CDC Health Advisory Notes Increase in Reported Cases of Cyclospora cayetanensis Infection

PUBLISHED: Aug 8, 2017
Relevant to: Ambulatory Care, Critical Access Hospitals, Home Health, Hospitals, Long Term Care, Medical Office/Clinic

The Centers for Disease Control and Prevention (CDC), State and Local Health Departments, and the Food and Drug Administration (FDA) are investigating an increase in reported cases of cyclosporiasis. As of August 2, 2017, 206 cases of Cyclospora infections have been reported to CDC in persons who became infected in the United States and became ill on or after May 1, 2017. This is an increase in cases from 2016. These cases have been reported from 27 states, most of which have reported relatively few cases. Eighteen cases reported hospitalization; no deaths have been reported. At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source of infection are ongoing. It is too early to say whether cases of Cyclospora infection in different states are related to each other and/or to the same food item(s).

Background:

Cyclosporiasis is an intestinal illness caused by the parasite Cyclospora cayetanensis. People can become infected with Cyclospora by consuming food or water contaminated with the parasite; it is not transmitted directly from one person to another person. The most common symptom of cyclosporiasis is watery diarrhea, which can be profuse. Other common symptoms include anorexia, fatigue, weight loss, nausea, flatulence, abdominal cramping, and myalgia; vomiting and low-grade fever may also occur. Symptoms of cyclosporiasis begin an average of 7 days (range: 2 days to ≥2 weeks) after ingestion of the parasite. If untreated, the illness may last for a few days to a month or longer, and may have a remitting-relapsing course. The treatment of choice for cyclosporiasis is trimethoprim/sulfamethoxazole (TMP/SMX). No effective alternative treatments have yet been identified for persons who are allergic to or cannot tolerate TMP/SMX, thus observation and symptomatic care is recommended for these patients.

Recommendations for Healthcare Providers:

  • Consider a diagnosis of cyclosporiasis in patients who have prolonged or remitting-relapsing diarrheal illness.
  • If indicated, healthcare providers should specifically order testing for Cyclospora, whether testing is requested by ova and parasite (O&P) examination, by molecular methods, or by a gastrointestinal pathogen panel test. Several stool specimens may be required because Cyclospora oocysts may be shed intermittently and at low levels, even in persons with profuse diarrhea.

Cyclosporiasis is a nationally notifiable disease; healthcare providers should report suspect and confirmed cases of infection to public health authorities. Contact the local health department if assistance is needed with reporting or submitting specimens.

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