By: Heather Williams

A Cyclospora outbreak has hit Texas this summer, and it is easily surpassing recorded outbreak numbers from previous outbreak events.  With 68 cases so far in the past month, health officials are on alert.  While some of the previous Texas outbreaks have been traced back to cilantro from Mexico, no source has been identified in this outbreak so far.

The Texas Department of State Health Services is asking healthcare providers to be vigilant in identifying this illness, issuing a Health Advisory updated July 17, 2017 recommending patients exhibiting symptoms consistent with Cyclospora symptoms to be tested for the parasite. The prompt reporting to the public health department allows investigators a better opportunity to identify the possible commonalities between cases to attempt to link as many cases as possible to a common source.  Knowing the common source will help minimize additional exposure and prevent additional cases of Cyclosporiasis during this outbreak.

Note: Speak to a Cyclospora Lawyer Now

According to the Health Advisory, The Texas Department of State Health Services is asking healthcare providers observing the following symptoms to test for the parasite Cyclospora: “diarrhea lasting more than a few days, 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 gasterointestinal (GI) pathogen panel test) that include detection of Cyclospora.  A single negative stool specimen does not exclude the diagnosis; three specimens are optimal.”

What is Clyclospora?

Cyclospora is a tiny one celled parasite that causes the intestinal infection known as Cyclospriasis.  The bug cannot be seen with the naked eye.  A microscope must be used to see it.  Like most intestinal parasites, Cyclospora is spread with fecal contamination.  Because the bug is so tiny, only a small amount of contaminated fecal matter ingested can cause illness.  This parasite requires a significant amount of time for the organisms to build up numbers in passed stool, it is unlikely for Cyclospora to be passed directly from person to person; however, if the stool contaminates a water or food source, over time it can become infectious and start the cycle all over again.

How Do I Know If I Have Been Infected With Cyclospora?

Symptoms of Cyclosporiasis, the illness associated with infection with the Cyclospora parasite usually begin anywhere from 2 days to 2 weeks from ingestion of the Cyclospora oocysts in contaminated food or water.  Extreme and recurring watery diarrhea may last between weeks to months and often recur over and over again with periods of normal bowel movements between.  You may experience loss of appetite, fatigue, weight loss, stomach cramps and pain, bloating, increased gas, bloating, nausea, vomiting, body aches, flu-like symptoms and/or a low-grade fever.  Some people, however, present no symptoms and recover without any medical treatment.

In some places throughout the world, Cyclosporiasis is more prevalent because the parasite is endemic to the area, meaning it naturally lives there.  These are generally tropical or subtropical regions of the world.  People traveling to those endemic zones should take additional food and water precautions.  In the United States, Cyclopsporiasis is rarer and generally associated with a small outbreak.  People of all ages are at risk for infection if exposed, but the immune compromised are at a higher risk.

If you feel you may be infected with Cyclospora, seek medical attention.  Your health care provider will test for Cyclosporiasis with a stool specimen.  You may be asked for multiple stool samples over several days to capture the parasite.  You may also be tested for other organisms that produce similar symptoms.

If you are diagnosed with Cyclosporiasis, your health care provider will provide a combination antibiotic of trimethoprim-sulfamethoxazole, which is also known as Bactrim, Septra, or Cotrim.  At this time there is no effective alternative, so if you are allergic to sulfa drugs your health care provider may discuss with your some potential options.  You may also be treated for the symptoms an urged to rest and drink plenty of fluids.

The recommended treatment is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim*, Septra*, or Cotrim*. People who have diarrhea should also rest and drink plenty of fluids.

History of Outbreaks in Texas

A source has not been identified in the Cyclospora outbreak that has hit Texas over the past month, but of the outbreaks in Texas where a sources was identified, cilantro imported from Mexico has been responsible.  Cilantro is not the only cause of Cyclospora outbreaks across the United States though.   Previous outbreaks across the United States were associated with pre-packaged salad mix, raspberries, basil, snow peas, and mesclun lettuce.  Determining the source of Cyclopspra can be difficult sometimes if the origin food is often mixed or used as a garnish.

Between 2000 and 2015, Texas has experienced 5 Cyclospora outbreaks.  This year’s outbreak has reached more affected cases than in previous years.  In February 2004 there were 38 cases documented by the Center for Disease Control and Prevention (CDC).  There was no identified source.  In June and July 2012, eight years later 16 cases were identified by the CDC and no source was identified.  In June and July of 2013, cilantro imported from Mexico was responsible for 38 CDC reported cases.  Cilantro imported from Mexico was also responsible for 26 CDC reported cases in June and July 2014.  And according to the CDC, a 3 state outbreak including Georgia, Texas, and Wisconsin between May and July 2015 had 90 reported cases with the source being imported cilantro from Mexico.

Preventing the Spread of Cyclospora

Cyclospora infects food and water from contact with infected feces.  To protect food, thoroughly wash and dry produce with clean water to ensure any residual contamination may be removed. Freezing and cooking food to an appropriate temperature may also help protect you from infection.  If you are in a high risk area where water may be contaminated, boil water to kill the parasite prior to consuming.  The body does not retain any immunity to the parasite, so having been infected before does not provide any protection for future infection.