HEALTH ADVISORY:
Recommendation to Test Patients with Consistent Symptoms for Cyclospora
June 21, 2018

During the past five summers, a large number of cyclosporiasis cases have occurred in Texas. Therefore, the Texas Department of State Health Services is advising healthcare providers to consider testing patients for the parasite Cyclospora if they have diarrheal illness lasting more than a few days or diarrhea accompanied by severe anorexia or fatigue. Diagnosis of cyclosporiasis can be made by submission of stool specimens for “Ova and Parasite” testing, with additional specific orders for Cyclospora identification. A single negative stool specimen does not exclude the diagnosis; three specimens are optimal. Cyclospora may also be detected by molecular methods (e.g., polymerase chain reaction (PCR)).

Symptoms of cyclosporiasis usually begin 2 to 14 days after ingestion of Cyclospora oocysts in contaminated food or water. Watery diarrhea can last from a few days to weeks or months, and affected patients may relapse. Additional symptoms may include anorexia, fatigue, weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting, and low-grade fever.

Previous outbreaks of cyclosporiasis have been associated with consumption of imported fresh produce, including: fresh cilantro, pre-packaged salad mix, raspberries, basil, snow peas, and mesclun lettuce. Although washing may not eliminate all risk of transmission since Cyclospora can be difficult to completely remove from produce, thorough washing of all fresh produce is recommended. Cyclospora does not appear to be spread through direct person-to-person contact.

Rapid reporting to public health is essential to preventing additional cases of cyclosporiasis. Healthcare providers and laboratories are required to report confirmed cyclosporiasis cases to their respective local health department. Contact information can be found at /idcu/investigation/conditions/contacts/.

Information about Cyclospora is available at Cyclospora Infection (Cyclosporiasis) Resources and https://www.cdc.gov/parasites/cyclosporiasis/health_professionals/index.html.