Cyclosporiasis

What is cyclosporiasis?

Cyclosporiasis (“sigh-klo-spor-EYE-us-is”) is a form of food poisoning you get from the parasite Cyclospora cayetanensis (also called C. cayetanensis or Cyclospora). It causes watery, sometimes explosive, diarrhea and other gastrointestinal (gut) symptoms that can take a long time to go away.

How serious is Cyclospora?

A Cyclospora infection can be mild or very serious. You’re most at risk for a serious infection if you have a compromised (weakened) immune system (for instance, you’re living with HIV/AIDS or cancer or you’re taking immunosuppressive medications). If you don’t treat cyclosporiasis, you can be sick for a long time or have symptoms get better and then come back.

Who does cyclosporiasis affect?

Cyclosporiasis is most common in tropical or subtropical parts of the world and areas with poor sanitation. This includes countries in Central and South America, the Middle East and South East Asia. You’re most at risk for cyclosporiasis if you live in, travel to or eat produce imported from these areas. You’re at risk for severe illness if you have a weakened immune system.

What are the symptoms of cyclosporiasis?

Symptoms of cyclosporiasis usually start within a week of exposure (eating or drinking contaminated food or water) and include:

• Watery or explosive diarrhea.
• Loss of appetite.
• Bloating and gas.
• Fatigue (extreme tiredness).
• Low-grade fever.
• Nausea.
• Stomach cramps.
• Vomiting.

What causes cyclosporiasis?

Cyclosporiasis is caused by eating or drinking food or water that’s contaminated with the parasite C. cayetanensis.

How is cyclosporiasis spread?

Cyclosporiasis spreads (is transmitted) when the poop (feces) of someone who has a Cyclospora infection gets into a water supply. You can get infected with it by drinking untreated water or eating fruits and vegetables that came in contact with contaminated water.

Previous outbreaks of cyclosporiasis in the U.S. have been linked to imported fresh produce, including basil, cilantro, raspberries and snow peas.

How does Cyclospora get into food?

Cyclospora gets into food from contaminated water. Food that’s grown or washed with untreated water is at risk for Cyclospora contamination.

Is cyclosporiasis contagious?

No, cyclosporiasis isn’t contagious. There’s no evidence that it spreads from person to person.

Is cyclosporiasis viral or bacterial?

Cyclosporiasis is a parasitic illness, not caused by a virus or bacteria. Cyclospora is a protozoan — a very small (single-celled) organism that you can only see with a microscope.

How do you know if you have Cyclospora?

Only a healthcare provider can tell you for sure if you have cyclosporiasis. You may have Cyclospora if you have watery or explosive diarrhea and you’ve recently traveled in areas where Cyclospora is common or eaten produce imported from those areas.

How is cyclosporiasis diagnosed?

A healthcare provider diagnoses cyclosporiasis by taking a stool (poop) sample, examining you and asking you about your symptoms and health history. They may ask you about foods you’ve eaten recently or whether you’ve traveled to areas where Cyclospora is common.

What tests will be done to diagnose cyclosporiasis?

A stool test is done to diagnose cyclosporiasis. You’ll provide a sample of your poop in a sterile container that your provider gives you. A lab will examine your poop sample to look for Cyclospora. You may have to provide several stool samples on different days to confirm a Cyclospora infection.

How is cyclosporiasis treated?

Cyclosporiasis is treated with antibiotics. Your provider may also prescribe oral or IV hydration or antidiarrheal medications.

What can/can’t I eat/drink with cyclosporiasis?

If you have cyclosporiasis, avoid eating or drinking anything that makes diarrhea and dehydration worse, like alcohol and caffeine. Some diets help you reduce diarrhea. Ask your provider what foods you should eat and which to avoid.

What medications are used to treat cyclosporiasis?

Your provider may use some or all of these treatments for cyclosporiasis:

• Antibiotics. Trimethoprim/sulfamethoxazole (TMP/SMX) is a combination of two antibiotics that’s most effective in treating Cyclospora infections. Your provider may prescribe ciprofloxacin instead if you’re allergic to sulfa medications.
• Antidiarrheal medications. Your provider might prescribe or recommend medications that stop diarrhea, like diphenoxylate-atropine or loperamide. This helps prevent dehydration. It also helps your body hold onto important nutrients.
• Hydration. Your provider might give you special fluids to help rehydrate you and restore your electrolytes (minerals that keep your body working properly).

Complications/side effects of the treatment

Taking antibiotics when you don’t need to can contribute to antibiotic resistance. Your provider may wait and see if your infection goes away on its own before prescribing antibiotics.

What happens if a Cyclospora infection goes untreated?

If you don’t treat a Cyclospora infection, your symptoms could last a month or longer. This puts you at risk of severe dehydration and other complications.

