Disinfectant Efficacy Report Form In Microbiology: Fill & Download for Free

CANCER IS SERIOUS BUSINESS (Read it, it may save your life)A quote worth sharing“The system is rigged. They want us to believe that it'll protect us, but that's a lie. We protect us. We do. Nobody else. Not the companies, not the scientists, not the government”. 'Us'. - Rob Bilott (Dark Waters)The Man who cured CancerForgotten Genius: “Royal Raymond Rife”The inventor and his invaluable contributions to imaging and medical microscopyScience has known for quite some time that all things vibrate at their own personal frequency. Certain emotions sustained over time can change our vibrational frequencies and manifest in illness. Recently I read an article that explained how current research is using resonant frequency to destroy cancer cells. As exciting as that prospect is, it’s not a new approach. Royal Raymond Rife made an invaluable contribution to medical microscopes.As a scientist, inventor, and engineer, particularly in imaging and medical microscopy, Royal Raymond Rife was a genius. He was to medical optics what Nikola Tesla was to physics. In 1913, industrial tycoon Henry Timken of the Timken Roller Bearing Company in Canton, Ohio, sought Rife’s help to solve a manufacturing problem. The solution was a scanning machine that could evaluate the quality of the steel used in the company’s roller bearings before going into production. The scanner improved the quality of the company’s products and streamlined production to such a degree that Timken was overjoyed. When he learned that Rife’s passion was medical imaging, Timken gave him his full financial support and set him up at the family’s estate in San Diego to create his personal lab. No expense was too great and nothing was held back.Rife’s previous work had led him to believe that microorganisms (bacteria, viruses, and parasites) were at the root of all disease. To prove his theory, he had to see these pathogens in their live state during his experiments, some of which were so small, particularly viruses, that no imaging equipment existed that could come close to viewing them. That wasn’t a stumbling block to Rife. As a mechanical engineer and microscopy expert, he built a microscope that could magnify 60,000 times, and the superior magnification was equaled by its resolution. The microorganisms Rife was viewing were so infinitesimally small that the atoms in the chemical stain normally used to expose microorganisms would have obscured them. Instead Rife’s microscope used monochromatic light that caused the organism to fluoresce. Rife could identify the virus he was observing by the color it refracted.Years later in 1944, both the “Journal of the Franklin Institute for Scientific and Mechanical Arts and The Smithsonian” featured the Rife Universal Microscope alongside the newly created electron microscope in articles on emerging technology in optics. In The Smithsonian article entitled “The New Microscopes,” three micrographs from the Rife Universal Microscope were printed. The resolution of those images was unmatched by any existing technology, including the electron microscope. In fact they’re still unmatched even by today’s technology. What’s more, those images were taken ten years prior by Rife in 1934. Rife discovered that a simple electromagnetic wave wasn’t enough to destroy a microorganism. Instead he found a radio frequency wave was readily accepted by the body if it was emitted by a gas within a glass tube. The other astounding feature of the Rife Universal Microscope was that viruses could be viewed in their live state, like a movie, whereas the electron microscope could only view viruses in still images, or like photos. When studying any organism, observing how it moves and behaves in real time provides much more valuable information than viewing it as a static image. Over the course of 20 years, Rife would build five of his microscopes, some requested by the most prestigious research scientists in the world. The Rife Universal Microscope created a paradigm shift in pathology and microbiology research because much of what his device could do is still considered impossible today. But the biggest change was yet to come. Knowing everything vibrated at its own frequency, Rife believed that if he could discover the vibrational frequencies at which disease-causing microorganisms vibrated, then he could bombard them with that frequency until they shook so hard they exploded, the same way an opera singer matches the frequency of a wine glass with her voice and shatters it. Rife discovered that a simple electromagnetic wave wasn’t enough to destroy a microorganism. Instead he found a radio frequency wavThe other astounding feature of the Rife Universal Microscope was that viruses could be viewed in their live state, like a movie, whereas the electron microscope could only view viruses in still images, or like photos. When studying any organism, observing how it moves and behaves in real time provides much more valuable information than viewing it as a static image.Over the course of 20 years, Rife would build five of his microscopes, some requested by the most prestigious research scientists in the world. The Rife Universal Microscope created a paradigm shift in pathology and microbiology research because much of what his device could do is still considered impossible today. But the biggest change was yet to come.Knowing everything vibrated at its own frequency, Rife believed that if he could discover the vibrational frequencies at which disease-causing microorganisms vibrated, then he could bombard them with that frequency until they shook so hard they exploded, the same way an opera singer matches the frequency of a wine glass with her voice and shatters it.Rife discovered that a simple electromagnetic wave wasn’t enough to destroy a microorganism. Instead he found a radio frequency wave was readily accepted by the body if it was emitted by a gas within a glass tube. This allowed the frequency wave to penetrate deeply into the body with scalpel-like precision. Because the wave was precisely tuned to the frequency of the microorganism, only the pathogen was affected, leaving the surrounding tissue unharmed.Rife considered a disease cured when he could destroy a microorganism ten consecutive times using what he called its Mortal Oscillatory Rate (MOR). His surviving records show he found the MOR for 24 microorganisms including anthrax, cholera, tetanus, B. coli, influenza, spinal meningitis, tuberculosis, pneumonia, syphilis, gonorrhea, leprosy, streptococcus, conjunctivitis, bubonic plague, staphylococcus, diphtheria, and typhoid.It’s exciting and enraging to think that cancer, along with many other diseases, was cured 83 years ago, and yet half a million people die from malignancies every year.By now Rife’s accomplishments were attracting a lot of attention from the press and he was working with the most respected medical experts of the day. These included Dr. E. C. Rosenow, bacteriologist and head of the pathology department at the Mayo Clinic, Dr. Arthur Kendall, bacteriologist at Northwestern University, Dr. Milbank Johnson of the University of Southern California (USC) and head of the Medical Society of California, Lee De Forrest, technology scientist, and William D. Coolidge, physicist.Unfortunately Rife was also attracting a lot of negative press, mainly from the FDA, American Medical Association, medical establishment and Harvard University. To prove his detractors wrong, he along with Dr. Rosenow invited several of Rife’s most prestigious but severest critics to a demonstration where he destroyed the poliomyelitis virus with its MOR (Mortal Oscillatory Rate) in 1932, twenty years before the vaccine was invented and thirty years before it became available to the public.Hidden beneath his critics’ astonishment at what they’d seen was panic. They knew Rife’s microscope and beam-ray technology would mean the loss of billions of dollars to hospitals, pharmaceutical companies, and research institutes, not to mention the overnight elimination of entire fields of medical science and research, as well as the discrediting of thousands of careers of the most highly respected university and medical center physicians, scientists and administrators. Just days after the demonstration, Dr. Rosenow was fired from his position at the Mayo Clinic, and the fix was in to bury Rife’s research.Uneasy about