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- Obligate intracellular coccidian parasite; infects epithelial cells of small intestine. Destroys brush border and alters mucosal architecture.
- Excreted in stool as oocysts (spherical, 8-10 μm in diameter), which may be shed intermittantly and at low levels. Sporulation (maturation of oocysts) occurs outside host and takes 7-12d.
- Transmitted by fecal-contaminated soil, food and water. Humans only known host and reservoir. Human-to-human transmission unlikely as excreted oocysts must sporulate before becoming infectious.
- Both sporadic infections and outbreaks occur. Frequency peaks during spring & summer in the U.S., associated with fruits and vegetables, i.e., raspberries, mixed salad greens, cilantro, and basil.
- 2018 outbreak season comprised 2 multistate outbreaks and 761 laboratory-confirmed cases.
- Lack of validated molecular typing tool limits outbreak investigations.
- Endemic areas, i.e., Peru, Nepal, Haiti, Guatemala, Indonesia. Low-level endemicity in US cannot be excluded.