Cyclosporiasis: Symptoms, Treatment and How It Spreads

Most stom­ach ill­ness­es improve with­in a few days. But when diar­rhea lingers, returns after you start feel­ing bet­ter or leaves you feel­ing tired and run down, it may be a sign of some­thing more than a typ­i­cal stom­ach bug.

Recent cas­es of Cyclospo­ra have brought atten­tion to this intesti­nal infec­tion. While health offi­cials con­tin­ue inves­ti­gat­ing the source, know­ing the symp­toms, how it spreads and when to seek med­ical care can help you get the care you need.

Cyclospo­ra is a micro­scop­ic par­a­site that caus­es an intesti­nal infec­tion called cyclospo­ri­a­sis. Peo­ple typ­i­cal­ly become infect­ed by con­sum­ing food or water con­t­a­m­i­nat­ed with the par­a­site. Because it is too small to see with­out a micro­scope, con­t­a­m­i­nat­ed food or water may look, smell and taste normal.

Most peo­ple recov­er com­plete­ly with appro­pri­ate treat­ment, but Cyclospo­ra infec­tions can last much longer than a typ­i­cal stom­ach ill­ness. With­out treat­ment, symp­toms may con­tin­ue for weeks and may lead to dehy­dra­tion, fatigue and unin­tend­ed weight loss.

What are the symp­toms of Cyclospora?

The most com­mon symp­tom of Cyclospo­ra infec­tion is fre­quent, watery diar­rhea. Symp­toms often begin about one week after expo­sure, but they can appear any­where from a few days to more than two weeks later.

Oth­er symp­toms may include:

• Stom­ach cramps or bloating

• Nau­sea or decreased appetite

• Fatigue

• Unin­ten­tion­al weight loss

• Low-grade fever

• Headache or body aches

Cyclospo­ra can some­times be dif­fi­cult to rec­og­nize because symp­toms may come and go. Some peo­ple may begin feel­ing bet­ter before diar­rhea returns. Oth­ers may expe­ri­ence mild symp­toms or have no symp­toms at all.

How do peo­ple get Cyclospora?

Peo­ple usu­al­ly become infect­ed by eat­ing food or drink­ing water con­t­a­m­i­nat­ed with Cyclospo­ra. The par­a­site has been asso­ci­at­ed with out­breaks involv­ing cer­tain fresh fruits, veg­eta­bles, herbs and sal­ad products.

How­ev­er, this does not mean all pro­duce is unsafe. Prac­tic­ing safe food han­dling habits can help reduce the risk of many food­borne illnesses.

Cyclospo­ra is also dif­fer­ent from many com­mon stom­ach ill­ness­es because it does not typ­i­cal­ly spread direct­ly from per­son to per­son. The par­a­site needs time out­side the body before it becomes infectious.

Even so, good hygiene is impor­tant when you are sick. Wash your hands thor­ough­ly and avoid prepar­ing food for oth­ers while you are expe­ri­enc­ing diar­rhea. Oth­er infec­tions that cause sim­i­lar symp­toms can spread more eas­i­ly from per­son to person.

When should you see a health­care provider?

Many com­mon stom­ach ill­ness­es improve with­in a few days. Cyclospo­ra infec­tions often last longer and may require spe­cif­ic test­ing and treatment.

Con­tact your health­care provider if you:

• Have diar­rhea last­ing more than a few days

• Notice symp­toms improve and then return

• Are los­ing weight with­out trying

• Have per­sis­tent fatigue or weakness

• Have recent­ly trav­eled or eat­en food con­nect­ed to a known outbreak

It is also impor­tant to watch for signs of dehy­dra­tion, including:

• Dry mouth

• Dark urine

• Dizzi­ness or lightheadedness

• Dif­fi­cul­ty keep­ing flu­ids down

Severe dehy­dra­tion, con­fu­sion, faint­ing or rapid­ly wors­en­ing symp­toms require urgent med­ical attention.

How is Cyclospo­ra diag­nosed and treated?

Diag­nos­ing Cyclospo­ra requires a stool test. How­ev­er, stan­dard stool test­ing does not always auto­mat­i­cal­ly include test­ing for Cyclospo­ra, so your health­care provider may need to request a spe­cif­ic test.

If Cyclospo­ra is con­firmed, the stan­dard treat­ment is a com­bi­na­tion antibi­ot­ic called trimetho­prim-sul­famethox­a­zole (TMP-SMX). Be sure to let your health­care provider know about any med­ica­tion aller­gies before start­ing treatment.

Your provider can also eval­u­ate your symp­toms, check for dehy­dra­tion and make sure oth­er pos­si­ble caus­es of pro­longed diar­rhea are considered.

What can help while you recover?

Replac­ing lost flu­ids is one of the most impor­tant parts of recov­ery. Take small, fre­quent sips of water, broth or elec­trolyte drinks rather than drink­ing large amounts at once.

As your appetite improves, grad­u­al­ly return to your nor­mal diet. Foods such as toast, rice, bananas, pota­toes, soup and lean pro­teins may be eas­i­er to tol­er­ate while your diges­tive sys­tem recovers.

It may help to tem­porar­i­ly avoid alco­hol, caf­feine, greasy foods, spicy foods and heavy dairy prod­ucts if they wors­en symptoms.

How can you reduce your risk?

Safe food han­dling habits can help low­er your risk of many food­borne illnesses.

When prepar­ing produce:

• Wash your hands before and after han­dling food

• Rinse fruits and veg­eta­bles thor­ough­ly under run­ning water

• Scrub firm pro­duce with a clean pro­duce brush

• Refrig­er­ate cut pro­duce promptly

• Avoid wash­ing pro­duce with soap or bleach

Wash­ing pro­duce can help remove con­t­a­m­i­nants, but it may not elim­i­nate every Cyclospo­ra parasite.

When trav­el­ing in areas where food or water safe­ty may be uncer­tain, choose sealed or treat­ed water, avoid ques­tion­able ice and select foods that are ful­ly cooked and served hot.

Fre­quent­ly Asked Questions:

Is Cyclospo­ra con­ta­gious?
Not usu­al­ly. Unlike some stom­ach ill­ness­es, Cyclospo­ra does not typ­i­cal­ly spread direct­ly from per­son to per­son because the par­a­site needs time out­side the body before it can infect some­one else.

Can wash­ing pro­duce remove Cyclospo­ra?
Wash­ing pro­duce helps reduce con­t­a­m­i­na­tion, but it is not guar­an­teed to remove every parasite.

Can you get Cyclospo­ra more than once?
Yes. Pre­vi­ous infec­tion does not pro­vide last­ing pro­tec­tion from future infections.

Will a reg­u­lar stool test detect Cyclospo­ra?
Not always. Your health­care provider may need to request a spe­cif­ic test to iden­ti­fy the parasite.

Get Care for Per­sis­tent Diarrhea

Per­sis­tent diar­rhea can have many caus­es, and symp­toms alone are not always enough to deter­mine what is mak­ing you sick. A health­care provider can eval­u­ate your symp­toms, check for dehy­dra­tion, order appro­pri­ate test­ing and rec­om­mend treat­ment if needed.

If diar­rhea lasts longer than expect­ed, returns after improv­ing or makes it dif­fi­cult to stay hydrat­ed, don’t wait to seek care. Sched­ule a vis­it with a QMG pri­ma­ry care provider or find same-day care near you if your symp­toms are get­ting worse and you can’t wait.