Dr. Rosenow’s fate and what might be brewing for him behind the scenes, Rife pressed on. He knew a microorganism was at the root of cancer and was determined to find it. That same year, he discovered a virus in a breast tumor that he called the BX virus. Even more, he found the BX virus to be pleomorphic, meaning that it changed form based on its terrain. He discovered its MOR and was able to destroy it.Never having used his beam ray on a living creature, Rife introduced the BX virus into rats. Sure enough, they developed huge tumors. Using his beam ray to expose the tumors to their MOR, Rife was able to completely heal the rats. Seeing these incredible results, Dr. Johnson from USC insisted that it was time to try the beam ray on human patients. Rife was apprehensive, but insisted that if they were to have human trials, a research committee comprised of physicians at the top of the most prestigious medical associations had to be part of the proceedings. Dr. Johnson agreed and pulled a committee together that even included Dr. Alvin Ford, President of the American Association of Pathologists, a member Rife specifically requested.The trials included 16 terminally ill patients with various cancers and were conducted at the Ella Scripps mansion and estate in La Jolla, CA in 1934. In just 70 days, the committee declared the first 14 patients cured of their cancer. The remaining two were declared cured three weeks later. Incredibly, the patients only required two 3-minute sessions per week to achieve total recovery. Rife found that more-frequent sessions didn’t allow the lymphatic system enough time to take up the released toxins from the destroyed virus and remove them from the body.Later that year, a black tie banquet was held to honor Rife and “Celebrate the End of All Disease.” Less than 15 years later, however, none of the people at that dinner would even admit to knowing Rife, who would be left in poverty with his career ruined. His five microscopes would be confiscated along with the majority of his records and the two known beam-ray machines in existence. Today scientists are still struggling to recreate Rife’s technology from the remnants of what wasn’t destroyed of his writings.It’s exciting and enraging to think that cancer, along with many other diseases, was cured 83 years ago, and yet half a million people die from malignancies every year. As an institution mired in politics and money, the medical establishment seems to be the worst at killing its prophets and saints. Hopefully this new generation of courageous scientists will be able to put together the pieces from an unsung genius and recreate the “end of all disease” in his memory.Hyperthermia (up to 113°F) kills cancer cell usually with minimal injury to normal tissue research should be done to channel and target it for curing cancer without damaging our brain and other organs.Watch it before it gets removed“Cancer cure coverup” Dr. S. R. Burzynski another genius who cured cancer.A pioneering medical doctor and PhD biochemist who won the largest and possibly the most convoluted legal battle against the Food and Drug Administration in American history. Burzynski's battles were centered on his belief in Antineoplastons, a gene-targeting cancer therapy he discovered in the 1970s. The ultimate approval of Antineoplastons would mark the first time in history a single scientist, not a pharmaceutical company, would hold the exclusive patent and distribution rights on a paradigm-shifting, life-saving medical breakthrough. Burzynski's first-person testimonials of cancer patients who chose his treatment instead of surgery, chemotherapy or radiation with full disclosure of original medical records to support their diagnosis and recovery.There is almost nothing about this film that isn't controversial. Even the Wikipedia entry, which is pretty tough on the doctor and his treatment, is challenged by the flims website, which claims "the Wikipedia editors refuse to allow anything that show these medicines in a positive light to be allowed to be included in the Wiki post."Watch the documentary by Eric Merola.Must watch might save someone's lifeDid you know?Ignaz Philipp Semmelweis, a Hungarian physician and scientist, now known as an early pioneer of antiseptic procedures. Described as the "saviour of mothers".Semmelweis discovered that the incidence of puerperal fever (also known as "childbed fever") could be drastically cut by the use of hand disinfection in obstetrical clinics. Puerperal fever was common in mid-19th-century hospitals and often fatal. Semmelweis proposed the practice of washing with chlorinated lime solution in 1847 while working in Vienna General Hospital First Obstetrical Clinic, where doctors' wards had three times the mortality of midwives wards.He published a book of his findings in Etiology, Concept and Prophylaxis of Childbed Fever.Despite various publications of results where hand washing reduced mortality to below 1%, Semmelweis's observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. He could offer no acceptable scientific explanation for his findings, and some doctors were offended at the suggestion that they should wash their hands and mocked him for it. In 1865, the increasingly outspoken Semmelweis supposedly suffered a nervous breakdown and was committed to an asylum by his colleagues. He died 14 days later after being beaten by the guards, from a gangrenous wound on his right hand which might have been caused by the beating. Semmelweis's practice earned widespread acceptance only years after his death, when Louis Pasteur confirmed the germ theory, and Joseph Lister, acting on the French microbiologist's research, practised and operated using hygienic methods, with great success.Must ReadFor the past 27 years, Life Extension has identified life-saving medications that languished too long in the FDA’s archaic approval process.When effective new drugs are delayed, the inevitable consequence is needless human suffering and death. An equally insidious problem is the chilling effect bureaucratic roadblocks have on the development of better drugs that might actually cure the disease.Just imagine the difficulty of raising the tens of millions of dollars needed to get a new cancer drug into the approval pipeline when prospective investors see the FDA deny a drug with documented efficacy, as was done recently with Provenge. (Refer to page 7 for the complete story of the FDA’s denial of Provenge.)Another problem with the FDA’s unpredictable approval pattern is the outrageous cost of the cancer drugs that actually make it to market. Classes of cancer drugs (like anti-angiogenesis agents) that Life Extension long ago advocated are finally approved. The problem is that the out-of-pocket cost of these new drugs can exceed $12,000 per month. The media has reported on heart-wrenching stories of cancer patients who choose to die rather than send their families into bankruptcy from paying these costs.It’s easy to point fingers at drug companies for charging such extortionist prices, but the harsh reality is that getting these medications approved by the FDA is so costly and risky that the high prices can arguably be justified by the hideously inefficient drug approval process that now exists.In this article, we review a few of many drugs that have been shown to be effective against cancer, but are not yet approved by the FDA. While there are dozens of anti-cancer drugs in various stages of the approval process, the sad truth is that thousands of compounds with anti-cancer activity will never be submitted for FDA approval due to lack of patentability, lack of investor funding, or just plain unwillingness to deal with today’s cancer bureaucracy.It has become brutally apparent that the system of drug approval needs a radical overhaul. We have some specific proposals at the end of this eye-opening article.Each day, about 1,500 Americans perish from cancer. Each day, over 3,000 Americans are diagnosed with this dreaded disease.1 While the general population is relatively ignorant about medicine, virtually everyone knows that a cancer diagnosis means exposure to therapies that produce miserable—if not lethal—side effects. The public is also aware that in too many cases, government-approved therapies fail to cure the disease.