Cyclospora Infection (Cyclosporiasis)

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Cyclosporiasis is an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis.

Cyclosporiasis is caused by consuming food or water contaminated with feces (stool) that contains the Cyclospora parasite. People living or traveling in countries where cyclosporiasis is endemic may be at increased risk for infection. Past outbreaks in the United States have been associated with consumption of imported fresh produce, including fresh cilantro, pre-packaged salad mix, raspberries, basil, snow peas, and mesclun lettuce. Cyclospora does not appear to be spread through direct person-to-person contact.

Symptoms of cyclosporiasis usually begin 2 to 14 days after ingestion of contaminated food or water. The major symptom is watery diarrhea lasting a few days to a few months, and may relapse. Additional symptoms may include anorexia, fatigue, weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting, and low grade fever.

Diagnosis of cyclosporiasis requires submission of stool specimens and requires special lab tests that are not routinely done. Healthcare providers should specifically request “Ova and Parasite” testing with additional specific orders for Cyclospora identification if they suspect cyclosporiasis in patients that have diarrheal illness lasting more than a few days or diarrhea accompanied by severe anorexia or fatigue.

Thorough washing of fresh produce is recommended, but may not eliminate the risk of transmission since Cyclospora can be difficult to wash off all types of produce.

School Exclusion Policy
Children with confirmed cyclosporiasis should be kept out of school or childcare until they are diarrhea and fever-free. Rules for exclusion of sick children from school and childcare are outlined in the Texas Administrative Code, specifically Rule 97.7  for schools and Rule 746.3603 for childcare.

Recent Texas Trends
From 2001-2011, the number of cyclosporiasis cases reported in Texas was in the single or low double digits. Texas has seen an increase in cases reported beginning in 2012, with 44 cases of cyclosporiasis reported, including a restaurant outbreak of 9 lab confirmed cases. An increase was noted nationally during 2013, including 351 cases of cyclosporiasis reported in Texas, more than any other state. From 2013-2018, Texas averaged 267 cyclosporiasis cases. Epidemiologic and trace back investigations indicated that some illnesses among Texas residents in 2013, 2014, and 2015 were linked to fresh cilantro from Puebla, Mexico.

Recently the number of cyclosporiasis cases reported in Texas nearly tripled, from 353 in 2018 to 1,039 in 2019, then dropped to 581 in 2020.

Last updated July 20, 2022