.080 don't have an exact number on how many oocytes are 0:13:34.120 --> 0:13:36.920 you pooping out. But what makes this really challenging is 0:13:36.920 --> 0:13:40.800 that it's not a lot. This is not cholera where 0:13:41.000 --> 0:13:45.319 you or neurovirus where you're releasing you know, thousands, tens 0:13:45.360 --> 0:13:50.160 of thousands. It is low numbers of these oocytes, and 0:13:50.200 --> 0:13:54.079 it can be sporadic, so you might even though you're 0:13:54.080 --> 0:13:58.480 having diarrhea continuously, you might not be releasing oocytes in 0:13:58.559 --> 0:14:02.200 every stool. And it's part because of this. It's not 0:14:02.440 --> 0:14:05.520 every single parasite that's getting extreated, right, Like, it's only 0:14:05.559 --> 0:14:07.040 the osiites that they're producing. 0:14:07.320 --> 0:14:10.679 That's kind of I mean, that's so rude, right, just 0:14:10.760 --> 0:14:14.319 save the save the osides, save the diarrhea for the os. 0:14:14.000 --> 0:14:16.719 Or the Nope. They're like, no, no, no, We're just 0:14:16.800 --> 0:14:19.360 going to keep it continuous, keep it, keep it moving. 0:14:19.800 --> 0:14:22.119 And so that can make it really hard to diagnose 0:14:22.280 --> 0:14:25.640 because if you're looking in the stool for these osiites, 0:14:25.680 --> 0:14:27.680 they might be in very low numbers and they might 0:14:27.680 --> 0:14:29.280 not be there on one day, and so you might 0:14:29.320 --> 0:14:31.560 have to look for multiple days in a row. They're 0:14:31.600 --> 0:14:35.240 also hard to detect on like typical stool studies don't 0:14:35.240 --> 0:14:38.560 actually look for them, and they don't stain the same 0:14:38.600 --> 0:14:41.040 way that other parasites do, which means you actually have 0:14:41.080 --> 0:14:44.360 to use like special stains to find them. They're easier 0:14:44.360 --> 0:14:47.040 to detect with PCR based methods, and so I did 0:14:47.120 --> 0:14:50.400 check they are on our like GI pathogen panel that 0:14:50.480 --> 0:14:53.720 I order when someone has unexplained diarrhea that I don't 0:14:53.720 --> 0:14:55.600 know if I need to treat or not. It is 0:14:55.640 --> 0:14:58.760 on ours. But again, even though PCR helps, because you're 0:14:58.840 --> 0:15:01.960 increasing the number, like the amount of DNA in the sample, 0:15:02.120 --> 0:15:04.200 it makes it easier to detect. If you only have 0:15:04.280 --> 0:15:06.360 a couple of osides there, you still might not pick 0:15:06.400 --> 0:15:07.520 it up. You might pick it up. 0:15:09.120 --> 0:15:14.960 That's interesting, and it's really interesting. How does it resolve? 0:15:16.520 --> 0:15:20.080 I mean either with time, though some people can have 0:15:20.160 --> 0:15:23.440 a kind of relapsing remitting course. So we do see 0:15:23.440 --> 0:15:27.160 that some people, you know, recover and then weeks later 0:15:27.400 --> 0:15:29.640 might have more symptoms or the symptoms are just like 0:15:29.760 --> 0:15:33.840 really really prolonged. We also see especially in people who 0:15:33.840 --> 0:15:37.880 are immunal compromised, so whether they are on immunosuppressive medications 0:15:38.000 --> 0:15:41.840 or maybe have uncontrolled HIV, the disease can spread outside 0:15:41.840 --> 0:15:45.480 of just the intestine and cause disease elsewhere, like say 0:15:45.480 --> 0:15:48.920 the biliary system that's the gall bladder and liver, or 0:15:49.080 --> 0:15:53.560 we sometimes see these kind of post infectious inflammatory type 0:15:53.560 --> 0:15:56.760 syndromes that we see after other food borne illnesses like 0:15:56.800 --> 0:16:00.000 salmonella or Camplia bacter and these are