*Now im gonna tell you something which you might find as a complete shocker*A conversation with the lawyer Rob Bilott is like a slap across the face. It doesn’t feel good. But it does get your attention.According to Bilott, we face a “unique health threat” from a class of industrial chemicals that most Americans have never heard of. These chemicals are widely used in everyday products such as non-stick cookware and stain-resistant fabrics, even though science show they are linked to a range of deadly diseases, reproductive problems and other ailments. Powerful corporations are fighting to protect the use of these profitable chemical compounds, Bilott says, and US regulators are doing next to nothing to stop them. It’s worth listening to what Bilott has to say. He has spent the last two decades advocating for people in West Virginia and Ohio whose water was contaminated with one of these toxins, a chemical called perfluorooctanoic acid, or PFOA.Do watch these movies if you haven't watched it yet. Based on this agenda.*Now lets get into some details*3MPFAS DANGER3M has long known it was contaminating the US food supplyMultinational manufacturer 3M, which developed two types of industrial chemical now found in the blood of virtually all Americans, has known since 2001 that those chemicals were entering the food supply, according to a newly surfaced study.That year, the company sponsored a study of several types of food from around the US. The study surfaced this week, when the Intercept’s Sharon Lerner reported that the document was on file with the US Environmental Protection Agency.3M made Scotchgard and other non-stick, waterproof, or stain-resistant products using PFOA and PFOS, two chemicals in a class known as PFAS. Production of Scot ended after 2000. In 2001, 3M funded the study to test food samples from six US cities. High levels of the compounds were found in ground beef, milk, green beans and apples. The contaminated food came from Alabama, Tennessee, Florida, and Georgia.In a statement to Quartz, 3M said it published the report in 2001 and “shared this report with the EPA within seven days,” adding, “This report is one of thousands of documents we have placed in the public domain related to the study of PFAS chemistries. We will continue to engage with members of our communities, elected officials and regulators to share information about these chemistries,” 3M wrote.What 3M knew about PFASAs Lerner has reported, 3M knew as early as the 1970s that PFAS was accumulating in human blood, and conducted experiments on rats and monkeys that led the company to believe the compounds “should be regarded as toxic.”PFAS do not degrade in the environment. Decades of use has created a widespread and ongoing Contamination crisis. At this point, most people in the US have been exposed to chemicals in the PFAS family, of which there are as many as 5,000, and water supplies serving tens of millions are likely contaminated as well. The revelation about PFAS entering the food supply, however, is a relatively new addition to the roster of ways people have been exposed.PFAS chemicals have been linked to a range of health risks including cancer, thyroid disease, elevated cholesterol, immune-system issues, and developmental problems in fetuses.Both 3M and DuPont have ceased production of PFOA and PFAS in the US, but DuPont continues to manufacture it in China. In Brazil, contamination is widespread due to a popular pesticide that degrades into PFAS. In Jordan0, researchers found PFAS in women’s breast milk at levels more than double the advised US health level. American dairy farmers have found PFAS in their milk. Other chemicals in the PFAS family, including GenX, continue to be manufactured in places like North Carolina.Decades of widespread use of PFAS for everything from waterproofing clothes to firefighting foam has made the exposure global: Health issues arising from PFAS are estimated to cost Europe 50 billion euros per year. A UN committee responsible for toxic chemical policy agreed to ban the compounds this year (the US is not party to the pact).PFAS back in the newsWord of the 19-year-old 3M study comes a week after nonprofit Environmental Working Group published a photo of a poster containing unreleased US Food and Drug Administration findings about PFAS in food. The agency detected PFAS in chocolate cake, meat, seafood, sweet potatoes, and pineapple. It was the first known test of food for PFAS by the FDA.After EWG’s poster release, the FDA published its findings along with a press release stating that the “FDA does not have any indication that these substances are a human health concern” at the levels detected, adding that the “science surrounding the potential health effects of PFAS is developing” and “current evidence suggests that the bioaccumulation of certain PFAS may cause serious health conditions.”“However, with the decrease in production and use of certain PFAS, levels in humans in the US have been declining,” the FDA added.As Lerner reports, Rob Bilott—whose 1999 lawsuit against DuPont on behalf of residents near its Teflon plant in West Virginia put PFAS contamination on the map wrote a June 11 letter to the FDA asking whether it knew about 3M’s food study before now and if how long officials knew there were high levels of the compounds in food.The FDA said in a statement that it has received Bilott’s letter “and is reviewing it at this time.”Why are highly fluorinated chemicals harmful?Highly fluorinated chemicals contain carbon-fluorine (C-F) bonds, which are some of the strongest bonds in nature. That makes them both incredibly resistant to breakdown and very useful. For instance, they can make products grease or stain-resistant, nonstick, or waterproof. However, this comes at a cost.The highly fluorinated chemicals that have been well-studied have been associated with:testicular and kidney cancerliver malfunctionhormonal changesthyroid disruptionhigh cholesterolobesityulcerative colitislower birth weight and sizeOther highly fluorinated chemicals are suspected of similarly causing health problems, but have not been well tested.Because they are resistant to breakdown, these chemicals can persist in our bodies for years. In the environment, they can last for millions of years. This means that the highly fluorinated chemicals released during our lifetimes will build up in the environment, and many future generations will be exposed to them, at even higher levels than we are today.Scientists from all over the world signed the Madrid Statement to share their concerns about highly fluorinated chemicals and are asking for a limit to the production and use of these chemicals.On May 1, 2015, the Madrid Statement was published in Environmental Health Perspectives, a high-impact scientific journal.How are we exposed?Highly fluorinated chemicals are used in consumer products such as cookware, clothing, outdoor apparel, carpeting, and food packaging to provide nonstick, oil- and water resistant properties. They are also used in some kinds of cosmetics.We are exposed to them by direct contact with these products, but also through the air we breathe, the water we drink, and the food we eat.They have been detected at high levels in humans and wildlife all over the globe.What can you do?Ask yourself, “Do I really need products that are stain-resistant, nonstick, or waterproof?” Knowing the consequences, you might choose to give up some conveniences or product performance.Steps you can take:Avoid products that are oil repellant or stain resistant.Only purchase waterproof gear when you really need it.Avoid cosmetics with PTFE or any word containing “perfluor” or “polyfluor” on their ingredients list.Replace your Teflon nonstick cookware with cast iron, glass, or ceramic.Avoid microwave popcorn and greasy foods wrapped in paper.Tell retailers and manufacturers you want products without fluorinated chemicals.Support companies committed to phasing out highly fluorinated chemicals, such as the apparel brands that have joined Greenpeace’s detox campaign, and the fast food chains that removed them from food packaging as a result of EWG's action.If you are concerned about PFAS in your drinking water, consider installing an in-home filter on your tap. EWG summarized what is known about the efficacy of the different filter options.All products from these apparel brands are free of highly fluorinated chemicals after these dates.Look Carefully at the imagesHarsh truth is that medical facilities prioritise business rather than treatment and patient are customer for few doctor's.*SOURCES*Forgotten Genius: Royal Raymond Rife - Be Hive Of HealingHyperthermia in Cancer Treatment.Cancer Is 'Serious Business.' Is the 'Documentary'?'My Cancer Free Life'? Not So FastBurzynski: The Cancer Cure Cover-UpIgnaz Semmelweis - WikipediaThe Lawyer Who Became DuPont’s Worst Nightmare3M knew it was contaminating the food supply back in 2001Highly Fluorinated ChemicalsImage source- Google“Must Read” External LinkLife-Saving Cancer Drugs Not Approved by the FDA

