Cyclosporiasis, the ‘Explosive Diarrhea Disease,’ Is Still With Us

By now, we’ve all heard of cyclosporiasis, the infection that can cause bouts of intense diarrhea along with body aches, fatigue, nausea, and perhaps a low-grade fever. Infectious diseases expert Eric Sachinwalla, MD, with Jefferson Health, says that after consultation with Philadelphia’s Department of Public Health, there are not a lot of cases of cyclosporiasis in our region, including the Lehigh Valley. 

However, the illness does happen, with clinicians noting they are always aware of “normal” outbreaks.

The illness comes from the Cyclospora parasite, an organism that lives in soil and contaminates soil and water sources. It must spend time in the soil maturing before it becomes dangerous. It’s logical that the organism can then make its way from the soil to produce grown on farms and in gardens. 

“When we eat the produce, we can become infected,” Dr. Sachinwalla says. “In your body, it doesn’t just live inside, it invades the cells.”

While the latest reports link cyclosporiasis to lettuce, Dr. Sachinwalla says continuing to eat lettuce and salads is a personal decision. But he advises treating them differently.

“If you’re buying greens from the grocery store, wash them yourself – even if they’re labeled ‘prewashed’ – and wash them aggressively,” he says. “The organism is hardy and hard to kill. That’s why it causes these outbreaks. In my personal life, I’m being more meticulous about how I’m washing produce.” 

Even if you grow your own, you should be on alert. “It’s a lot safer when you know where the greens come from and what you’ve put on them,” Dr. Sachinwalla says, “but Cyclospora is environmental. So, wash your produce aggressively regardless.” 

According to the Centers for Disease Control and Prevention, cooking produce to 158-degrees Fahrenheit can kill the Cyclospora parasite.

It can be challenging to tell whether a case of diarrhea is caused by the Cyclospora parasite. One clue is that parasite-causing diarrhea can last up to a week or more versus one to two days. Dr. Sachinwalla says if you’re in our region and having diarrhea, don’t jump to a Cyclospora conclusion. But if you have watery diarrhea that lasts for more than a few days, it's best to consult your primary care clinician.

Testing for cyclosporiasis requires a stool specimen. The sample is either examined under a microscope or the DNA is tested. Patients must visit their clinician because there is no home test. Standard treatment of the disease involves a seven- to 10-day regimen of a particular antibiotic (sulfamethoxazole/trimethoprim).

Cyclosporiasis is not necessarily worse in children than adults. The main concern is that younger children are more vulnerable to dehydration from diarrhea, and anyone with a weakened immune system, children included, may experience more prolonged or severe illness.

“The first step if a parent suspects cyclosporiasis is to ensure their child remains hydrated with fluids or oral rehydration solution,” says pediatric infectious diseases specialist Hina Zaidi, MD, with LVPG Pediatric Infectious Diseases–1210 Cedar Crest. “If there are any concerns for dehydration, prolonged diarrhea, bloody stools, or persistent vomiting, the child's parents should notify their pediatrician and seek medical care as soon as possible.” 

Treatment for adults is similar. “If you’re having diarrhea from any cause, make sure you’re hydrated,” Dr. Sachinwalla says. “If you’re getting headaches or not urinating much, you’re behind on fluids, so just maintain hydration throughout the day.”

Both doctors say that anyone having worrisome signs of possible cyclosporiasis should contact their clinician for next steps.