Cyclosporiasis symptoms, prevention and when to care for yourself at home or get help
Headlines this summer have been warning about thousands of people in the U.S. getting an intestinal illness caused by a parasite via produce. But there's more to the story beyond what's in the headlines.
One of our urgent care physicians, Jennifer L. Campbell, DO, and one of our pediatric emergency medicine physicians, Hazel Guinto, MD, explain what's really happening with this cyclosporiasis outbreak, including who is most at risk, how to prevent it, what symptoms to watch for and what to do if you or your family get sick from it.
What is cyclosporiasis
Cyclosporiasis is an intestinal illness caused by a microscopic parasite called Cyclospora cayetanensis. It can cause diarrhea, stomach cramps, nausea and other digestive issues.
Cyclosporiasis outbreaks have often been linked to fresh fruits and vegetables that've been contaminated with the parasite either through the soil the produce is grown in or its water source.
Important: cyclosporiasis is not contagious
Cyclosporiasis does not typically spread directly from person to person. This outbreak also appears to be specific to humans, which means you cannot get sick from your pets or other animals and vice versa.
Symptoms of cyclosporiasis
Symptoms typically start about one week after eating vegetables or fruit contaminated with the parasite, although they can appear anywhere from two days to two weeks or longer after infection.
Common symptoms include:
- Watery diarrhea
- Frequent bowel movements
- Stomach cramps
- Bloating
- Nausea
- Loss of appetite
- Fatigue
- Weight loss
- Low-grade fever
- Increased gas
- Headache or body aches
Many people describe the diarrhea as sudden and severe.
One unusual feature of cyclosporiasis is that symptoms can improve and then return. Without treatment, illness may last for several weeks or even longer.
Who is most at risk for severe illness
Most healthy people recover from cyclosporiasis without needing medical care or long-term problems. However, some groups may be more likely to develop severe illness, dehydration or complications.
As with many infections, young children, the elderly and immunocompromised groups are at the highest risk for severe illness from cyclosporiasis.
These higher-risk groups include:
- Older adults
- People who are pregnant
- People with weakened immune systems
- People receiving chemotherapy
- Organ transplant recipients taking immunosuppressive medications
- People with chronic medical conditions
Although most healthy people recover fully, severe dehydration can occur if frequent diarrhea is not treated. As of the time of our publication, deaths associated with this cyclosporiasis outbreak have primarily involved people with underlying medical conditions who developed severe dehydrated and related complications.
Good news for families
Dr. Hazel Guinto notes that most children recover well. However, parents of immunocompromised children should contact their healthcare team sooner because these patients may need earlier testing and specialist input.
How to prevent cyclosporiasis infection
During an outbreak, choosing produce that's well-cooked produce (to at least 158°F or 70°C) or with peels that can be removed may help reduce your risk.
These steps may also help lower your risk of infection:
- Wash fruits and vegetables under running water
- Wash produce even if the package says "pre-washed"
- Scrub firm produce such as melons and cucumbers with a clean produce brush before cutting
Always wash your hands with soap and water before handling food, before eating and after using the restroom. Hand sanitizer on its own is not enough.
Still craving a crisp, fresh salad? One of our registered dietitian nutritionists (RDNs) recommends these recipes that don't use leafy greens.
What to do if you get sick with cyclosporiasis
How to care for yourself at home
Focus on hydration and getting enough nutrients.
"Diarrheal illnesses like cyclosporiasis can lead to dehydration and malnutrition," says Dr. Campbell. "It is very important to stay hydrated with water and electrolytes from sugar-free or low sugar sources. And nutrition is important to sustain our bodies during illness and support our immune system."
Try to:
- Drink water frequently
- Regain electrolytes from powders or drinks like Pedialyte or sports beverages
- Rest as much as possible
- Eat bland foods that are easier to digest, such as:
- Toast
- Rice
- Crackers
- Potatoes
- Low-fat proteins with some salt
- Resume a healthy diet as symptoms improve
Some people find probiotics helpful while recovering from a diarrheal illness. Talk with your healthcare provider if you're unsure whether they're right for you.