Maybe this article would be useful?Page on Periopeak (This seems to be a commentary on the 2nd PubMed article below, found it through a Google search on the PubMed article below..Minimally-invasive non-surgical periodontal therapyAlso, I searched PubMed (Home - PubMed - NCBI) with this search phrase"Periodontal Debridement"[Majr] and rec'd 38 results.These seemed to be the most relevant of the 38 PubMed results(I do not have a dentistry background, so the search phrase and/or these results may or may not help answer your question…but hopefully a few are at least reasonably close)Dent Update. 2013 Sep;40(7):596.Technique tips--Non-surgical management of deep periodontal pockets--avoid the scalpel!Ray-Chaudhuri A, Poonian S, Briggs P.Author informationPMID: 24147396 [PubMed - indexed for MEDLINE]Dent Update. 2013 May;40(4):289-90, 293-5.Minimally-invasive non-surgical periodontal therapy.Ower P.Author informationAbstractPeriodontitis is a complex disease that has both oral and systemic consequences. The treatment of periodontitis may be both surgical and non-surgical but, in recent years, there has been a shift towards managing disease non-surgically in preference to surgery. Fundamental to all types of therapy is the patient's role in disease control, in the form of self-performed plaque control, and it is important that the patient understands this. Non-surgical periodontal therapy has a long history and has traditionally been carried out using a variety of hand and powered instruments, the objective being root surface disinfection by the removal of plaque, calculus and contaminated root cementum. However, over the last 30 years or so, it has become apparent that calculus does not cause disease, cementum does not become significantly infected and bacteria and their toxins are only loosely adherent to the diseased root surface. This has led to the development of less invasive instrumentation principles which may be better for patients, more cost-effective and more easily applied in different clinical settings. Clinical Relevance: This paper aims to describe and justify a minimally-invasive approach to the management of the diseased root surface in periodontitis, to clarify the terminology used and to suggest how these principles may be applied in general practice.PMID: 23829010 [PubMed - indexed for MEDLINE]Dent Today. 2013 Apr;32(4):122-5.Endoscopic periodontal debridement.Young GR.Author informationPMID: 23659103 [PubMed - indexed for MEDLINE]J Clin Periodontol. 2013 Mar;40(3):227-41. doi: 10.1111/jcpe.12026. Epub 2013 Jan 16.A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis.Matesanz-Pérez P, García-Gargallo M, Figuero E, Bascones-Martínez A, Sanz M, Herrera D.Author informationAbstractAIMS:To update the existing scientific evidence on the efficacy of local antimicrobials as adjuncts to subgingival debridement in the treatment of chronic periodontitis.MATERIAL AND METHODS:Fifty-six papers were selected, reporting data from 52 different investigations. All the studies reported changes in probing pocket depth (PPD) and clinical attachment level (CAL) and most in plaque index (PlI) and/or bleeding on probing (BOP). Meta-analyses were performed with the data retrieved from the studies fulfilling the inclusion criteria.RESULTS:The overall effect of the subgingival application of antimicrobials was statistically significant (p = 0.000) for both changes in PPD and CAL with a weighted mean difference (WMD) of -0.407 and -0.310 mm respectively. No significant differences occurred for changes in BOP and PlI. Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction (WMD between 0.5 and 0.7 mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo (WMD between 0.1 and 0.4 mm).CONCLUSIONS:The scientific evidence supports the adjunctive use of local antimicrobials to debridement in deep or recurrent periodontal sites, mostly when using vehicles with proven sustained release of the antimicrobial.J Clin Periodontol. 2013 Mar;40(3):242-51. doi: 10.1111/jcpe.12052. Epub 2013 Jan 9.Clinical and microbiological effects of systemic antimicrobials combined to an anti-infective mechanical debridement for the management of aggressive periodontitis: a 12-month randomized controlled trial.Silva-Senem MX, Heller D, Varela VM, Torres MC, Feres-Filho EJ, Colombo AP.Author informationAbstractAIM:To compare the 1-year clinical and microbiological outcomes of an enhanced anti-infective therapy with versus without systemic antimicrobials in patients with generalized aggressive periodontitis (GAP).METHODS:In this 12-month randomized, double-blinded, placebo-controlled trial, 35 individuals assigned to a control (n = 17) or test group (n = 18) received full-mouth supra and subgingival ultrasonic debridement followed by scaling and root planing with chlorhexidine rinsing, brushing, and irrigation. Subjects received either amoxicillin (AMX, 500 mg) + metronidazole (MET, 250 mg) or placebos, TID for 10 days. Subgingival samples were obtained and analysed for their composition by checkerboard. Data were subjected to non-parametric tests.RESULTS:Both therapeutic protocols resulted in similar significant clinical improvement for most parameters at 1 year (p < 0.01). The AMX + MET group exhibited shallower residual pockets than the placebo (p = 0.05). Most periodontal pathogens decreased, whereas beneficial bacteria increased in counts in both groups over time (p < 0.0012). High levels of some periodontal and other microbial pathogens were associated with disease persistence regardless treatment.CONCLUSIONS:The enhanced anti-infective mechanical therapy is comparable with its combination with systemic AMX+MET for most clinical parameters and for maintaining low levels of periodontal pathogens for up to 1 year after treatment of GAP.© 2012 John Wiley & Sons A/S.PMID: 23297772 [PubMed - indexed for MEDLINEJ Clin Periodontol. 2011 Sep;38(9):820-7. doi: 10.1111/j.1600-051X.2011.01751.x. Epub 2011 Jul 7.Subgingival debridement of periodontal pockets by air polishing in comparison with ultrasonic instrumentation during maintenance therapy.Wennström JL, Dahlén G, Ramberg P.Author informationAbstractAIM:The objective was to determine clinical and microbiological effects and perceived treatment discomfort of root debridement by subgingival air polishing compared with ultrasonic instrumentation during supportive periodontal therapy (SPT).MATERIAL AND METHODS:The trial was conducted as a split-mouth designed study of 2-month duration including 20 recall patients previously treated for chronic periodontitis. Sites with probing pocket depth (PPD) of 5-8 mm and bleeding on probing (BoP+) in two quadrants were randomly assigned to subgingival debridement by (i) glycine powder/air polishing applied with a specially designed nozzle or (ii) ultrasonic instrumentation. Clinical variables were recorded at baseline, 14 and 60 days post-treatment. Primary clinical efficacy variable was PPD reduction. Microbiological analysis of subgingival samples was performed immediately before and after debridement, 2 and 14 days post-treatment.RESULTS:Both treatment procedures resulted in significant reductions of periodontitis-associated bacterial species immediately and 2 days after treatment, and in significant reduction in BoP, PPD and relative attachment level at 2 months. There were no statistically significant differences between the treatment procedures at any of the examinations intervals. Perceived treatment discomfort was lower for air polishing than ultrasonic debridement.CONCLUSION:This short-term study revealed no pertinent differences in clinical or microbiological outcomes between subgingival air polishing and ultrasonic debridement of moderate deep pockets in SPT patients.Periodontol 2000. 2011 Feb;55(1):124-42. doi: 10.1111/j.1600-0757.2010.00342.x.Subgingival air-polishing in the treatment of periodontal biofilm infections.Petersilka GJ.PMID: 21134232 [PubMed - indexed for MEDLINE]Publication Types, MeSH Terms, SubstancesPublication TypesReviewUnfortunately, it seems that these articles are not available for free online. They may be available for free at a local academic or medical library. Many academic and medical libraries are open to the public. While no library has all medical journals, one close by just might. Call ahead and ask for a reference librarian. He or she may be able to give some assistance if you are not an affiliate of their library.Also, a public library may be able to get you the full text of a specific journal article for free (through interlibrary loan).Also, I searched Cochrane Reviews Cochrane ReviewsDid not find anything relevant through Browse Free SummariesCochrane SummariesWith the phrase….scaling root planingIf the above is not useful, and you think I could help out more, just reply here. I'll do what I can.

