Cyclosporiasis: Everything to know about the parasitic illness

As kids, we learned the importance of eating our fruits and vegetables every day.

But many across the U.S. are temporarily nixing healthy options like berries and lettuce from their diet due to rising numbers of cyclosporiasis.

A parasitic intestinal illness that’s transmitted to humans from contaminated food or water, cyclosporiasis is nothing new, with approximately 2,700 cases occurring annually in the U.S. However, this year’s numbers are significantly above average.

Since early May, the CDC has confirmed more than 1,600 cases across 34 states, including Pennsylvania and Delaware—though it’s possible nearly 7,000 Americans have been infected.

With numbers continuing to rise and the source of the outbreak under investigation, Gul Madison, MD, an infectious disease specialist at Trinity Health Mid-Atlantic Medical Group’s Infectious Disease Darby, breaks down the origin, symptoms, treatment and potential long-term complications of cyclosporiasis.

The parasite Cyclospora, which causes cyclosporiasis, usually originates on farms when produce comes into contact with human feces. This may occur due to poor hand hygiene by agricultural workers during harvesting, infected irrigation water or contaminated soil.

“When you ingest that contaminated food or water, the parasite gets into the gastrointestinal tract. It causes an infection in your gut and leads to the symptoms—the most common being severe, ‘explosive’ diarrhea,” says Dr. Madison.

Other symptoms may include:

• Abdominal pain
• Cramping
• Bloating
• Nausea
• Overall “sick to your stomach” feeling
• Low grade fever
• Severe fatigue
• Involuntary weight loss

The average incubation period for cyclosporiasis is seven days, but individuals may see the onset of symptoms anywhere from two days to two weeks after becoming infected. According to Dr. Madison, you won’t know you have it until the symptoms develop.

Though it can be severe in older folks, children and those who are immunocompromised, cyclosporiasis is generally a mild illness that can often be treated at home. Steps toward wellness include:

• Hydrating with water and electrolytes
• Trying to eat small meals
• Reaching out to your health care provider or going to the emergency room if the diarrhea doesn’t resolve after a few days
• Taking the antibiotic Bactrim as prescribed by your health care provider

If left untreated, even otherwise healthy individuals can suffer from cyclosporiasis for weeks or months, and potentially develop long-term complications such as:

• Chronic dehydration
• Chronic electrolyte imbalance
• Malabsorption
• Malnutrition
• Recurrence, mainly in the immunocompromised

While avoiding all fruits and vegetables for the time being might seem like the safest option, there are ways to enjoy them and minimize risk of infection.

According to Dr. Madison, cooking produce is ideal whenever possible, as heat kills the parasite. Simply washing produce doesn’t guarantee removal of Cyclospora, but it does reduce risk when done properly:

• Wash your hands with soap and water before prepping the produce
• Wash the produce thoroughly under running water
• For firm items, such as cucumbers, use a produce brush to clean again thoroughly
• Cut off damaged parts
• Put in the refrigerator within two hours of preparing

How long will we have to be extra cautious with produce? According to Dr. Madison, it’s hard to say. But there may be a light at the end of the tunnel.

“Looking at the past outbreaks, though they were much smaller in scale, the majority of them were in summer months from May to August,” she says. “Knowing that we still have a rise in cases, I expect the outbreak will continue throughout July and potentially next month. Then, we’ll see what happens next.”

Visit Infectious Disease Darby for infectious disease care at Trinity Health Mid-Atlantic and to make an appointment.