Cyclosporiasis

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Background
Cyclosporiasis is an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis. People can become infected with Cyclospora by consuming food or water contaminated with the parasite. People living or traveling in countries where cyclosporiasis is endemic may be at increased risk for infection. Illness occurs most often in tropical and subtropical regions.

Since early July, 2019, there has been an increase in the number of cases of cyclosporiasis reported in Maryland.  This is part of an overall recent rise in cyclosporiasis cases in other parts of the US. MDH is working with local, state and federal health officials to investigate this increase.  To date, no specific source for these cases has been identified.

Symptoms of Cyclosporiasis
Symptoms of cyclosporiasis begin an average of 7 days after exposure to Cyclospora. Symptoms may include the following:
  • ​Watery diarrhea (most common)
  • Loss of appetite
  • Weight loss
  • Cramping
  • Bloating
  • Increased gas
  • Nausea
  • Fatigue

If a person ill from cyclosporiasis is not treated, symptoms can persist for several weeks to a month or more. Anyone experiencing symptoms of cyclosporiasis should contact their healthcare provider. They can test for Cyclospora and prescribe the correct treatment.

Diagnosis of Cyclosporiasis
Cyclosporiasis is diagnosed by examining stool specimens. Testing for Cyclospora is not routinely conducted in most U.S. laboratories, even when stool is tested for parasites. Therefore, if indicated, health care providers should specifically request testing for Cyclospora.

Transmission of Cyclosporiasis
In the United States, foodborne outbreaks of cyclosporiasis have been linked to various types of imported fresh produce, such as raspberries, basil, snow peas, mesclun lettuce, and cilantro.

Prevention of Cyclosporiasis
Consumers and retailers should always follow safe fruit and vegetable handling recommendations:
  • ​Wash: Wash hands with soap and warm water before and after handling or preparing fruits and vegetables. Wash cutting boards, dishes, utensils, and counter tops with soap and hot water between the preparation of raw meat, poultry, and seafood products and the preparation of fruits and vegetables that will not be cooked.
  • Prepare: Wash all fruits and vegetables thoroughly under running water before eating, cutting, or cooking. Scrub firm fruits and vegetables, such as melons and cucumbers, with a clean produce brush. Cut away any damaged or bruised areas on fruits and vegetables before preparing and eating.
  • Store: Refrigerate cut, peeled, or cooked fruits and vegetables as soon as possible, or within 2 hours. Store fruits and vegetables away from raw meat, poultry, and seafood.

Cases of Cyclosporiasis in Maryland, as of August 17, 2019:
          Year           Confirmed Cases
          2019                     122
          2018                      39
          2017                      37

Information for the Public
MDH Fact Sheet
CDC: About Cyclospora

Information for Clinicians
CDC Resources for Health Professionals
CDC Lab Identification of Cyclospora Parasites

Information for Local Health Departments
MDH Cyclospora Case Report Form

Other Resources
FDA: Cyclospora and Fresh Produce
FDA: Guide to Minimize Microbial Food Safety Hazards of Fresh-cut Fruits and Vegetables