How do I manage the symptoms of cyclosporiasis?

The best way to manage the symptoms of cyclosporiasis is to make sure you’re staying hydrated and getting enough nutrition.

• Drink plenty of fluids. Water, broth, sports drinks or oral rehydration solutions (Pedialyte®, Enfalyate®, CeraLyte®) keep you hydrated better than other drinks.
• Over-the-counter medications like loperamide (Imodium®, Diamode) and bismuth subsalicylate (Pepto-Bismol®, Kaopectate®) can help stop diarrhea, but check with your healthcare provider before taking them.
• Keep an eye on your symptoms. If you can’t keep anything down or you have severe diarrhea, contact your healthcare provider. You may need IV fluids or nutrition

How do you prevent cyclosporiasis?

Proper food handling is the best way to reduce your risk of cyclosporiasis. This helps you avoid ingesting food or water that could be contaminated. Not all disinfecting or sanitizing methods kill Cyclospora.

Things you can do to avoid getting cyclosporiasis include:

• Wash your hands with soap and water before, during and after food prep.
• Thoroughly rinse or peel fresh fruits and vegetables before eating.
• Don’t leave peeled, cooked or cut fruits and vegetables out of the refrigerator for more than two hours.
• Store vegetables and fruit separately from raw meat, seafood and poultry.
• Wash all food prep surfaces, dishes and utensils with hot water and detergent after use.
• Don’t drink untreated water. Drink bottled water and use it for food prep if you’re not sure if the water is treated.
• Avoid eating produce from areas where Cyclospora is common.

What can I expect if I have cyclosporiasis?

If you have a healthy immune system, you should make a full recovery from cyclosporiasis. You may get better on your own or with antibiotic treatment. You can have symptoms for a week or longer before getting better.

If you have a weakened immune system and have cyclosporiasis, your provider will monitor you closely. Cyclospora can cause ongoing and severe illness if your immune system can’t fight it off.

How long does cyclosporiasis last?

The course of cyclosporiasis varies a lot. For some people, it’s self-limiting, meaning it goes away on its own. In others, symptoms may go away and then come back. If left untreated, symptoms can go on for months.

Complications of cyclosporiasis

Cyclosporiasis can make it harder to hydrate yourself properly. Losing a lot of fluid can lead to serious complications, including:

• Severe dehydration.
• Electrolyte imbalance, which can cause problems with your heart and other organs.
• Hypovolemia (loss of fluid volume in your body).

Does Cyclospora go away on its own?

A Cyclospora infection sometimes goes away on its own, but it can also last a long time and put you at risk for dehydration. It’s best to check with your healthcare provider to know if you should treat a Cyclospora infection with antibiotics.

How do I take care of myself with cyclosporiasis?

Taking care of yourself with cyclosporiasis includes staying hydrated and trying to get whatever nutrition you can. Severe diarrhea can lead to life-threatening complications.

You can drink lots of fluid like broth, water, sports drinks or oral rehydration solutions to help replace the fluid you’ve lost and prevent life-threatening electrolyte problems. Don’t drink caffeinated beverages or alcohol. Eat food however you’re able — even if it’s small bites at a time.

Take all antibiotics as prescribed, even if you’re feeling better.

When should I see my healthcare provider for cyclosporiasis?

Contact your healthcare provider if you think you have cyclosporiasis, especially if you have large amounts of watery diarrhea (several episodes per day). Contact your healthcare provider right away if you have a compromised immune system and any symptoms of infectious disease.

If you’re being treated for cyclosporiasis and your symptoms worsen or come back after finishing your medication, be sure to contact your provider right away.

When should I go to the ER?

If you can’t keep any food or liquid down and you have several episodes of severe, watery diarrhea a day, you should seek medical attention for dehydration. Go to the nearest ER if you have symptoms of severe dehydration, including:

• Confusion or mental changes.
• Weakness or light-headedness.
• Feeling dizzy when you stand up.
• Not peeing or barely peeing.
• Dark-colored pee (urine).

What questions should I ask my doctor?

• How do I take my medication?
• How can I manage my symptoms at home?
• What medications can I take at home for my symptoms?
• What can I eat or drink? What foods and beverages should I avoid?
• How can I keep myself hydrated?
• What should I do if my symptoms get worse or change?
• What symptoms should prompt me to call you or go to the ER?

A note from Cleveland Clinic

Cyclosporiasis is rare in the U.S., but imported, fresh produce sometimes causes outbreaks. You’re also at risk if you live in or travel to tropical and subtropical areas where Cyclospora is common. Fortunately, cyclosporiasis is not usually life-threatening and can be treated with antibiotics.

If you have cyclosporiasis, be sure to drink plenty of fluids to stay hydrated. If you’re having trouble keeping food or fluids down, don’t hesitate to seek medical attention.