By: Candess Zona-Mendola and Jory D. Lange, Jr.

An outbreak of Cyclospora parasitic infections has been announced in the state of Texas this week. According to the Texas Department of State Health Services alert:

“The Texas Department of State Health Services is encouraging healthcare providers to test 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 requires submission of stool specimens for “Ova and Parasite” testing with additional specific orders for Cyclospora identification or testing by molecular methods (e.g., polymerase chain reaction (PCR), or a gastrointestinal (GI) pathogen panel test) that include detection of Cyclospora. A single negative stool specimen does not exclude the diagnosis; three specimens are optimal.”

The outbreak has prompted the health agency to put the entire state on notice – asking doctors to test patients with more than a few days of diarrhea for the parasite. Anyone with a confirmed diagnosis is asked report their illness immediately. There is a high likelihood that more cases will be identified in the coming days and weeks.

What We Know versus What We Are Waiting For

The agency released details that there are 68 confirmed cases. The first cases were reported in mid-June of 2017. We do not know how recent cases have been reported. Although a common source has yet to be identified, outbreaks of this kind in the past have been linked to imported produce, including: pre-packaged salads, cilantro, raspberries, snow peas, basil, and lettuce. Other outbreaks have also been identified from a contaminated water source.

The Texas Department of State Health Services has not yet identified the source of the infections, but is in the process of investigating the identified cases to find a commonality – be it a food or water source. This is typically done through a series of interviews with those who have become ill to determine what they have eaten or drank within the last two weeks.

At this time, the exact locations of the cases in Texas has not been released.

FAQ’s on Cyclospora

  • What is Cyclospora?

Cyclospora cayetanensis is a one-celled microscopic parasite.  When people eat food or drink water contaminated with Cyclospora, they can develop the intestinal illness, Cyclosporiasis.

  • Can I become infected with Cyclospora through person-to-person contact?

Infections of this kind through person-to-person contact are not likely, as process of maturation (sporulation) of the parasite is thought to require days to weeks.

  • Who is at the highest risk for infection?

People of all ages and health statuses are at risk for infection. The CDC reports that those who are living in or traveling to the tropics and subtropics may be at increased risk because Cyclosporiasis is endemic in some countries in these zones.

  • What are Cyclospora symptoms?

According to the CDC, it usually takes about one week for symptoms to develop.  Cyclosporiasis causes watery diarrhea.  Frequent, and sometimes explosive, bowel movements are common.  People may also experience lack of appetite, weight loss, stomach pain or cramps, increased gas, bloating, nausea, or fatigue.  Vomiting, headaches, fever, body aches, and flu-like symptoms have also been reported.  People often report feeling unusually tired.

Without medical intervention, symptoms may persist from a few days to a month or more.  Sometimes symptoms seem to go away only to return one or more times later.

  • Are there future complications of Cyclosporiasis?

Potentially. Although Cyclosporiasis usually is not life threatening, some more severe cases have reported complications during and after the infection. These complications include: malabsorption (inability for intestines to absorb nutrients), ongoing bowel issues, cholecystitis (inflammation of the gallbladder), and Reiter’s Syndrome or Reactive Arthritis (inflammation and pain in joints). Those who are elderly, very young, or have compromised immune systems are the most likely to develop reoccurrence of the infection and/or complications.

  • Can Cyclospora be treated?

Yes.  Doctors treat Cyclospora with the antibiotics trimethoprim-sulfamethoxazole, also known by their brand names, Bactrim, Septra, or Cotrim.  People experiencing diarrhea should also rest and drink plenty of fluids.

If you are allergic to sulfa drugs, the CDC recommends that you see your doctor to discuss other potential treatments.

Protecting Your Family During an Outbreak

The ways that food and water become contaminated with Cyclospora oocysts are not fully understood. But this does not mean that you can’t help protect yourself and your family from infection. During this outbreak, there are some preventative measures that can be taken to reduce the risk of infection. For example, it is a good idea to wash fresh produce completely. This may not totally eliminate the risk, so it is also recommended to pat dry product with a paper towel. Also, it is a good idea to cook foods thoroughly to kill the parasite. Proper handwashing is also recommended as a preventative measure. WedMD mentioned that “cooking and freezing may eliminate or reduce the risk of Cyclospora infection.” The CDC further recommends “avoiding food or water that may have been contaminated with feces is the best way to prevent Cyclosporiasis.”

It is important to note that someone can relapse or become re-infected with Cyclospora. This is why medical treatment is highly recommended. Those who have been ill with the infection are also encouraged to refrain from swimming in bodies of water, to prevent the spread of illness. For those who own swimming pools, treatment with chlorine or iodine is unlikely to kill Cyclospora oocysts.