When it comes to kids, Dr. Guinto advises:
- As soon as they're able to eat, they can go back to a healthy, age-appropriate diet
- Breast-fed babies can continue nursing to stay hydrated
Foods to avoid when you have cyclosporiasis
Our physicians recommend children and adults stay away from:
- Fried foods
- Greasy foods
- High-fat foods like ice cream or rich desserts
- Spicy foods
- Sugary foods and drinks
- Dairy products
- Caffeinated drinks
Signs you should call your primary care provider
Contact your primary care provider if you have:
- Diarrhea lasting more than several days
- Symptoms that improve and then return
- Concerns about dehydration
- Ongoing symptoms despite home care
When kids should go to the pediatrician
Dr. Guinto recommends contacting a pediatrician for:
- Fever of 104°F or higher with gastrointestinal symptoms
- Diarrhea lasting more than three days
- Recurrent diarrhea
- Bloody diarrhea
- Severe stomach pain
- Signs of dehydration, which may include:
- Dark urine
- No tears when crying
- Sunken eyes
- Sunken soft spot in infants
Children with severe abdominal pain, bloody diarrhea or fever may need emergency care rather than urgent care.
When to go to urgent care
Dr. Campbell recommends going to urgent care if you're experiencing watery diarrhea that:
- Occurs more than three times a day
- Hasn't improved after five to seven days
Urgent care can test for cyclosporiasis and other causes of prolonged diarrhea.
Reserve your spot at urgent care
When to go to the emergency department
Seek immediate attention in the emergency department if you have these signs of a serious diarrheal illness:
- High fever
- Significant abdominal pain
- Bloody diarrhea
- Inability to drink fluids
- Dark urine
- Severe dehydration symptoms
How cyclosporiasis is treated
While some healthy people improve without treatment, healthcare providers may prescribe antibiotics because symptoms can last for weeks and may return. They will typically treat it with an antibiotic called sulfamethoxazole-trimethoprim (Bactrim).
Depending on severity, treatment may also include:
- Replacing lost fluids
- Managing nausea
- Managing abdominal cramping
- Electrolyte replacement
- IV fluids for significant dehydration
What is the difference between cyclosporiasis and Cyclospora?
Cyclosporiasis is the intestinal illness or infection you get from the Cyclospora cayetanensis parasite. People typically become infected by eating food or drinking water contaminated with the parasite rather than directly between people.
Cyclospora cayetanensis is the parasite that gets you sick. It's also referred to as Cyclospora or C. cayetanensis. This microscopic parasite infects the small intestine and can cause diarrhea, stomach cramps, nausea, fatigue and other digestive issues.
Healthcare providers will understand if you refer to the sickness by either name.
Is cyclosporiasis contagious?
No. Direct person-to-person spread is unlikely because the parasite must spend one to two weeks in the environment before it becomes infectious.
Unlike bacteria and viruses, parasites have a more complex life cycle. After the parasite leaves an infected person's body in stool, it is not immediately able to infect someone else. It must spend time usually in soil or water, before it becomes infectious.
How long after I eat contaminated produce does it take to develop symptoms?
Days 0-14 days after exposure
- Usually no symptoms
Around 1 week after exposure
- Watery diarrhea begins
- Cramping, bloating, nausea and fatigue may develop
Weeks 1-4 of the infection
- Symptoms may continue
- Some people feel better for a few days before symptoms return
Weeks to months after exposure
- In some cases, symptoms can linger or recur on and off if the infection is not treated
Can cyclosporiasis go away on its own?
Yes, most healthy people recover without treatment. However, some people have higher risk of needing treatment if they are a young child, an older person, pregnant, immunocompromised or have a chronic condition.
Contact your healthcare provider if symptoms worsen or if you have signs of dehydration.
How long does cyclosporiasis last?
Both Dr. Campbell and Dr. Guinto note that typically the illness lasts for a few weeks. However, for a few people, the symptoms may come and go over a couple of months.
