Cyclospora Infection (Cyclosporiasis)

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

Transmission
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
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
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.

Prevention
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
Over the last five years, 2018–2022*, the average number of cases of cyclosporiasis in Texas has been 579 cases per year, ranging from 312 cases in 2021 to 1,039 cases in 2019. Nationally, previous outbreaks of cyclosporiasis have been associated with consumption of imported fresh produce, including cilantro, pre-packaged salad mix, raspberries, basil, snow peas, and mesclun lettuce.

*2022 data provisional and subject to change.