things like inflame 0:16:00.360 --> 0:16:04.320 in the eye, joint pain and inflammation, bladder inflammation, and 0:16:04.360 --> 0:16:06.440 so that's kind of an interesting component that like we 0:16:06.480 --> 0:16:08.640 don't really have a handle on, and it doesn't happen 0:16:08.680 --> 0:16:11.080 all that often, but it certainly can happen where you 0:16:11.160 --> 0:16:15.640 have this prolonged extra intestinal illness as a result of 0:16:15.800 --> 0:16:20.880 like inflammatory response to this parasite. The good news is 0:16:20.920 --> 0:16:25.560 that it is treatable and we use actually an antibiotic. Yeah, 0:16:25.680 --> 0:16:28.480 even though it's not a bacteria. I double checked the 0:16:28.480 --> 0:16:31.120 mechanism of action of the main antibiotic that we use, 0:16:31.160 --> 0:16:35.120 which is trimethiprine sulfa mythsoxicide or backdrum arcepter in the US. 0:16:35.160 --> 0:16:37.480 So glad that you pronounce that because I just wrote 0:16:37.520 --> 0:16:40.520 like to whatever the initials are, that that's appreciated, Like 0:16:41.520 --> 0:16:42.360 Eron's going to handle this. 0:16:44.200 --> 0:16:46.800 The mechanism of it is that it's a foll late blocker. 0:16:46.840 --> 0:16:49.320 It blocks a synthesis of fol late, and so like 0:16:49.520 --> 0:16:54.080 all organisms need fol late, and most single celled organisms, 0:16:54.080 --> 0:16:57.080 including bacteria and many parasites make their own fold late, 0:16:57.760 --> 0:17:00.040 and we don't. We get it from our diet, and 0:17:00.080 --> 0:17:02.600 so by blocking the synthesis of full late, they this 0:17:02.720 --> 0:17:06.640 particular antibiotic can also work against some parasites, though not all, So. 0:17:06.760 --> 0:17:07.639 That's very cool. 0:17:07.760 --> 0:17:09.520 I know, I relooked it up, and I was like, 0:17:09.560 --> 0:17:12.480 I love learning things like that that I knew once before. 0:17:13.320 --> 0:17:16.439 So it is treatable if you can detect it. So 0:17:16.520 --> 0:17:18.800 really a lot of times it's diagnosis that is one 0:17:18.800 --> 0:17:22.800 of the biggest challenges. The good news, too, is that 0:17:22.920 --> 0:17:25.720 even though it's hard to detect and it can last 0:17:25.800 --> 0:17:28.639 for such a long time, it usually is a self 0:17:28.680 --> 0:17:32.280 limited illness in that the mortality rate is very low. 0:17:32.880 --> 0:17:35.520 I do not have an exact number, but for example, 0:17:35.520 --> 0:17:37.320 in the US in the last few years, there have 0:17:37.400 --> 0:17:40.639 been only a small handful, like single digit number of 0:17:41.160 --> 0:17:47.040 deaths associated with Cyclospora. Globally, it probably contributes much more 0:17:47.080 --> 0:17:51.919 than we realize to mortality rates. However, because this is 0:17:52.080 --> 0:17:54.760 a parasite that is endemic in a lot of tropical 0:17:54.800 --> 0:17:58.640 and subtropical regions in the world where diarrheal illnesses kill 0:17:58.760 --> 0:18:01.359 children under age five, it's the leading cause of death. 0:18:02.200 --> 0:18:05.880 So the dehydration that can accompany any kind of diarrheal 0:18:05.960 --> 0:18:09.160 illness is something to take very seriously, especially in small 0:18:09.240 --> 0:18:11.280 kids and the elderly. So I don't want to say 0:18:11.280 --> 0:18:13.880 that this is like not an important illness. It definitely is, 0:18:14.800 --> 0:18:16.600 and we're probably underestimating it overall. 