Emerging causes of traveler's diarrhea: Cryptosporidium, Cyclospora, Isospora, and Microsporidia

Travel is a risk factor for acquiring infection with a spore-forming protozoa: Cryptosopridium, Cyclospora, Microsporidia, and Isospora. Certain travel destinations have a high disease burden and intense exposure. Patients present with persistent diarrhea and a history of recent travel to a developing country in the tropics. Very mild infections may be underdiagnosed and may cause typical traveler's diarrhea. In a patient with a history of travel and persistent diarrhea unresponsive to the usual antibiotic and antidiarrhea treatment, stool studies for all four of these protozoa infections should be performed. If immune status is normal and the disease is mild, symptomatic therapy may suffice. Effective treatment is available for Cyclospora, Microsporidia, and Isospora.