Health Advisory: Test patients with symptoms consistent with Cyclospora infection

Background

Cyclosporiasis is an intestinal illness caused by the Cyclospora parasite.

People can become infected with Cyclospora by consuming food or water contaminated with the parasite. People of all ages are at risk of infection. Symptoms of cyclosporiasis usually begin 2 to 14 days after ingestion of Cyclospora eggs, or oocysts, in contaminated food or water. Watery diarrhea can persist for several weeks to a month or more, and affected patients may experience a return of symptoms after improvement. Additional symptoms may include anorexia (loss of appetite), fatigue, weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting, and low-grade fever.

Previous outbreaks have been associated with the consumption of raw produce, including fresh cilantro, broccoli, Italian parsley, pre-packaged salad mix, raspberries, basil, snow peas, and mesclun lettuce.

Recommendations for Healthcare Providers

Clinicians should order testing for patients who have symptoms consistent with cyclosporiasis. They can submit stool specimens for "ova and parasite" testing with a modified acid-fast stain, modified safranin ("hot") stain, and/or UV autofluorescence screen with specific orders for Cyclospora identification. Due to the intermittent shedding of the parasite, a single negative stool specimen does not exclude the diagnosis; three specimens taken at least 24 hours apart are optimal. Cyclospora may also be detected by molecular methods such as polymerase chain reaction (PCR), though not all panels include a target for Cyclospora.

Rapid reporting to public health is essential to identify outbreaks and prevent additional cases of cyclosporiasis. Healthcare providers and laboratories are required to report confirmed cyclosporiasis cases to the corresponding local health department within one week. DSHS asks that healthcare providers remain vigilant in surveillance and testing. Clinical specimens are encouraged to be submitted to the DSHS laboratory for confirmation.

Recommendations for the public

DSHS recommends vigorously washing hands with soap and water before and after handling or preparing fruits and vegetables, and thoroughly washing/scrubbing all fresh produce, cutting boards, dishes, utensils, and countertops. Consumers, retailers, and restaurants should be aware that washing may not eliminate all risks of transmission since Cyclospora can be difficult to remove from produce. Routine chemical disinfection or sanitizing methods are unlikely to kill the parasite. Cyclospora is primarily transmitted through raw or undercooked food. Cyclospora does not appear to spread through direct person-to-person contact.

Additional information

Reporting contacts:

• Disease Reporting Contacts | Texas DSHS

Cyclospora background:

• Cyclospora Infection (Cyclosporiasis) | Texas DSHS
• Cyclosporiasis | CDC
• Clinical Overview of Cyclosporiasis | Cyclosporiasis | CDC