By: James Peacock
Utilizing their Health Alert Network (HAN), the CDC recently sent out a warning to consumers and healthcare workers to be on the lookout for Cyclospora infections this summer. According to the CDC report, there have been 206 Cyclospora infections between May 1 and August 2, 2017. This is more than double the amount of cases that took place in that same timeframe last year, which was 88. These 206 cases of illness have been reported from 27 different states, most of which have reported only a small number of infections. Eighteen instances of hospitalization have been reported, and there have not been any deaths. There have not been any source for these infections found, and there is little evidence at this point that points towards whether or not the Cyclospora infections are connected or independent. While many different states have reported Cyclospora infections, by far the hardest hit state appears to be Texas.
Cyclospora in Texas
The Texas Department of State Health Services has been investigating an outbreak of Cyclospora infections since July 17. At that point, there had been 68 reported cases of illness, the first of which began to be reported in mid-June. Over the last month, Texas health officials have repeatedly updated the total case count of the outbreak as more information becomes available. The latest case count, as of August 8, is 197 cases. Forty of the 254 counties in Texas have reported cases of Cyclospora poisoning. The hardest hit counties include Bexar with 25 cases of illness, Dallas with 12 cases, Harris with 54 cases, Tarrant with 18 cases, and Travis with 14 cases. The 197 cases in less than two months have already eclipsed the total number of cases reported in Texas for the entirety of 2016, which was 148. Health officials are still looking for a source of the outbreak, and have also alerted health officials to be on the lookout for Cyclospora infections.
Cyclospora are single celled protozoa that can be found in a variety of animals and environments. There are quite a few different types of Cyclospora, but only one species, Cyclospora cayetanensis, has been known to cause illness in humans. Immature oocysts are shed through fecal matter. It takes around one or two weeks outside of the body in order for the oocysts to mature. After this maturation process, Cyclospora protozoa can become infective. Not much is known about the number of protozoa required to cause a case of illness, but again, Cyclospora must undergo a maturation process prior to becoming infectious.
Upon exposure to the Cyclospora protozoa, symptoms will appear between 7 and 10 days afterward. There is a wide variety of symptoms that can present with a Cyclospora infection including loss of appetite, weight loss, watery diarrhea, nausea, abdominal cramping, bloating, headache, fever, vomiting, and body aches. These symptoms can last up to months, although they may go away on their own within a few days. Cyclospora infections do present with the chance to cause a relapse, meaning that the illness may return even after symptoms originally subside. According to the CDC estimates from January of 2011, there have been no deaths attributed to Cyclospora infections.
Cyclospora infections can still be fairly serious, though, and can even result in hospitalization being required. Anyone can get a Cyclospora infection, but children, the elderly, those with suppressed immune systems, and those living in tropical or subtropical areas are more likely to catch a Cyclospora infection. Persons with those specific risk factors are also at an increased risk of catching a more serious infection, and because of this Cyclospora infections are much more common in the summer than in the winter. In the United States, the majority of Cyclospora infections take place between May and July.
Cyclospora Testing and Diagnosis
If you or a loved one begins to show the symptoms of a Cyclospora infection, it is a good idea to go see a doctor. Often, the doctor will recommend rest and hydration, but they will also probably run some tests to find the cause of the infection. Cyclospora is not necessarily tested for on every occasion, so if you believe that you have a Cyclospora infection–and are presenting the symptoms listed above–it is a good idea to suggest that your doctor run a Cyclospora test. The fact that Cyclospora is not usually tested for is one of the reasons that the CDC HAN announcement was issued. The test for Cyclospora involves a stool sample, and it will attempt to isolate Cyclospora oocysts. As stated by the Texas department of State Health Services, “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.” For more information about the testing process, click here. If you test positive for a Cyclospora infection, the doctor will likely prescribe a round of antibiotics. The antibiotic Trimethoprim/sulfamethoxazole, usually sold under the names Bactrim, Septra, or Cotrim, is typically used to treat cases of Cyclosporiasis.
Like any foodborne illness-causing pathogen, there are steps that can be taken to prevent the spread of Cyclospora infections. Thoroughly washing produce prior to eating it is very important in halting the spread of infection, especially for a pathogen like Cyclospora, whose outbreaks are typically tied to fresh produce. It is also highly recommended that all foods be thoroughly cooked. Meats should be cooked to an internal temperature of 160 degrees Fahrenheit in order to eliminate any potential pathogen contamination. Seafood should be cooked to an internal of 145 degrees Fahrenheit. The proper washing of hands is likely the best way to prevent infection, especially when it comes to pathogens that are spread along the fecal-oral route. Exercising caution while cooking, including keeping ingredients separate to reduce the risk of cross contamination, will greatly decrease the odds of getting a foodborne illness. For more tips and tricks on preventing food poisoning, click here.