Cyclospora infection (cyclosporiasis) is a serious condition caused by microscopic parasites that usually results in watery, frequent diarrhea, stomach cramps, fatigue, and fever. Most individuals acquire the infection after eating food or drinking water contaminated with the parasite. Cyclospora infections tend to occur in tropical countries or are acquired after consuming imported foods that are laced with the parasitic organism.
The diarrheal illness can occur in individuals of any age. While recent outbreaks occurring in America are associated with fresh produce, especially lettuce and raspberries, spreading through human contact is unlikely. Usually, the first symptoms tend to appear after a one-week incubation period.
This infection is often misdiagnosed because the symptoms mimic many other types of viral and bacterial infections. Because of that, it requires a specific stool test to accurately diagnose the condition to ensure the patient receives the appropriate treatment (usually an antibiotic) and follow specific food safety precautions to a limited further exposure to the disease.
- Who Is at Risk for Cyclospora Infection?
- Common Symptoms
- Diagnosing Cyclospora Infection
- Treating the Condition
- Preventing Cyclosporiasis
Who Is at Risk for Cyclospora Infection?
Cyclospora infection parasites are not contagious between individuals. Those most at risk for contracting a Cyclospora infection include individuals who have traveled to a developing country or ingested contaminated water and food containing the parasitic organism that was purchased locally. However, the onset of the infection can take days or weeks after exposure or ingestion of Cyclospora cayetanensis, the one-cell parasite that causes the infection.
The numbers of cyclospora infection cases in the United States were sporadic prior upto the 1990s and involved individuals who would travel to a developing country, suffered from HIV or had another condition involving a weakened immune system. However, in the last few decades, many imported produce products including raspberry, fresh basil, and lettuce have found to be the root cause of many of the Cyclospora infection outbreaks occurring in northern America, especially in Canada and the United States.
Prolonged bouts of diarrheal episodes caused by ineffective treatments of Cyclospora infection can lead to serious dehydration in the body. While this can usually be overcome by drinking more than normal amounts of fluids, some individuals will require hospitalization to receive fluids intravenously to eliminate the potentially serious side effects of severe dehydration. Those most at risk of the complications associated with Cyclospora infections include:
- Individuals suffering from other serious illnesses and conditions
- The elderly
- Young children
Not every individual infected with Cyclospora cayetanensis will ever develop a noticeable symptom or show any signs of the condition. However, those that do express symptoms usually notice the initial signs of the infection between 2 to 11 days after drinking water or consuming food contaminated with the parasitic organism. The most common Cyclospora infection symptoms involve:
- Watery, frequent diarrheal episodes
- Stomach cramps
- Unexpected weight-loss
- Loss of appetite
- Increased gas – flatulence
- Severe episodes of constipation followed by episodes of diarrhea
- Achy muscles
- Malaise – the sense of feeling unwell
- Long-lasting fatigue
Some individuals experience bouts of diarrhea that lasts for weeks, which can lead to dehydration and/or malnutrition. This includes individuals suffering from HIV (human immunodeficiency virus) or other conditions that compromise the body's immune system. Without appropriate treatment, the infection can continue to cause debilitating symptoms for months and eventually lead to significant life-threatening problems involving gastrointestinal issues. Excessive dehydration can cause various problems in the body including:
- Sunken eyes
- The inability to produce tears
- Dry tongue
- Dry mouth
- Decreasing urine output
Diagnosing Cyclospora Infection
To date, medical science has yet to develop a blood test that can accurately diagnose cyclosporiasis. Additionally, Cyclosporiasis (Cyclospora infection) is often misdiagnosed because the signs and symptoms mimic other gastrointestinal problems. Usually, the doctor will order specific laboratory tests that can identify the parasitic organism found in the patient's stool.
To ensure the organism is caught during the diagnostic process, the doctor may order stool specimens taken from different days. This is because the excessive bouts of diarrhea up to make a difficult to obtain stool that contains enough of the parasitic organisms to be detected under a microscope. In addition to checking the stool for the Cyclospora cayetanensis parasite, the test might also identify other harmful organisms known to produce similar symptoms in the body.
The doctor will also obtain a comprehensive personal medical history to discuss any recent trips to developing countries that are known to increase the risk of acquiring the infectious parasite. Further evaluation may be required through an infectious disease physician or gastroenterologist
Treating the Condition
Many cases of Cyclospora infection are asymptomatic (never display symptoms) and will cure itself without treatment. However, when treatment is required, the doctor will likely prescribe trimethoprim-sulfamethoxazole, as an oral treatment that lasts up to ten days. Typically, the doctor will order an additional follow-up stool examination after the first round of drug treatment to determine if more treatment is necessary to kill off the parasitic organism.
Alternative treatments include nitazoxanide or ciprofloxacin work well in older patients. Some of these medications for treating cyclosporiasis are not approved before and during pregnancy.
With appropriate treatment, an infection involving Cyclospora cayetanensis parasitic organisms can be cured. Prescribing the right antibiotics for individuals showing the common symptoms and signs associated with the infection can ensure a hasty recovery. However, individual suffering from HIV (human immunodeficiency virus) may experience a relapse or recurrence after successfully resolving the symptoms.
Preventing Cyclospora Infections
Individuals can follow specific food safety practices as an effective solution for preventing many infections, including cyclosporiasis and other contagions involving food and waterborne contaminants. Food and water safety is crucial when traveling in any area or sanitation practices are uncertain. Doctors will recommend washing hands using certified pure water and disinfecting (alcohol-formulated) hand sanitizing prior to consuming any food or water.
Scientists also recommend cooking food until it is steaming hot and avoiding raw or uncooked fruits and vegetables that might be contaminated with Cyclospora cayetanensis. However, and third world (developing) countries, many bottling companies will refill empty water bottles using tap water and reseal the bottle cap using glue. Use only filtered water that has been labeled safe because particles and cysts measuring 1 millionth of the meter (one micron) or larger have been removed (filtered) out. Avoid consuming any foods in their raw state including salad greens, salsas, and fruit whenever visiting a developing country.
It is important to note that acquiring Cyclospora infection can still occur within the United States, especially when handling raw fruits and vegetables that have been grown outside America. Using food safety measures at home when handling packaged raw fruits and vegetables including bags of chop salad is essential to minimizing the potential of acquiring cyclosporiasis.
It is important to note that no known vaccine is available for preventing the infection. In addition, acquiring the bacterial parasite does not provide immunity from further outbreaks if contaminated food or water is ingested at any time in the future after the initial outbreak. That said, it is highly unlikely that the infection can be directly passed between individuals, especially if proper food and water safety precautions have been taken.