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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