Cyclospora Outbreak: What You Need To Know

The cyclospora outbreak in the US which began in mid June has now

affected 285 people in 11 states. The CDC still does not know the

exact source of the parasite which has hospitalized 18 people thus

far. The CDC has only verified the parasite in fecal samples from 5

people to date.



Over 125 cases have been identified in Iowa. There is no clear history

of an originating source based on travel history thus far. According

to a report this week from the Iowa Dept of Public Health, the source

may be more likely originating from fresh vegetables as opposed to

fruit.

Cyclospora is a one-celled parasite which is too small to be seen by

the human eye. It causes explosive watery diarrhea, as well as nausea

and vomiting. Other common symptoms include fatigue, muscle aches, low

grade fever, and loss of appetite.



Cyclospora outbreaks originate from contaminated food or water, often

in tropical or subtropical climates. Outbreaks that have occurred in

the US in the past have generally have been linked to imported fresh

produce.



Raspberries, basil, lettuce, snow peas have been sources of previous

outbreaks since the 1990s.



Often times, in healthy persons, the illness is self- limited, and

resolves with supportive care including fluids, and medicine for

nausea if vomiting develops. The illness can last as little as 2-7

days–but can linger for several weeks to sometimes months in some

cases.



The onset can be as soon as 1 day but up to 2 weeks after exposure to

the parasite. It may not be uncommon to develop relapses associated

with this parasite.



When patients appear ill or dehydrated, intravenous fluids may be

necessary to restore fluid volume and electrolytes.



In immunocompromised patients, the illness generally begins slowly,

and may cause right sided upper abdominal pain with symptoms mimicking

gallbladder disease with elevated liver enzymes.



Diagnosis can be made by detecting the parasite in stool specimens,

specifically by identifying oocytes. There are currently no blood

tests that can detect antibodies to Cyclospora.



The Polymerase Chain Reaction (PCR) test can detect Cyclospora DNA in

stool specimens. It is commercially available, and is likely the most

acccurate method to make the diagnosis.



Antibiotics which can be used to treat the infection include Septra or

Bactrim. Cipro can also be used in patients with a sulfa

allergy–however, this may not be optimal therapy.



Antibiotics may help to reduce symptoms and also improve the time to

recovery for those with prolonged symptoms as well as loss of

appetite. In most cases, appropriate antibiotics can stop the diarrhea

within 2 days.



It is unclear what the source of contamination is at this time-the

produce itself, or related to contaminated irrigation systems involved

in farm settings.



The CDC is recommending that people be careful by taking precautions

to wash any fresh fruits and vegetables thoroughly until we know the

food source that is causing the outbreak.

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