Cyclosporiasis

Situation:

Local, state, and federal partners are working together to investigate outbreaks of cyclosporiasis in several states. At this time, no specific sources have been confirmed, and investigations are ongoing. Cases have been reported in Lake County as part of the current outbreak.

Frequently Asked Questions (FAQ)

What is Cyclosporiasis/ Cyclospora?

Cyclosporiasis is an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis, also known as Cyclospora.

What are the signs and symptoms of Cyclosporiasis?

People who are infected with Cyclospora may or may not have symptoms. Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea with frequent and sometimes explosive bowel movements.

Without treatment, the illness may last from a few days to over a month.  Symptoms may seem to go away and then return one or more times (relapse).  Other symptoms could continue after the gastrointestinal symptoms have stopped.

Other symptoms may include:

  • Loss of appetite
  • Weight loss
  • Cramping
  • Bloating
  • Increased gas
  • Nausea
  • Fatigue

Less common symptoms include:

  • Vomiting
  • Body aches
  • Headache
  • Low-grade fever
  • Other flu-like symptoms
How serious is Cyclosporiasis?

Cyclosporiasis is not usually life-threatening. Cyclosporiasis can make it harder to stay properly hydrated.  Losing lots of fluids can cause serious complications like severe dehydration, electrolyte imbalance, and loss of fluid volume in your body.

How long does it take to get sick if you get Cyclospora?

The time between being infected and becoming sick is usually about one week. It can range from 2 days to two weeks or longer.

Who is at risk for Cyclospora?

People of all ages can be infected with Cyclospora.

In the U.S., outbreaks have been linked to different types of fresh produce.  In the past, these included produce grown in the U.S. and imported from other countries. Basil, cilantro, lettuce, raspberries, snow peas, and sweet peas have all caused outbreaks before.

More often, people can be at increased risk when living or traveling in subtropical regions of the world where cyclosporiasis is common.

How does Cyclospora spread?

Cyclospora spreads when people eat food or drink water that was contaminated with feces (poop).  This could include drinking untreated water or accidentally swallowing contaminated swimming water.  Cyclospora can survive in chlorinated pool water for a long time. Direct person-to-person transmission is not likely because it takes 1-2 weeks in the environment outside of the body for Cyclospora to become infectious after passing in a bowel movement.

How can I prevent getting Cyclospora?

You should avoid eating food or drinking water that may be contaminated with feces.

You can also help prevent Cyclospora by following recommendations for safe food handling, preparation, and storage.  These include:

  • Washing your hands with soap and water before and after handling or preparing raw fruits and vegetables, and after using the bathroom.
  • Washing all fruits and vegetables thoroughly under running water before eating, cutting, or cooking them.  As an extra precaution, consider washing even fruits and vegetables labeled as pre-washed if no specific source has been identified.
  • Scrub firm fruits and vegetables, such as melons and cucumbers with a clean produce brush.
  • Cut away any damaged or bruised areas on fruits and vegetables before preparing and eating them.
  • Refrigerate cut, peeled, or cooked fruits and vegetables as soon as possible (within 2 hours).
  • Cooking fruits and vegetables to at least 158 degrees Fahrenheit (70 degrees Celsius).
  • Wash all food prep surfaces, dishes, and utensils with hot water and soap after use.
  • Avoiding swimming if you have diarrhea, and waiting at least two weeks to swim after it goes away.
  • Avoid drinking untreated water or using it to cook.
Can you get Cyclospora more than once?

Yes, people can get infected with Cyclospora more than once.

Is there a test for Cyclospora?

Yes. Before testing you, your healthcare provider will review your health history, ask about symptoms, and do a physical exam.  You may be asked about anything you had to eat or drink recently or if you’ve traveled.

If your healthcare provider thinks you have cyclosporiasis, they will recommend testing a sample of your stool (poop).  Sometimes it can be difficult to detect with laboratory tests, even when you have symptoms.  You may need to provide several stoop samples on different days to detect Cyclospora because levels of the parasite in your poop can vary. Cyclospora is not detected with routine stool testing.  If your doctor thinks you may have Cyclospora, they should specifically request testing for Cyclospora.

What is the treatment for Cyclospora?

If you are having symptoms and think you may have Cyclospora, please see your healthcare provider.  Cyclosporiasis is treated with trimethoprim-sulfamethoxazole, such as Bactrim, Septra, or Cotrim.  If you are allergic to sulfa drugs, talk with your healthcare provider about other possible options like ciprofloxacin.

It is important to rest and drink plenty of fluids when experiencing diarrhea.

Is there anything else I can do to feel better?

Make sure you stay hydrated and get whatever nutrition you can to avoid serious complications. You should:

  • Get fluids, including water, sports drinks, or both.
  • Avoid drinking caffeine or alcohol.
  • Eat food however you can, even if it’s just small bites at a time.
  • Take all antibiotics as prescribed, even if you’re feeling better.
How long does it take to get better if you get Cyclospora?

Most people with healthy immune systems will eventually recover without treatment.  However, if it is not treated, people with Cyclospora could be sick for anywhere from a few days to a month or longer.  Symptoms may also go away, but then return one or more times (relapse).  People who are not in good health or who are immunocompromised may have a higher risk for severe or long illness.  With proper treatment, most people feel better after a week or two.

When should I see my healthcare provider?

Call your healthcare provider if you have several bouts of watery diarrhea per day.  Contact them again if your symptoms come back or get worse after you finish a full course of antibiotics.

You should go to the emergency room (ER) if you have signs of severe dehydration, including confusion, dizziness, dark-colored pee, or you’re not peeing as much as you should.

For more information, visit https://www.cdc.gov/cyclosporiasis/index.html