0:18:16.840 --> 0:18:20.920 Oh absolutely, yeah, I mean for sure, and I'm sure 0:18:20.920 --> 0:18:22.560 that you'll get into some of the reasons for that 0:18:22.640 --> 0:18:25.919 in like the current and what's going on. And also 0:18:26.080 --> 0:18:29.199 I think that, yeah, there's a lot more when it 0:18:29.240 --> 0:18:34.719 comes to like the shape of outbreaks, yes, associated with cyclospora. 0:18:34.960 --> 0:18:38.240 Yeah, it's really it's really interesting, and like what who 0:18:38.280 --> 0:18:41.000 is getting the most seck? Like here in the US 0:18:41.000 --> 0:18:44.040 it's mostly adults, whereas in other parts of the world 0:18:44.040 --> 0:18:46.879 it's mostly children and not super young children, but like 0:18:47.240 --> 0:18:52.000 you know, children aged two to five, ten, twelve, And 0:18:52.040 --> 0:18:54.000 so that kind of gives us ideas as to like 0:18:54.400 --> 0:18:57.080 how endemic this parasite really is. How much is it 0:18:57.160 --> 0:18:59.159 just something that we live with versus something that is 0:18:59.200 --> 0:19:04.040 only their occasion. Yeah, it's also interesting, it is I 0:19:04.080 --> 0:19:04.360 have a. 0:19:04.359 --> 0:19:08.119 Question about symptoms during you know, all these things. So 0:19:08.440 --> 0:19:10.639 diarrhea can be caused by a lot of different things, 0:19:11.320 --> 0:19:14.000 and it can resolve on its own quite you know, 0:19:14.200 --> 0:19:17.920 sooner rather than later. At what point with an illness 0:19:17.960 --> 0:19:20.600 like this with cyclospora should someone And I know this 0:19:20.640 --> 0:19:23.240 is not a medical advice podcast, but like, at what 0:19:23.280 --> 0:19:25.879 point is going to the doctor for a diagnosis like 0:19:26.160 --> 0:19:27.040 something that like. 0:19:27.200 --> 0:19:29.000 You know, that's that's a good idea. 0:19:29.160 --> 0:19:31.960 Yeah, that's such a such a good question, Aaron. There's 0:19:31.960 --> 0:19:36.040 not like a perfect answer to it. It so much 0:19:36.119 --> 0:19:39.560 depends on how severe your symptoms are. I would say 0:19:39.960 --> 0:19:43.680 probably on average, like two to three days of severe 0:19:43.720 --> 0:19:45.879 diarrhea that's not going away or getting. 0:19:45.600 --> 0:19:48.080 Better, okay, like not being able to keep anything down, 0:19:48.240 --> 0:19:49.720 not being able to set things down. 0:19:50.240 --> 0:19:52.000 It's going to differ if you're having a lot of 0:19:52.000 --> 0:19:54.440 fevers or if you're super super sick. But I would 0:19:54.480 --> 0:19:56.199 say probably two to three days is the point at 0:19:56.200 --> 0:19:58.760 which we know it's probably not neuro it's probably not 0:19:58.840 --> 0:20:01.200 something it might be something that we need to treat, 0:20:01.240 --> 0:20:04.440 is really the question. Yeah, okay, And it is hard 0:20:04.440 --> 0:20:07.040 because this isn't necessarily something that's always tested for or 0:20:07.040 --> 0:20:08.359 picked up on on the first try. 0:20:08.760 --> 0:20:11.760 Yeah, well, and I imagine too it's different for you know, 0:20:12.000 --> 0:20:14.480 different people of like if it's your a small child 0:20:14.560 --> 0:20:17.480 or if you're you know, elderly, then it could be 0:20:17.560 --> 0:20:18.800 more severe, more quickly, and. 0:20:18.760 --> 0:20:22.480 So exactly exactly, Okay, okay, cool, trying to think if 0:20:22.480 --> 0:20:23.879 there was anything else I wanted to make sure that 0:20:23.880 --> 0:20:25.960 you knew. I feel like there's a lot more. But Aaron, 0:20:26.560 --> 0:20:29.080 can you tell me where the heck this thing came from? 0:20:29.560 --> 0:20:30.439 Let's give it a go. 0:20:44.880 --> 0:20:48.080 If this current outbreak is the first time that Cyclospora 0:20:48.160 --> 0:20:52.320 has been on your radar, first of all, count yourself lucky, because, 0:20:52.440 --> 0:20:55.360 as you just shared Aarin, it is not something that 0:20:55.480 --> 0:20:59.280 anyone wants to deal with. And second, it's totally understandable 0:20:59.440 --> 0:21:02.120 if you had never heard of this parasite before, because 0:21:02.480 --> 0:21:05.760 it was not actually that long ago that researchers first 0:21:05.800 --> 0:21:10.240 identified Cyclospora as infecting humans, as a parasite capable of 0:21:10.240 --> 0:21:11.080 infecting humans. 