If symptoms continue after antibiotic treatment or keep coming back, follow up with your healthcare provider.
What foods are linked to the Cyclospora parasite?
Past outbreaks have been linked to:
- Lettuce and bagged salad mixes
- Raspberries
- Basil
- Cilantro
- Snow peas
During this outbreak, U.S. Centers for Disease Control and Prevention (CDC) and U.S. Food & Drug Administration (FDA) are currently investigating if the infections are being caused by certain iceberg lettuce products.
Can the parasite live on pre-washed produce or produce that has been canned or frozen?
The parasite may survive in some, but not all, of these forms of preparation:
- Yes, it may still live on pre-washed produce: Contamination typically occurs before produce reaches the grocery store, including when sold as pre-washed
- No, it's unlikely to survive in canned produce: The canning process used for commercially canned foods and home-canned foods is typically much hotter than the minimum needed to kill the Cyclospora parasite
- Yes, it may still live in frozen produce: Produce that's sold in store freezers should not be considered parasite-free because flash freezing is not a guaranteed parasite-killing step
- No, it doesn't survive in well-cooked produce: Cooking food to 158°F (70°C) or warmer will kill the parasite
What is safe to eat?
During this outbreak, Dr. Guinto recommends:
- Choosing fruits that can be peeled
- Cooking herbs and leafy greens to at least 158°F (70°C)
How should I clean my produce? Should I use hot water, brushes or special rinses?
Dr. Guinto notes that Cyclospora is resistant to many common disinfectants. However, washing and cleaning your produce can still reduce the number of parasites and therefore some of your risk of illness.
To reduce your risk while preparing food, CDC and FDA recommend:
- Discarding the outer two to three layers of produce, when possible
- Washing produce under running water
- Washing produce that's labeled pre-washed
- Using a clean produce brush on firm produce such as cucumbers and melons
- Avoiding cross contamination from unwashed produce touching kitchen utensils or counters
Washing alone may not be enough. The most effective way to kill the parasite is to cook food to at least 158°F (70°C).
How can I tell if I have cyclosporiasis, a stomach bug or food poisoning?
"It may be hard to tell the difference between cyclosporiasis and a 'GI bug' like the norovirus," explains Dr. Campbell. However, the timing is longer for cyclosporiasis.
The incubation period, or time from exposure to onset of symptoms, is:
- One to two days for norovirus
- Seven days or more for cyclosporiasis
Depending on the person, the course of illness also varies as it's:
- Typically a few days for norovirus
- From a few weeks up to a month for cyclosporiasis
Thankfully, cyclosporiasis typically isn't as contagious as norovirus because it doesn't spread between humans through contact or surfaces contaminated with fecal matter. Cyclosporiasis also doesn't usually cause vomiting as norovirus does.
How can I or my family stay safe and still have fun at a picnic, summer camp or outdoor festival?
You don't need to skip summer because of the Cyclospora cayetanensis parasite. Following basic food safety and hygiene habits can go a long way toward reducing your risk.
Dr. Guinto recommends:
- Washing hands with soap and water before meals and after using the restroom
- Choosing foods that are cooked to at least 158°F (70°C) and served hot
- Drinking from safe water sources, such as bottled water
- Not using ice when its source is questionable
- Avoiding water activities, including swimming and splash areas if you have diarrhea
Stay informed and safe this summer
The news about this outbreak continues to evolve. However, even if you or a loved one gets sick with cyclosporiasis, it's unlikely to cause long-term issues.
To follow the latest news about this outbreak, including food recalls, our physicians recommend you review CDC's Cyclosporiasis guide and surveillance publication.
Next steps
Concerned you or a loved one may have cyclosporiasis?
Learn more about Jennifer L. Campbell, DO.
Learn more about Hazel Guinto, MD.
Learn more about primary care at Main Line Health.
Learn more about pediatric care at Main Line Health.
Learn more about urgent care at Main Line Health.
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Urgent care vs the emergency department: How to decide quickly
Your guide to summer water safety for kids
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