The contrasting epidemiology of Cyclospora and Cryptosporidium among outpatients in Guatemala

We compared epidemiologic characteristics of Cryptosporidium and Cyclospora in surveillance data from outpatient departments in Guatemala. Routinely-submitted stool specimens were screened by microscopy. Age, sex, and symptom data were collected. Cyclospora was detected in 117 (2.1%) and Cryptosporidium in 67 (1.2%) of 5,520 specimens. The prevalence of Cyclospora peaked in the warmer months, while Cryptosporidium was most common in the rainy season. Both affected children more than adults, but Cryptosporidium affected children at a younger age than Cyclospora (median age 2 years versus 5 years; P < 0.001). Cyclospora showed a stronger association with diarrhea than Cryptosporidium, even when data were stratified by age. These contrasts may reflect differences in the relative importance of transmission modes, the frequency of exposure, and the development of immunity.