Cyclosporiasis

Cyclosporiasis is an intestinal illness caused by a parasite. You get sick from consuming food or water that contains the parasite.

State and federal partners are working together to investigate a multistate outbreak linked to iceberg lettuce in 9 states. CDC is also investigating other outbreaks of cyclosporiasis nationally that are unrelated to this outbreak.

Due to the significant number of cyclosporiasis cases, CDC is publishing weekly surveillance data updates.

The symptoms of cyclosporiasis can vary, but the most common symptom is watery diarrhea and sometimes explosive bowel movements. Other common symptoms include:

• Loss of appetite
• Weight loss
• Cramping
• Bloating
• Increased gas
• Nausea
• Fatigue

Less common symptoms include:

• Vomiting
• Body aches
• Headache
• Low-grade fever
• Other flu-like symptoms

People usually experience symptoms of cyclosporiasis about one week, although it could be earlier or later, after consuming contaminated food or water.

Yes. Cyclosporiasis is treated with certain antibiotics. Most people who are healthy will eventually recover without treatment. However, if not treated, you may be sick for anywhere from a few days to a month or longer. You may also have symptoms that seem to go away but then return one or more times. People in poor health or those who are immuno-compromised may be at a higher risk for severe or long illness.

Direct person-to-person transmission of cyclosporiasis is unlikely. It spreads when people consume contaminated food or water.

Based on the information available, the best way to prevent cyclosporiasis is to avoid food or water that may be contaminated with feces.

The following recommendations will help to reduce the risk of foodborne illness related to fresh produce:

• Wash hands with soap and water before and after handling or preparing raw fruits and vegetables.
• Wash all fruits and vegetables thoroughly under running water before eating, cutting, or cooking - even if it is labeled as pre-washed.
• Scrub firm fruits and vegetables, such as melons and cucumbers, with a clean produce brush.
• Cut away any damaged or bruised areas on fruits and vegetables before preparing and eating.
• Refrigerate cut, peeled, or cooked fruits and vegetables as soon as possible (within two hours).

Federal, state, and local public health officials in several states are investigating a multistate outbreak linked to shredded iceberg lettuce served at Taco Bell locations in 9 states. Do not eat shredded iceberg lettuce from Taco Bell locations in Illinois, Indiana, Kansas, Kentucky, Michigan, Ohio, Oklahoma, Pennsylvania, and West Virginia.

In the United States, foodborne outbreaks of cyclosporiasis have been linked to different types of imported fresh produce, including:

• Basil
• Cilantro
• Mesclun lettuce
• Raspberries
• Snow peas

Please note, this is not an all-inclusive list. You should follow the recommendations above for cleaning all fresh produce.

To date, no outbreaks have been linked to commercially frozen or canned produce.

Yes. You can contract cyclosporiasis again, if you consume contaminated food or water.

Consider cyclosporiasis in patients presenting with prolonged or relapsing watery diarrhea, particularly during the May–August cyclosporiasis season, even without a history of international travel.

Specifically request Cyclospora laboratory testing on stool specimens because routine ova and parasite (O&P) examinations do not reliably detect the parasite. Consider molecular (PCR-based) diagnostic testing where available, because it can improve detection.

Be aware that diagnosis can be difficult, and several stool specimens may be required. Because Cyclospora oocysts may be shed intermittently and at low levels, even in persons with profuse diarrhea. Providers can consider collecting more than one specimen across different days to increase identification of the parasite.

Yes. Report all cases of cyclosporiasis to the Pennsylvania Department of Health at 877-PA-HEALTH or your local health department.

Given the typical lifecycle of Cyclospora, person-to-person transmission is unlikely, even within healthcare settings. The Cyclospora parasite needs time (days to weeks) after being passed in a bowel movement to become infectious for another person. If an affected patient is continent of stool, the level of environmental contamination is probably small.

Cyclospora is unlikely to be killed or inactivated by routine chemical disinfection. No EPA registered disinfectant products have been demonstrated to be effective. When affected patients are incontinent or diapered, the risk of contamination of surfaces might be higher. Facilities should clean surfaces initially with a detergent to remove any visible soil and scrub the surfaces thoroughly. After this cleaning, an EPA-registered hospital disinfectant should be used. Immediately after cleaning, health care personnel should remove gloves used during cleaning and wash their hands following hand hygiene protocol.