By: Robert W. Frenck, Jr. MD, FAAP
If your child has been dealing with watery diarrhea that won't seem to go away, especially during the summer months or after travel, they may have a parasitic infection called cyclosporiasis.
Cyclosporiasis most often spreads through contaminated water or food, especially fresh produce. Even without treatment, the infection usually goes away on its own in people who are otherwise healthy. But it can take weeks.
Here are answers to common questions parents have about cyclosporiasis, including what to watch for and when to seek care for your child.
Current cyclosporiasis outbreaks in the U.S.
State and federal health officials are investigating several outbreaks of cyclosporiasis in the United States. As of August 4, the Centers for Disease Control and Prevention (CDC) had received reports of 10,468 confirmed cases of cyclosporiasis in 47 states and knew of at least 12,255 more cases that weren't yet confirmed.
One multistate outbreak is linked to Cyclospora-contaminated iceberg lettuce from Taylor Farms de Mexico. Michigan, one of 15 states in this outbreak, reported the cyclosporiasis-related deaths of two people with underlying medical conditions. Parent company Taylor Fresh Foods recalled all of its iceberg lettuce sourced from central Mexico. If your family has any of the recalled iceberg lettuce at home, do not eat it. Throw it away or return it to the store where it was purchased for a refund.
While the Taylor Farms recall is linked to this specific outbreak, health officials are investigating other cases of cyclosporiasis around the country. Taking a few precautions when handling and preparing fresh produce can help keep your family healthy.
(See "Steps to reduce your family's risk of
Cyclospora infection," below.) What is cyclosporiasis?
Cyclosporiasis is an infection of the intestines caused by the parasite Cyclospora cayetanensis. Infection occurs when a person consumes food or
water contaminated with feces containing
Cyclospora. Fresh produce, including herbs, berries, lettuce and other vegetables, has been linked to outbreaks of infection.
Cyclospora eggs need to mature in the environment for days to weeks before they can infect someone. This is why the infection is not likely to spread directly from one person to another. When we ingest mature
Cyclospora eggs, they go to the small intestine. There, the parasites come out of the egg and infect cells in the small intestine and cause disease.
Some of these parasites form new eggs (called oocysts) that are released in the stool (poop), and this cycle is repeated.
What are the symptoms of cyclosporiasis in kids?
The most common symptom of cyclosporiasis is watery diarrhea. The diarrhea can be severe and may come and go over time. Other symptoms may include:
Some children develop symptoms that improve and then return days or weeks later. Without treatment, symptoms may last for several weeks or even months.
Not everyone infected with
Cyclospora develops symptoms. But they can still pass the parasite's eggs in their stool, which can contribute to a continued outbreak.
How do children get cyclosporiasis?
Children become infected by eating or drinking something contaminated with the parasite.
Common sources of
Cyclospora include:
Fresh fruits and vegetables
Herbs such as basil or cilantro
Contaminated drinking water
Food prepared with contaminated water
Most outbreaks in North America have been linked to fresh imported produce. Children may also become infected while traveling to countries where cyclosporiasis is more common.
Can cyclosporiasis spread from person to person?
No. The parasite is passed in stool, but must remain in the environment for about 1 to 2 weeks before it can cause infection in another person.
While someone with
Cyclospora is not directly contagious to others, eggs that are shed in the stool can later infect other people through contaminated food or water.
When do symptoms of cyclosporiasis start?
Symptoms typically begin about 1 week after exposure, although they can start as soon as 2 days or as long as 2 weeks or more after infection.
Because symptoms may not appear right away, it can be difficult to identify the food or water source that caused the illness.
How are symptoms different from other stomach bugs?
Most intestinal infections make children feel miserable for a few days and then gradually get better. Cyclosporiasis is different because children often have watery diarrhea, bloating and fatigue that can linger for weeks. Some seem to recover, only to have symptoms come back again.
That unusually long or relapsing course of symptoms is one of the biggest clues that cyclosporiasis may be the cause.
How is cyclosporiasis diagnosed?
Your child's doctor may suspect cyclosporiasis based on symptoms, recent travel and possible exposure to contaminated food or water.
Diagnosis usually requires testing a stool sample for the parasite. Special laboratory tests may be needed because Cyclospora can be difficult to detect. In some cases, more than one stool sample is needed to confirm the diagnosis. Many laboratories now use molecular testing panels that can identify Cyclospora along with other causes of infectious diarrhea.
How is cyclosporiasis treated?
The recommended treatment for cyclosporiasis is an antibiotic medication called
trimethoprim-sulfamethoxazole (TMP-SMX).
Treatment usually lasts 7 to 10 days, although some children with
weakened immune systems may need longer treatment.
Children who cannot take
sulfa medications should discuss alternative treatment options with their doctor. There are fewer effective alternatives, but other medications may sometimes be considered.
Your child should also drink plenty of fluids to help
prevent dehydration from diarrhea.
When should I call the pediatrician?
Contact your child's doctor if they have:
Diarrhea lasting more than a few days
Severe or persistent watery diarrhea
Signs of dehydration
Unexplained weight loss
Blood in the stool
Persistent vomiting
Fever with diarrhea
Symptoms that improve and then return
Seek urgent medical care if your child has severe
dehydration, is difficult to wake or cannot keep fluids down.
Are some children at higher risk for complications?
Most healthy children recover fully. However, cyclosporiasis can be more serious in children with underlying medical conditions or weakened immune systems, including those who:
Have
cancer
Received an organ transplant
Take medicines that suppress the immune system
Have certain immune disorders
These children may have more severe or prolonged illness and may need closer medical supervision.
How can families prevent cyclosporiasis?
There is no vaccine to prevent cyclosporiasis, but there are steps you can take to help prevent infection.
Steps to reduce your family's risk of
Cyclospora infection:
Use safe drinking water, especially when traveling, and avoid any food or water that may be contaminated with feces.
Wash hands with soap and water before preparing or eating food. Clean kitchen counter tops, cutting boards, utensils, etc. with hot, soapy water to avoid cross-contamination, and follow other food safety recommendations.
When eating fresh produce during Cyclospora season (May 1 through August 31), federal officials recommend that it can be helpful for families to:
Rinse fresh fruits and vegetables thoroughly under clean running water before eating, cutting, peeling or cooking them. This includes bagged produce labeled "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 produce before preparing and eating it. When possible, discard outer layer of fruits and vegetables. For example, throw away the outer two to three layers of leafy greens.
- Refrigerate cut, peeled or cooked fruits and vegetables as soon as possible (within 2 hours).
- Prioritize cooking any produce to a temperature of at least 158°F (70°C) as the safest option, since even careful washing may not completely remove Cyclospora.
Remember
Cyclosporiasis can cause prolonged watery diarrhea, stomach cramps, fatigue and weight loss in children. Because symptoms can last for weeks or come and go over time, it is important to contact your pediatrician if diarrhea does not improve. Prompt diagnosis and treatment can help your child recover more quickly.
More information
Image:
Cyclospora cayetanensis parasite oocysts (eggs) in a stool sample. Photomicrograph provided by CDC/ DPDx.
About Dr. Frenck
Robert W. Frenck Jr., MD, FAAP, is board-certified in pediatrics and pediatric infectious diseases and chair of the American Academy of Pediatrics Section on Infectious Diseases. He practices at Cincinnati Children's Hospital Medical Center and is a Professor of Pediatrics at the University of Cincinnati.