It’s a diseases caused by an intestinal parasite.ABOUTJOURNALSRESEARCH TOPICSARTICLESSUBMITImpact Factor 4.123 | CiteScore 5.4More on impact ›in Cellularand Infection MicrobiologyClinical MicrobiologyTOGGLE NAVIGATIONARTICLE ALERTSTHIS ARTICLE IS PART OF THE RESEARCH TOPICAdvances in Diagnosis and Therapeutic Intervention for Foodborne Parasitic Diseases View all 10 ArticlesSuggest a Research Topic >2,453TOTAL VIEWSREVIEW ARTICLEFront. Cell. Infect. Microbiol., 11 February 2020 | Advances in Cyclosporiasis Diagnosis and Therapeutic InterventionAdvances in Cyclosporiasis Diagnosis and Therapeutic InterventionJunqiang Li1,2†, Zhaohui Cui2†, Meng Qi3 and Longxian Zhang2*1Academy of Chinese Medical Sciences, Henan University of Chinese Medicine, Zhengzhou, China2College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, China3College of Animal Science, Tarim University, Alar, ChinaCyclosporiasis is caused by the coccidian parasite Cyclospora cayetanensis and is associated with large and complex food-borne outbreaks worldwide. Associated symptoms include severe watery diarrhea, particularly in infants, and immune dysfunction. With the globalization of human food supply, the occurrence of cyclosporiasis has been increasing in both food growing and importing countries. As well as being a burden on the health of individual humans, cyclosporiasis is a global public health concern. Currently, no vaccine is available but early detection and treatment could result in a favorable clinical outcome. Clinical diagnosis is based on cardinal clinical symptoms and conventional laboratory methods, which usually involve microscopic examination of wet smears, staining tests, fluorescence microscopy, serological testing, or DNA testing for oocysts in the stool. Detection in the vehicle of infection, which can be fresh produce, water, or soil is helpful for case-linkage and source-tracking during cyclosporiasis outbreaks. Treatment with trimethoprim-sulfamethoxazole (TMP-SMX) can evidently cure C. cayetanensis infection. However, TMP-SMX is not suitable for patients having sulfonamide intolerance. In such case ciprofloxacin, although less effective than TMP-SMX, is a good option. Another drug of choice is nitazoxanide that can be used in the cases of sulfonamide intolerance and ciprofloxacin resistance. More epidemiological research investigating cyclosporiasis in humans should be conducted worldwide, to achieve a better understanding of its characteristics in this regard. It is also necessary to establish in vitro and/or in vivo protocols for cultivating C. cayetanensis, to facilitate the development of rapid, convenient, precise, and economical detection methods for diagnosis, as well as more effective tracing methods. This review focuses on the advances in clinical features, diagnosis, and therapeutic intervention of cyclosporiasis.IntroductionCyclosporiasis is caused by Cyclospora cayetanensis, and in humans it typically induces periodic profuse watery diarrhea (Shields and Olson, 2003a; Ortega and Sanchez, 2010; Almeria et al., 2019; Giangaspero and Gasser, 2019). Human C. cayetanensis infection has been documented in over 56 countries worldwide, and 13 of these have recorded cyclosporiasis outbreaks (Li et al., 2019a). The latest large scale cyclosporiasis outbreaks occurred in 2013 and 2018 in multiple states of the US (Abanyie et al., 2015; Casillas et al., 2018).As of today, 22 Cyclospora species are identified in humans and various animals, including vipers, moles, myriapodes, rodents, and monkeys (Li et al., 2015a, 2019a; McAllister et al., 2018). C. cayetanensis is the only documented Cyclospora species known to infect humans (Ortega and Sanchez, 2010; Li et al., 2019a). The overall prevalence of C. cayetanensis was 3.6% in humans worldwide (Li et al., 2019a). Of the other species, C. papionis was detected in 17.9% of the captured baboons in Kenya (Li et al., 2011) and C. macacae in 6.8% of the rhesus monkeys in China (Li et al., 2015b). In humans, most of these infections are contracted via the fecal-oral route, and water, berries, basil, cilantro, and other food produce can be a vehicle for Cyclospora transmission (Almeria et al., 2019). The Cyclospora infection is evidenced to be linked with consumption of contaminated food and water or contact with transmission vehicles of oocysts (Li et al., 2019a).Although large outbreaks of cyclosporiasis have been documented in developed countries, C. cayetanensis infections are most commonly reported in developing countries or in endemic areas (Li et al., 2019a). In susceptible individuals, cyclosporiasis is reported to be most prevalent in immunocompetent diarrheic patients (Li et al., 2019a). There are notable seasonal distributions of C. cayetanensis infections that commonly occur in rainy or summer season (Zhou et al., 2011; Kaminsky et al., 2016). Cyclosporiasis causes significant health problem to the people traveling or expatriating to the under developed or developing countries having poor sanitation and high population density (Fryauff et al., 1999; Mansfield and Gajadhar, 2004; Pandey et al., 2011; Kłudkowska et al., 2017).The entire genome of C. cayetanensis had been sequenced (Liu et al., 2016; Qvarnstrom et al., 2018), and there have been recent improvements in detection methods and therapeutic interventions for cyclosporiasis. This review presents an update on aspects of the clinical features, detection methods, therapy, and prevention of cyclosporiasis.Clinical FeaturesIntestinal Infection FeaturesClinical SymptomsFrequently the cyclosporiasis patient is an immunocompetent traveler living in an industrialized country, returning from a tropical and/or developing country such as the Dominican Republic, Mexico, Guatemala, Haiti, Peru, or Nepal, among others. Typical symptoms on presentation include watery diarrhea, abdominal cramps, vomiting, anorexia, weight loss, and severe fatigue. Less frequently patients also report flu-like symptoms (Marques et al., 2017; Giangaspero and Gasser, 2019). Cyclosporiasis patients with immune dysfunction can experience severe, protracted, or chronic watery diarrhea along with nausea, abdominal pain, mild fever, lethargy, and emaciation (Field, 2002; Shields and Olson, 2003a; Mansfield and Gajadhar, 2004). The condition can be particularly challenging in organ transplant recipients undergoing immunosuppressive treatment (Giangaspero and Gasser, 2019).Human cyclosporiasis can be asymptomatic, or range from mild to severe in endemic countries, such as Guatemala, Haiti, Peru, and Nepal (Mansfield and Gajadhar, 2004; Giangaspero and Gasser, 2019). The clinical outcomes of cyclosporiasis are related to the age and immune status of the host, endemicity in a specific area and some other unknown factors (Almeria et al., 2019). Infants and the elderly tend to exhibit more severe clinical symptoms, whereas milder or asymptomatic infections typically occur in older children and non-elderly adults (Giangaspero and Gasser, 2019).The incubation period of C. cayetanensis infection ranges from 2 to 11 days, and the median incubation period is ~7 days (Almeria et al., 2019). The clinical symptoms usually resolve with the treatment by specific drugs. However, persistent infection is seen in untreated patients that can last for a few days to a month or even longer (Thapa and Basnyat, 2017). The mean duration of diarrhea caused by cyclosporiasis is longer in AIDS patients (199 days) compared to other patients (57 days) (Schubach et al., 1997; Sancak et al., 2006; Ortega and Sanchez, 2010).Endoscopic ChangeIn a previous study involving endoscopy of 17 Peruvian