Cyclosporiasis

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What is Cyclosporiasis?

Cyclospora cayetanensis, also called Cyclospora, is a parasite that causes gastrointestinal illness referred to as cyclosporiasis. Although cases are reported year-round, infections are most common in the summer and early fall, when a national case increase occurs. Cyclospora is found in contaminated food or water and people become ill by consuming the infected items.

Signs and symptoms

Watery diarrhea
Loss of appetite
Weight loss
Cramping
Increased gas
Bloating
Fatigue
Nausea

Incubation period

Two to fourteen days or more (usually seven days)

Contagious period and spread

Cyclospora is spread by fecal→oral transmission and occurs by ingesting food or water contaminated by the parasite. Person-to-person transmission is very unlikely. After someone who is infected with the Cyclospora parasite has a bowel movement, the parasite must grow outside of the body in the environment, such as the soil, for one to two weeks. This time period outside of the body allows the parasite to become infective, which is where it contaminates food or water. The parasite is not considered infectious directly after stool is shed and needs this period of time to grow in a favorable environment, which is why person-to-person transmission is extremely unlikely.
There is increased risk for people living or traveling to tropical or subtropical areas where Cyclospora is endemic. Even in those countries, infections appear to be seasonal. Cyclospora is not endemic to the United States, but outbreaks have been linked to produce grown domestically. The majority of risk for cyclosporiasis is from either traveling internationally or consuming fresh imported produce.

Public health reporting requirements

Staff who become aware of a student or staff member with confirmed or suspected cCyclosporiasis should report the infection to the facility director or school nurse. The facility should report to the state or local public health agency within four days of diagnosis or positive lab results.

If other children or staff are ill with diarrhea, refer them to their health care providers and contact public health as soon as possible, as this could be an outbreak. Generally speaking, it is considered an outbreak if there is an increase in the number of ill children and/or staff members at the school or child care center. Suspected outbreaks should be reported to CDPHE or local health departments within four hours, even if the causative agent is not yet known.

Control of spread

Encourage and teach the importance of frequent handwashing and proper hygiene techniques, especially after using the toilet and before eating.
Practice proper food handling such as washing hands before and after preparing food, washing produce, proper refrigeration, and cleaning surfaces in between different prepped food items. Although washing produce is recommended, washing produce may not remove the parasite from food.
Cyclospora is unlikely to be killed by routine chemical disinfection or sanitizing procedures.
Heat and cooking are the main methods to kill the parasite. Uncooked food items, such as fresh fruits, vegetables, and leafy greens, are the most commonly implicated food items in Cyclospora outbreaks.
Avoid eating or drinking contaminated food or water.
Refer to Disease Prevention: Food Safety for information on food safety.

Treatment

The illness can last from a few days to over a month if someone does not receive treatment. Symptoms may also come and go multiple times during this timeframe, making it difficult to pinpoint when symptoms have fully resolved. Some people can be infected without showing any symptoms. People with weakened immune systems may experience severe or prolonged illness. The most common symptom is watery diarrhea. Ill people should be given plenty of fluids and rest to prevent dehydration and fatigue.

Cyclosporiasis is treated with antibiotics called trimethoprim-sulfamethoxazole, often known as Bactrim, Septra or Cotrim, all of which contain sulfa. If someone has a sulfa allergy, they should contact their healthcare provider for additional treatment options.

Exclusion

Child care and preschool

There are no direct exclusions for cyclosporiasis among children and caregivers during routine activities, since Cyclospora is unlikely to be transmitted person-to-person.
It is recommended that child care and preschools follow their normal illness exclusion policy for anyone experiencing diarrhea or fever, including food handlers, before being allowed to return to the facility. Since symptoms can last over a month without treatment, it is recommended that symptomatic individuals seek medical care. In child care settings, center staff may be considered food handlers and should follow this exclusion.
Determine if other children or staff have recently had diarrhea. Other children with diarrhea should be excluded, seen by their physician, and submit stool for testing.
EXCLUDE all infected children and or caregivers from working in any community/school/local gardens at the facility where handling produce or soil around produce may occur. Produce gardens can become contaminated if infected persons are allowed to continue farming/gardening.

Primary and secondary school

No direct exclusions for cyclosporiasis among children and staff during routine activities since Cyclospora is unlikely to be transmitted person-to-person.
It is recommended that schools follow their normal illness exclusion policy for anyone, including food handlers, experiencing diarrhea or fever before being allowed to return to the facility. Since symptoms can last over a month without treatment, it is recommended that symptomatic individuals seek medical care.
Determine if other children or staff have recently had diarrhea. Other children with diarrhea should be excluded, seen by their physician, and submit stool for testing.
EXCLUDE all infected children and staff from working in any community/school/local gardens at the facility where handling produce or soil around produce may occur. Produce gardens can become contaminated if infected persons are allowed to continue farming/gardening.

Role of teachers, caregivers, and family

If your child or a child you care for is infected with cyclosporaiasis, follow the advice of the child’s health care provider.
Practice good handwashing, especially after going to the bathroom, helping a child to the bathroom, or handling food.
Practice good food preparation especially for fresh uncooked produce. Refer to Disease Prevention: Food Safety for information on food safety.
Do not allow infected or suspected infected persons to farm or garden (food) while symptoms are ongoing.
Avoid drinking or consuming contaminated food or water items.