We spoke with Dr. Amy Beth Kressel, system level medical director, Infection Prevention, Parkview Health, about the parasite making headlines in the Midwest.
What is cyclosporiasis?
Cyclosporiasis is a parasite that seems to only to infect humans, though it does not have a direct human-to-human transmission. Not a whole lot is known about it, other than it has a pretty complex life cycle.
This parasite is not spread through infected stool. When the parasite is present in a person’s stool, that means that the parasite got into that environment. And it’s only after being in the environment for a while that the parasite can become active and infect people.
So, if the environment (e.g. a food source) is contaminated and someone eats that food, that’s how they get exposed.
Does this parasite need warm weather to fully develop?
When the weather gets warmer, the parasite can go through its full life cycle and become infectious.
Is this a parasite that we've dealt with in previous years?
Yes. It's a recently identified parasite, but it came on the scene with a big outbreak through fresh raspberries and has been sporadically found in the United States more often in the warmer summer months. Usually, you don't get big outbreaks, but rather, small, sporadic cases.
Which foods carry cyclosporiasis?
Fresh produce such as:
- Raspberries
- Cilantro
- Basil
- Salad mixes
What symptoms are you seeing with cyclosporiasis?
People are experiencing watery, sometimes explosive, diarrhea. They describe acute onset, like they must run to the restroom or being unable to control it.
Most people with a healthy immune system will have what we call self-limited symptoms. But symptoms can persist and recur if people don't get antibiotic treatment.
Is there a population at a greater risk?
Anybody can get symptoms, but those with a compromised immune system are going to have a harder time fighting this parasite. They are also likely to get dehydrated and get into trouble.
What are some precautions that people can take?
It might not be a bad idea for people with severe immunocompromise to avoid fresh produce right now. And the reason I say that is although there are recommendations to wash fresh produce, there can be errors in how you do that. We also don’t know the exact source of the outbreak.
If you do want to eat fresh produce, here are some recommendations:
- Wash your hands before and after handling any fresh produce in case there's any soil residue on your hands. You don't want to cross-contaminate anything else in your kitchen or yourself.
- Take off any outer layers. So, if we have a head of lettuce, you can peel off the outer layers, cut the stem, throw all that away. With green onions or scallions, peel off the outer layers, cut off the root.
- Wash produce. If something has a peel, it's recommended to wash the peel before eating it.
- If you have a melon or something with a hard surface, you can really scrub that surface with a brush.
- Anything that's bruised you should cut off, because the parasite might get into the bruised area. Don’t even try washing it.
Just be really cautious if you're eating fresh produce. Until we figure out what's going on with this high number of cases and rapidly increasing rate, it’s best to be extra careful.
Where are the largest areas of concern?
Michigan seems to be a hotspot. There's been a lot of increased activity there, but it may be that they just picked it up sooner than everybody else.
I can say we're seeing people with explosive diarrhea here, in Indiana. We don't know yet if it's cyclospora. The tests that are commonly run for infectious diarrhea do not pick up cyclospora, so you have to order special tests. And if people don't know to order the test because they don't know that cyclospora is around, you're going to miss those early cases. So I think we must assume that we have are an undercount.
I think that the numbers are going to increase because now physicians are aware of what's going on, and they're going to be ordering the special cyclospora tests. I don't think we have the full scope of what's going on yet.
And I should point out that we don't know the source of this, and we officially don't know if all these cases are related. But it seems likely, given the rapid rise in cases, that there must be some common exposure that we need to identify.
How is cyclosporiasis treated?
There are antibiotics that are recommended. The other important thing is hydration. Taking plenty of fluids and oral rehydration solutions can help you from getting dehydrated.
How are you tracking cases?
We have some internal data and other tools specific to our medical record in our system. We can contact our testing partners and our electronic medical record company, and they can give us an idea of trends.
If you have symptoms consistent with cyclosporiasis, seek medical care quickly to ensure further complications.