cyclosporiasis patients, moderate to marked erythema was observed in the distal duodenum of some cases and mild to moderate inflammation in the intestinal lamina propria of the other cases (Ortega et al., 1997). However, ulcer or hemorrhage like gross abnormalities were absent in both stomach and small intestine in any of the cyclosporiasis patients (Ortega et al., 1997).Histology ChangeStriking intestinal histological changes have been observed in patients with cyclosporiasis. Alteration of the overall architecture of the intestinal mucosa has been reported, with dramatic shortening of the intestinal villi and disruption of the surface epithelium (Ortega et al., 1997; Ortega and Sanchez, 2010). Villous atrophy and crypt hyperplasia in the duodenum and ileum have also been described (Connor et al., 1993; Field, 2002). In the aforementioned 17 Peruvian patients there was reactive hyperemia with vascular dilatation and congestion of villous capillaries (Ortega et al., 1997), and some patients have exhibited variably increased chronic inflammatory cells and intense lymphocytic infiltration in the lamina propria and epithelial tissue (Ortega et al., 1997; Wiwanitkit, 2006). Ortega et al. (1997) also reported extensive infiltration of lymphocytes into the surface epithelium, which was particularly prominent at the tip of the shortened villi. In another report, the C. cayetanensis induced inflammatory reactions were found to be lasted even after clearance of parasitic infection (Connor et al., 1999). Notably however, the pathogenesis underlying these symptoms has not been defined.Intracellular ChangesIncreases in lymphocytes in the intestinal surface epithelium have been reported during oocyst infections, during which parasitophorous vacuoles containing C. cayetanensis at various stages of the sexual and asexual life-cycle were observed in the apical cytoplasm of the enterocytes overlying the tips of the villi (Field, 2002). Via electron microscopy, rounded or more mature elongated fusiform merozoites up to 6 μm in length can be seen stacked in vacuoles within enterocytes, as well as occasional micro-gametocytes and macro-gametocytes (Field, 2002).In high-magnification light microscopic examination, the parasite was seen at the luminal surface and the glandular clefts (Ortega et al., 1997) with having two completely developed asexual forms, Type I and II meronts. About 8–12 fully mature merozoites (~0.5 × 3–4 μm) were observed in Type I meront while 4 fully differentiated merozoites (~0.7–0.8 × 12–15 μm) were in Type II meront (Ortega et al., 1997). The parasite was also observed to have sexual forms, such as gametocytes. As typically seen in other coccidia, the merozoites of both Type I and II meronts contained rhoptries, micronemes, and nuclei. Meanwhile, the characteristic wall-forming body types I and II and polysaccharide granules were observed in macro-gametocytes of the parasite (Ortega et al., 1997). However, the gastric antral biopsy could not detect the Cyclospora parasite (Ortega et al., 1997). The findings of light microscopic examination were all substantiated by the transmission electron microscopy of the both asexual and sexual forms of the parasite.External Features of InfectionCyclospora cayetanensis oocysts were evidenced to infect extraintestinal tissue such as biliary tract (Sifuentes-Osornio et al., 1995), resulting in acalculous cholecystitis in an AIDS patient (Zar et al., 2001). The pathogenesis of biliary infections is unknown. Presumably sporozoites from the intestinal lumen travel to bile ducts and initiate the development of Cyclospora there (Almeria et al., 2019).Although C. cayetanensis infection was not reported in the respiratory tract, oocysts were detected in the nasal secretion of two patients suffering from tuberculosis (Di Gliullo et al., 2000; Hussein et al., 2005). Additionally, C. cayetanensis infections were found to be linked with some other diseases, including Reiter syndrome (reactive arthritis syndrome) (Connor et al., 2001) and Guillain-Barre syndrome (Richardson et al., 1998).Detection in StoolOocyst Morphology DetectionWet SmearsWet smears and conventional microscopy methods have been widely used to detect C. cayetanensis oocysts in clinical stool samples (Ortega and Sanchez, 2010). The smears can be made directly from fresh stools, or concentrated samples obtained from formalin-ether sedimentation or sucrose flotation techniques that enhance detection efficiency of small amount of Cyclospora oocysts in stool samples (Becker et al., 2013). When observed, Cyclospora oocysts in stool are easily identified as spherical and refractile entities that are 8–10 μm in size and have a central morula (Li et al., 2019a). Since the Cyclospora oocysts shed discontinously, manifold fecal samples (each at 2–3 days interval) should be collected in a week or more from a patient for accurate detection of oocysts (Yang et al., 2014). Wet smear examination is a simple, direct, rapid, and reliable method for visual detection of parasites, but it is costly and laborious, and it requires specific expertise. Given the size similarity to some other microorganisms such as Cryptosporidium (4–6 μm), C. cayetanensis should be further differentiated by staining on wet or dry mounts (Almeria et al., 2019).Staining TestsThe oocyst walls of Cyclospora, Cryptosporidium, and Cystoisospora parasites have acid-fast lipids that help their detection by acid-fast staining (Garcia et al., 2017). Although the modified acid-fast stain test can be useful for identifying Cyclospora oocysts, variable levels of dye uptake may result in ghost oocysts, or pink-stained or poorly stained oocysts, or oocysts that are not stained at all and appear as non-refractile glassy spheres against the blue-green background, along with well-stained oocysts (deep red with a mottled appearance) (Ortega and Sanchez, 2010; Garcia et al., 2017; Almeria et al., 2019).Modified acid-fast staining with further minor modifications are developed to improve Cyclospora detection, one of which is the use of 1% H2SO4 as a decolorizer (Garcia et al., 2017). Another modification is devised with addition of dimethyl sulfoxide to the phenol-basic fuchsine, and the inclusion of acetic acid with malachite green as a combined decolorizer counter-stain to achieve better penetration and thus enhanced visualization of the internal structures of oocysts (Garcia et al., 2017). Apart from this, other modified acid-fast staining methods, such as Ziehl-Neelsen acid-fast stain (Brennan et al., 1996; Clarke and McIntyre, 1996), modified Kinyoun's acid-fast stain (Gonçalves et al., 2005; Behera et al., 2008; Dillingham et al., 2009; Bhandari et al., 2015), and modified Kinyoun's carbolfuchsin stain (Alakpa et al., 2002; Chacín-Bonilla et al., 2007) are commonly used. Some other staining methods, including modified safranin stain (Visvesvara et al., 1997), trichrome stain (Turgay et al., 2007), and lacto-phenol cotton blue stain (Parija et al., 2003) were also found to be highly sensitive to detect Cyclospora oocysts in fecal smears.Even with the aid of conventional staining methods for Cyclospora oocysts microscopic detection can be challenging (McHardy et al., 2014), but it remains the recommended diagnostic method. Of the various available stains, the modified Ziehl-Neelsen stain technique has been recommended for detecting Cyclospora oocysts in clinical samples (Brennan et al., 1996; Khanna et al., 2014).Fluorescence TestsCyclospora oocysts' strong autofluorescence properties render fluorescence microscopy useful for identification (Garcia et al., 2017). On 365- and 450–490-nm ultraviolet light exposures, the oocysts appear blue and green, respectively (Ortega and Sanchez, 2010; McHardy et al., 2014). In epifluorescence microscopic examination using a 330–380-nm ultraviolet filter, C. cayetanensis oocysts were observed to be easily visible in clinical samples (Eberhard et al., 1997), which enhances detection at least 2-fold over direct wet mounts, particularly in cases where the mounts or stained slides contain few oocysts (Berlin et al., 1998). The autofluorescence technique is reportedly markedly superior to wet smears and staining procedures for Cyclospora oocyst detection (Berlin et al., 1998).Flow CytometryOn the basis of morphological and autofluorescence properties of oocysts, a flow cytometry detection assay was developed for C. cayetanensis (Dixon et al., 2005). While