Cyclospora

Fact sheet on Cyclospora

What is Cyclospora?

Cyclospora cayetanensis is a parasite (germ) that can infect the intestines and make people sick with diarrhea.  People get infected from eating food or water that has been contaminated with the parasite. Cyclospora infection is called cyclosporiasis. 

What are the symptoms of cyclosporiasis?

The most common symptom is watery diarrhea. Other symptoms can include weight loss, bloating, lots of gas, cramps, nausea, vomiting, being tired, sore muscles, fever, and not feeling hungry. These symptoms can also be caused by many other diseases. Some people who become infected with Cyclospora may not get symptoms. Sometimes people who seem to be getting better may get sick again (relapse). For most people, the diarrhea will last for  a few days, but if not treated, some people can be sick for several weeks. It usually takes about one week to get sick after you have eaten a food with Cyclospora, though it can range from 2 to 14 days. 

How is Cyclospora spread?

The parasite is spread when people eat food or water that has come into contact with infected feces (stool).  This can happen when contaminated water is used to grow produce which is more common in areas with inadequate sanitation infrastructure. Cyclospora germs need 1-2 weeks in the environment (outside the body) to become infectious after being passed in a bowel movement. Because of this, Cyclospora is unlikely to be spread directly from person to person. 

Where does Cyclospora occur?

The Cyclospora organism is not common in the US environment and is more often found in tropical areas. Cases of cyclosporiasis in the US are often associated with international travel and exposure abroad. 

People without any travel can also get sick with Cyclospora from eating fresh, uncooked produce that has been contaminated.  Contaminated produce is often imported from a country where Cyclospora is more common, but there have been outbreaks with produce grown in the US.  Cyclosporiasis acquired in the US most commonly occurs between May and August.

What kind of foods are likely to have Cyclospora?

In the United States, foodborne outbreaks of cyclosporiasis have been linked to fresh produce, including raspberries, cabbage, basil, cilantro, parsley, broccoli, snow peas, sugar snap peas, and leafy greens. 

How is cyclosporiasis diagnosed and treated?

If you think you have cyclosporiasis, you should see your healthcare provider. Your healthcare provider can take a stool sample and send it to a laboratory for testing. Testing for Cyclospora is not always included in testing for the cause of diarrhea. Healthcare providers may need to specifically request testing for this parasite. 

Cyclospora can be treated with antibiotics. If you have diarrhea, you should rest and drink plenty of clear fluids. Do not take any medicine until asking your healthcare provider about it. People who have already had a Cyclospora infection can get it again.

Are there any restrictions for people infected with Cyclospora?

Yes. In order to protect the public, foodhandlers who have Cyclospora in their stool, must stay out of work until their symptoms have resolved. 

Health care providers are required by law to report cases of cyclosporiasis to the local board of health. 

How do public health officials in Massachusetts investigate Cyclospora?

Massachusetts residents who submit a stool specimen to their healthcare provider and test positive for Cyclospora are reported to local and state public health officials.  Public health officials investigate reported cases of Cyclospora by calling each case to ask a standard set of questions about fresh produce they ate during the 14 days before they got sick. DPH epidemiologists review data on an ongoing basis across Massachusetts looking for clusters of people with cyclosporiasis reporting a common exposure.  Food exposures reported by cases are reported to CDC to help detect national outbreaks.

How can cyclosporiasis be prevented?

When traveling outside of the United States, especially in tropical and subtropical regions with minimal water treatment and sanitation systems, reduce the risk of Cyclospora by avoiding tap water, fountain drinks, ice, and raw foods like fresh produce.

In the U.S., monitor reports from DPH, FDA, and CDC for announcements regarding specific foods that are linked to Cyclospora outbreaks that consumers should avoid.

Consider the following when consuming fresh produce during the summer:

• Wash hands with soap and water for at least 20 seconds before and after handling or preparing raw fruits and vegetables.
• Rinse fresh produce under clear running water, even if it is labeled as pre-washed.  Do not use soap or bleach to rinse produce. Rinsing is an important first step but does not reliably eliminate the parasite.
• Discard the outer layer of fruits and vegetables when possible. Peel produce like cucumbers and remove two to three of the outer layers of leafy greens like heads of lettuce.  Produce that can be peeled should be washed first.  
• Use a clean vegetable brush to scrub firm produce like melons and cucumbers.  Cut away damaged or bruised areas before preparing and eating.
• For any produce that can be cooked, cook to a temperature of at least 158°F (70°C). Cyclospora cannot survive at these elevated temperatures.
• Avoid cross-contamination by cleaning kitchen counter tops, cutting boards, and utensils with hot, soapy water after contact with fresh produce.
• Refrigerate cut, peeled, or cooked fruits and vegetables as soon as possible, and within two hours of preparation.

How many cases of Cyclospora are reported in Massachusetts?

The number of Cyclospora cases reported in Massachusetts are published monthly to the foodborne and waterborne illness data webpage.  

Where can I get more information?

• For questions about your own health, contact your doctor, nurse, or clinic
• Call the Massachusetts Department of Public Health Division of Epidemiology at [phone]
• Visit the Centers for Disease Control and Prevention (CDC) cyclosporiasis webpage
• Visit the Food and Drug Association (FDA) Cyclospora webpage