Cyclosporiasis (Cyclospora Infection)

What is cyclosporiasis?

Cyclosporiasis is a diarrheal illness caused by a microscopic parasite called Cyclospora cayetanensis. In the spring of 1996, a large outbreak occurred in the eastern United States due to contaminated raspberries imported from Guatemala. It became one of the diseases that must be reported to the New York City Department of Health and Mental Hygiene in January 1997. There were 18 cases of cyclosporiasis reported among New York City residents in 2008 (rate of 0.2 cases per 100,000 persons).

Who gets cyclosporiasis?

Anyone can get cyclosporiasis. In the past, Cyclospora infection was usually found in persons who lived or traveled in developing countries. More and more, cases are being recognized in countries such as the United States and Canada.

How is cyclosporiasis spread?

Cyclosporiasis can occur when a person ingests water or food that has been contaminated with the parasite. The infection can also be transmitted by a person putting something in his or her mouth that has been contaminated with infected stool (feces). Outbreaks in North America have been associated with various types of fresh produce. When passed in an infected person's stool, Cyclospora may require some time (days to weeks) in the environment before becoming infectious. It is therefore unlikely that cyclosporiasis is spread directly from one person to another.

What are the symptoms of cyclosporiasis?

Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, with frequent bowel movements. Other symptoms include loss of appetite, weight loss, bloating, increased gas, stomach cramps, nausea, vomiting, tiredness, muscle aches, and low-grade fever. Symptoms may subside and then return. Untreated, the illness may last a few days to a month or even longer. Some persons infected with Cyclospora do not develop any symptoms.

How soon after infection do symptoms occur?

The time between becoming infected and developing symptoms is usually about a week.

How is cyclosporiasis diagnosed?

If you think you may be infected with Cyclospora, you should talk to you doctor. Identification of this parasite in stool requires special laboratory tests that are not routinely used. Therefore, your doctor should specifically request testing for Cyclospora. More than one stool sample collected on different days may be needed. Your doctor may also want to have your stool checked for other infectious organisms that can cause similar symptoms.

What is the treatment for cyclosporiasis?

The current recommended treatment for infection with Cyclospora is a combination antibiotic called trimethoprim-sulfamethoxazole. Infected persons with diarrhea should rest and drink plenty of fluids. They should seek their doctor's advice before taking medicine to slow their diarrhea.

How can cyclosporiasis be prevented?

Cyclospora infection can be prevented by avoiding water or food that may be contaminated with stool.

Steps to take to Prevent Cyclosporiasis

Avoid food that may be contaminated.

  • Uncooked fruits and vegetables should be washed thoroughly before being eaten.

Wash your hands often.

  • Always thoroughly wash your hands with soap and water before handling food, after using the toilet or changing diapers, after handling animal stools (feces), and after gardening or other direct contact with soil.

Avoid water that may be contaminated.

  • Do not drink water directly from streams, lakes, springs or swimming pools.
  • Boil water for 1 minute at a rolling boil whenever you are unsure of the safety of a drinking water source, or use a water filter that has an absolute pore size of 1 micron or smaller, or one that has been National Sanitation Foundation (NSF) rated for "cyst removal."
  • Carefully dispose of sewage wastes so as not to contaminate surface water or ground water.
  • Comply fully with water advisories whenever issued by public health or government authorities.

Take extra care when traveling.

  • If you travel to developing countries, you may be at greater risk for cyclosporiasis because of poorer water treatment and food sanitation. Warnings about food, drinks and swimming are even more important when visiting developing nations. Avoid raw (uncooked) fruits and vegetables that you did not wash or peel yourself, unboiled tap water, ice made from unboiled tap water, and items purchased from street vendors.

Last Updated December 2009