the sample preparation time for flow cytometry is slightly longer than that for microscopy, the actual analysis time is much shorter. Furthermore, the flow cytometry is mostly automated that omits the problems of technical experience and tiresomeness of other manual analyses which may affect the results of detection (Li et al., 2014). A comparative study for the detection and quantification of Cyclospora oocysts observed no significant differences between flow cytometry and quantitative real-time PCR assays (Hussein et al., 2007).To sum up, among the various available detection methods of Cyclospora oocyst based on morphology, the modified Ziehl-Neelsen staining and autofluorescence techniques have been recommended for the detection of oocysts in the clinical samples (Berlin et al., 1998; Khanna et al., 2014).Serological TestsSerological screening for Cyclospora would facilitate epidemiological studies, especially in outbreak investigations (Ortega and Sanchez, 2010), but currently commercial serological assays to identify human exposure to Cyclospora are not available (Almeria et al., 2019). There have been attempts to characterize human serological immune responses to cyclosporiasis, involving specific IgG and IgM antibodies being tested via enzyme-linked immunosorbent assays (Wang et al., 2002), but specific diagnosis of infection at the individual patient level has not been achieved (Giangaspero and Gasser, 2019). The main constrain is the unavailability of suitable Cyclospora culture method that can be used for the propagation of oocysts and also the in-depth study of various aspects of the parasite (Eberhard et al., 2000; Cinar et al., 2015).Molecular DetectionOver the few decades, several conventional, nested, and quantitative PCR (qPCR) as well as multiplex PCR assays (together with other parasites) are developed for the identification of Cyclospora (Relman et al., 1996; Varma et al., 2003; Taniuchi et al., 2011; Li et al., 2015a, 2019a; Almeria et al., 2019) (Table 1). There is one commercially available fully automated system involving high-order multiplex PCR reactions that is capable of detecting C. cayetanensis with high sensitivity and specificity (Buss et al., 2015). The multiplex Biofire (Salt Lake City, UT, USA) FilmArray Gastrointestinal Panel is a commercially available DNA-based technology for the detection of C. cayetanensis (Ryan et al., 2017; Hitchcock et al., 2019).TABLE 1Frontiers | Peer Reviewed Articles - Open Access JournalsTable 1. Common Cyclospora cayetanensis detection methods.Recently, a molecular diagnostic method employing multiplex real-time PCR and a T4 phage internal control has been devised for the simultaneous detection of Cryptosporidium parvum, Giardia lamblia, and C. cayetanensis in human stools (Shin et al., 2018). The QIAstat gastrointestinal panel can detect a large range of acute gastroenteritis pathogens with a high sensitivity, including C. cayetanensis (Hannet et al., 2019). Molecular-based detection methods have the capacity to screen a number of organisms at a time with using multiplex platforms, and to detect them rapidly with high sensitivity (even detection of a single oocyst), thus overcoming some of the limitations of microscopy-based diagnosis. Now-a-days, the molecular techniques have been widely used in laboratory testing or verification of suspected clinical samples.Case-Linking and TrackingNumerous genotyping methods for C. cayetanensis have been developed, and successfully used for epidemiological trace-back investigations of cyclosporiasis. Recently, a multilocus sequence typing (MLST) tool involving five microsatellite loci has been established and used for epidemiological source tracking of C. cayetanensis (Guo et al., 2016). There have many other potential uses of this MLST tool (Hofstetter et al., 2019). It has been used to investigate the population genetics of C. cayetanensis (Li et al., 2017; Guo et al., 2018). More recently, qPCR (Guo et al., 2019) and standard PCR assays (Nascimento et al., 2019) have been evolved for the genotyping of C. cayetanensis that use the polymorphic region of parasitic mitochondrial genome. Relationships have been corroborated by a significant number of epidemiological linkages, suggesting the usefulness of the technique for aiding epidemiological trace-back, case-linkage, source-tracking, and distinct case cluster investigations (Barratt et al., 2019; Guo et al., 2019; Nascimento et al., 2019), especially during cyclosporiasis outbreaks.Detection in VehiclesFresh ProducesUsually only low numbers of protozoan oocysts exist in naturally contaminated produce. A very important step in the isolation process is the productive gaining of oocysts after a careful washing of the fresh produce (Shields et al., 2012; Li et al., 2019b). Different washing solutions have been used for the recovery of C. cayetanensis oocysts (Shields et al., 2012; Chandra et al., 2014; Lalonde and Gajadhar, 2016; Li et al., 2019b). A filter bag (BagPage®, Interscience Lab. Inc., Boston, MA) along with a commercial laboratory detergent (Alconox®, White Plains, NY) (Shields et al., 2012) is used as a valid wash protocol for the successful recovery of C. cayetanensis oocysts from fresh produce and thereby DNA extraction and a specific qPCR are followed for the detection of the parasite (Murphy et al., 2018a).In recent years, several molecular techniques have been developed for the detection of C. cayetanensis in fresh produce, including qPCR and various multiplex qPCR methods (Steele et al., 2003; Lalonde and Gajadhar, 2011, 2016; Murphy et al., 2017; Shapiro et al., 2019) (Table 1). qPCR can steadily identify a few oocysts in the fresh produce, such as three oocysts in a gram of fruit, or five oocysts in a gram of herbs or green onions (Lalonde and Gajadhar, 2016). In other reports as few as five oocysts were detected in samples of raspberries, cilantro, parsley, basil, and carrots via a qPCR technique (Murphy et al., 2017, 2018b; Almeria et al., 2018). Other methods for C. cayetanensis detection in fresh produce have been developed, including a new multiplex qPCR technique that is highly specific, precise, and robust and has potential for application in food-testing laboratories (Temesgen et al., 2019a). The limit of detection of that technique was estimated to be 10 oocysts for Cyclospora organisms. Another qPCR assay targeting the internal transcribed spacer 1 region was developed for the detection of C. cayetanensis in berries, and proved to be an effective approach that may be a suitable option for use in food-testing laboratories (Temesgen et al., 2019b). A multiplex PCR assay has been developed for simultaneous detection of four protozoan oocysts via a rapid, inexpensive, and simple protocol (Shapiro et al., 2019).Robertson et al. (2000) validated the use of lectin-coated paramagnetic beads for the isolation of Cyclospora oocysts from fruits and vegetables. As reported for the detection of Cryptosporidium parvum, specific antibody-coated beads can be used to isolate and concentrate the C. cayetanensis oocysts, but antibodies are not yet commercially available (Almeria et al., 2019).Water or SoilThere are many documented reports of Cyclospora oocysts contaminating water and soil derived from multiple countries (Sturbaum et al., 1998; Sherchand and Cross, 2001; Tram et al., 2008; Giangaspero et al., 2015; Bilung et al., 2017), and various techniques have been developed for the isolation and identification of Cyclospora oocysts from the environmental samples, such as water and soil (Quintero-Betancourt et al., 2002; Steele et al., 2003; Murphy et al., 2018b). As Cryptosporidium oocysts detection is performed by filtration or purification via immunomagnetic separation, followed by the labeling of oocysts with a specific fluorochrome and differential interference microscopy detection (Giangaspero and Gasser, 2019), Cyclospora oocysts can also potentially be detected. However, due to the lack of a specific antibody for C. cayetanensis oocysts, the probability can not be tested.Viability and Infectivity TestsDetermination of parasite viability and infectivity is important in clinical settings. Since there is no accurate assay for the evaluation of viability or infectivity of C. cayetanensis, it can be assessed via analysis of the sporulation rates of oocysts. It has been reported that C. cayetanensis oocysts complete sporulated in 2.5% potassium dichromate within 