0:21:11.280 --> 0:21:15.600 I was shocked, and I couldn't avoid some of the 0:21:15.680 --> 0:21:18.680 numbers because they're just so recent and in every single paper, but. 0:21:18.760 --> 0:21:22.800 Like so recent. What I know, nineteen seventy nine. 0:21:22.840 --> 0:21:25.440 That's like, that's so recent. 0:21:25.359 --> 0:21:29.720 So recent, So what happened that year. In nineteen seventy nine, R. W. Ashford, 0:21:29.760 --> 0:21:32.520 who was a British parasitologist who was in the Department 0:21:32.560 --> 0:21:35.760 of Pathology at the University of Papua New Guinea, he 0:21:35.880 --> 0:21:38.840 reported that he had come across three cases of what 0:21:38.920 --> 0:21:42.960 appeared to be a new species of Coccidian in routine 0:21:43.000 --> 0:21:46.600 stool samples from two patients over the years of nineteen 0:21:46.640 --> 0:21:49.920 seventy seven and nineteen seventy eight. Two of the three 0:21:49.960 --> 0:21:53.280 at least had been experiencing diarrhea and general malaise like 0:21:53.359 --> 0:21:55.920 flu like symptoms for some time, but a week or 0:21:55.960 --> 0:21:59.520 two and the infection over time begins like seem to 0:21:59.560 --> 0:22:02.920 resolve on its own. And at the time of finding 0:22:02.960 --> 0:22:06.080 these parasites, he was like, well, it's possible that this 0:22:06.119 --> 0:22:10.159 parasite is causing diarrhea, but it's not conclusive by any means, 0:22:10.160 --> 0:22:12.720 given that, you know, one patient was also coinfected with 0:22:12.840 --> 0:22:16.200 giardia and the other could have had diarrhea from something 0:22:16.200 --> 0:22:18.800 else of you know, just something they ate, virus, whatever. 0:22:19.520 --> 0:22:21.720 And he also had difficulty. 0:22:21.200 --> 0:22:25.320 Yeah, categorizing it, like it looked like a coxidian parasite, 0:22:25.400 --> 0:22:28.480 but he wasn't sure about the genus, and so the 0:22:28.520 --> 0:22:33.879 parasite remained unnamed and unclassified in that initial report. Wow, 0:22:33.920 --> 0:22:37.840 and owing in part to this sort of unclassification as 0:22:37.880 --> 0:22:40.800 well as just the relative obscurity of a three case 0:22:40.920 --> 0:22:44.080 case report, you know, in from like a journal of 0:22:44.119 --> 0:22:48.640 Tropical medicine or whatever, it's a pretty niche area of study, 0:22:48.800 --> 0:22:53.720 his initial paper mostly went unnoticed until sporadic reports over 0:22:53.760 --> 0:22:57.639 the next decade the nineteen eighties of a coxidyan parasite 0:22:57.680 --> 0:23:01.240 infecting humans and that show these these reports showed that 0:23:01.480 --> 0:23:05.360 this might not be one off infections. These cases might 0:23:05.400 --> 0:23:09.440 be indications of a more widespread disease or a widespread parasite. 0:23:09.840 --> 0:23:12.320 And the researchers who worked on these cases throughout the 0:23:12.359 --> 0:23:16.879 nineteen eighties, they also struggled with what this parasite was like. 0:23:16.960 --> 0:23:19.320 Some thought, you know, it kind of looks like fungal 0:23:19.359 --> 0:23:22.280 spores in certain settings, so they'd be like its fungal like. 0:23:22.640 --> 0:23:25.680