7–13 days at 25 or 32°C (Ortega et al., 1993, 1998). Unsporulated oocysts carry developing sporocysts, while sporulated oocysts carry two ovoid sporocysts, each of which has two sporozoites. The excystation of oocysts occurs on the exposure to trypsin (0.5%) and sodium taurocholate (1.5%) in phosphate-buffered saline, followed by mechanical disruption (Ortega et al., 1993). Based on the morphology and physicochemical properties of oocysts, electrorotation technique was developed for observing the changes in the oocysts (Dalton et al., 2001, 2004), but the technique is not handy due to procedural complexity and only can be used in research settings.Oocyst sporulation and infectivity testing in animal model is an ideal method for evaluating the viability and infectivity of the oocysts (Giangaspero and Gasser, 2019). However, due to the unavailability of effective in vitro culture methods and in vivo animal models for C. cayetanensis, sporulation in 2.5% potassium dichromate is currently regarded as the only indicator for oocyst viability (Eberhard et al., 2000).TherapyNo vaccine is available for cyclosporiasis (Giangaspero and Gasser, 2019) but early detection and treatment can yield a favorable clinical outcome. Expectant treatment and chemotherapeutic treatment is crucial in human cyclosporiasis, particularly in immunodeficient individuals. Although case fatality due to cyclosporiasis is rare in humans, long lasting diarrhea sometimes results in dehydration or malnutrition, and occasionally may cause severe dehydration and death in infants (Behera et al., 2008; Bednarska et al., 2015).Chemotherapy including treatment with 160 mg trimethoprim and 800 mg sulfamethoxazole (TMP-SMX, also known as co-trimoxazole) twice daily for 7 days can reportedly cure human cyclosporiasis (Hoge et al., 1995; Escobedo et al., 2009). TMP-SMX is considered as an effective drug, with many studies reporting low recurrence rates (Hoge et al., 1995; Madico et al., 1997; Goldberg and Bishara, 2012). It is also an effective chemotherapeutic treatment for C. cayetanensis infection in AIDS patients (Pape et al., 1994; Verdier et al., 2000) and those of them with biliary disease (Sifuentes-Osornio et al., 1995).In some patients, TMP-SMX creates intolerance and allergy. In such cases, ciprofloxacin antibiotic with having less effectivity than TMP-SMX is a suitable treatment option for cyclosporiasis in human (Verdier et al., 2000). Nitazoxanide is another drug that can also be used in the cases of sulfonamide intolerance and ciprofloxacin resistance (Diaz et al., 2003; Cohen, 2005; Zimmer et al., 2007). Nitazoxanide has been used to treat mixed parasite infection with intestinal protozoa (including C. cayetanensis) and helminths (Diaz et al., 2003). The efficacy of nitazoxanide for cyclosporiasis was reported to be ranging from 71 to 87%. The tolerance level of the drug was found to be very high with having no serious adverse effects (Table 2). Conversely, norfloxacin, metronidazole, tinidazole, and quinacrine have proven ineffective in some studies of human cyclosporiasis (Escobedo et al., 2009; Almeria et al., 2019). In a more recent study in mice silver nanoparticles were effective against Cyclospora infection (Gaafar et al., 2019). This will draw attention to its potential for use as an alternative to the standard therapy in both immunocompetent and immunosuppressed hosts.TABLE 2Frontiers | Peer Reviewed Articles - Open Access JournalsTable 2. Anti-Cyclospora oocyst drugs.PreventionCyclospora cayetanensis is contracted via a fecal-oral transmission cycle, and direct person-to-person transmission seems unlikely. In developed nations, C. cayetanensis infections can be common in people who travel to endemic areas of underdeveloped and developing countries and consume the contaminated food, specially fresh produce imported from that regions (Almeria et al., 2019). Cyclospora cayetanensis is mainly transmitted via feces contaminated food, water, and soil (Almeria et al., 2019). Therefore, improvement of personal hygiene and sanitary conditions can be a suitable preventive approach for C. cayetanensis infections because it obviously cuts off the fecal-oral route of transmission of the parasite in the endemic areas. The practice of not consuming of raw fresh produce, especially those supplied from endemic areas can avert the problem of cyclosporiasis in humans. Regular boiling and filtering of water necessary for drinking, food preparation, and washing of fresh produce can also prevent the infection (Almeria et al., 2019).While usual sanitizers and disinfectants can not destroy C. cayetanensis and coccidia in general, some exploratory methods for removing or inactivating C. cayetanensis oocysts in fresh fruits and raw vegetables have been investigated (El Zawawy et al., 2010; Butot et al., 2018; Hussein et al., 2018). In one study magnesium oxide nanoparticles had a significant anti-Cyclospora effect on both unsporulated and sporulated oocysts, prompting speculation that it may be useful as a preventive agent in food and water disinfection treatment (Hussein et al., 2018).Care should be taken to keep the fresh produce out of contamination at the field and packaging unit, and also from the farm workers to efferently prevent the C. cayetanensis infection in endemic areas. The practice of toilet use, hand washing after toilet use and before meal and proper disposal and treatment of human excreta are also important for prevention of cyclosporiasis. Any worker bearing the gastrointestinal diseases should not handle the vegetables or other produce. Other coccidiosis control measures can also be applied for the prevention and control of C. cayetanensis infections.ConclusionsIn conclusion, there are some advances in clinical features, diagnosis and therapeutic intervention of cyclosporiasis, which primarily diagnosed by the important clinical symptoms of watery diarrhea, abdominal cramps, and bloating. Conventional and laboratory diagnosis usually involves microscopy examination of wet smears, staining tests (typically the modified acid-fast stain), fluorescence microscopy, serological testing, or advanced molecular testing for oocyst DNA in the human stool. No vaccine is available for cyclosporiasis, but early detection and treatment can yield a favorable clinical outcome. Detection in a transmission vehicle such as fresh produce, water, or soil is helpful for case-linkage and source-tracking during cyclosporiasis outbreaks. The sensitivity of Cyclospora detection can be increased by the concentration of oocysts obtained from clinical or biological samples. Treatment with TMP-SMX has proven effective for cyclosporiasis. Ciprofloxacin, although less effective than TMP-SMX, can suitably be used in patients having sulfur drug intolerance. Nitazoxanide is an alternative drug can be used in the cases of sulfur intolerance and ciprofloxacin resistance. The water- and food-borne parasite Cyclospora has epidemiologically been investigated only in few underprivileged communities and developed nations. More epidemiological research on cyclosporiasis in humans should be conducted at various locations around the world, to achieve a better understanding of its characteristics in this regard. Attempts should also be made to establish in vitro or in vivo methods for cultivating C. cayetanensis. Rapid, convenient, precise, and economical detection methods for diagnosis, as well as effective tracing methods should be developed to monitor the transmission of C. cayetanensis infection.Author ContributionsLZ provided the ideas. JL and ZC wrote the draft manuscript. MQ participated in the modification of manuscript. All the authors had read the final manuscript.FundingThis study was supported by the Doctoral Startup Foundation of Henan University of Chinese Medicine (00104311-2019-31), and the National Key Research and Development Program of China (Grant Nos. 2017YFD0500405 and 2017YFD0501305).Conflict of InterestThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.AcknowledgmentsWe thank Dr. Owen Proudfoot from Liwen Bianji, Edanz Editing China (www.liwenbianji.cn/ac) for editing the English text of a draft of this manuscript.ReferencesAbanyie, F., Harvey, R. 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This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.*Correspondence: Longxian Zhang, [email protected]; [email protected]†These authors have contributed equally to this work