Health Advisory
SUMMARY:
• A significant increase in the number of reported cyclosporiasis cases have been seen in the National Capital Region (NCR) since mid-June 2019. The Fairfax County Health Department (FCHD) has identified seven confirmed cases since that time; the annual average number of reported cases is two per year (over the past five years).
• A food/water source of the outbreak has not been confirmed; investigation is ongoing. FCHD is working closely with the Virginia Department of Health to determine the source of the outbreak and will share information as it becomes available.
SUGGESTED ACTIONS:
• Healthcare providers should consider Cyclospora for all patients presenting with watery diarrhea. Other symptoms may include abdominal cramps, bloating, fatigue, weight loss and anorexia. Untreated illness may last from several days to more than a month and may be remitting and relapsing.
• Suspected or confirmed Cyclospora cases should be reported to Public Health. Contact the Health Department’s Communicable Disease Section at 703-246-2433 to report a suspected case and for additional guidance on testing and infection control measures.
• Stool specimen tests for ova and parasites usually do not include examination for Cyclospora unless such testing is requested. Similarly, not all gastrointestinal polymerase chain reaction (PCR) panels include a target for Cyclospora. Therefore, when evaluating persons with symptoms consistent with cyclosporiasis, specifically request testing for this parasite. If indicated, stool specimens also should be tested for other pathogens that can cause a similar illness.
• Contact FCHD (phone number above) if commercial lab testing is not available through your practice/facility. FCHD may be able to offer public health laboratory testing.
• Cyclospora oocysts may be shed intermittently and at low levels, even by persons with profuse diarrhea. A single negative stool specimen does not exclude the diagnosis; several specimens, processed and examined with sensitive methods, may be required.
• Trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim, Septra, or Cotrim), is the treatment of choice for Cyclospora. The typical regimen for immunocompetent adults is TMP 160 mg plus SMX 800 mg (one double-strength tablet), orally, twice a day, for 7–10 days. HIV-infected patients may need longer courses of therapy.
• Additional treatment information can be found here: https://www.cdc.gov/parasites/cyclosporiasis/health_professionals/
ADDITIONAL INFORMATION:
Cyclosporiasis occurs often in tropical and subtropical regions. In the United States, foodborne outbreaks of cyclosporiasis have been linked to various types of imported fresh produce, such as raspberries, basil, snow peas, mesclun lettuce, and cilantro; no commercially frozen or canned produce has been implicated to date.
Cyclospora infects the small intestine and typically causes watery diarrhea, with frequent, sometimes explosive, stools. Other common symptoms include loss of appetite, weight loss, abdominal cramping/bloating, increased flatus, nausea, and prolonged fatigue. Vomiting, body aches, low-grade fever, and other flu-like symptoms may be noted. If untreated, the illness may last for a few days to a month or longer and may follow a remitting-relapsing course.
Avoiding food or water that may have been contaminated with feces is the best way to prevent cyclosporiasis.
Consumers and retailers should always follow safe fruit and vegetable handling recommendations as these steps are crucial in preventing communicable disease transmission:
• Wash: Wash hands with soap and warm water before and after handling or preparing fruits and vegetables.
• Prepare: Wash all fruits and vegetables thoroughly under running water before eating, cutting, or cooking. Fruits and vegetables that are labeled "prewashed" do not need to be washed again at home. Scrub firm fruits and vegetables, such as melons and cucumbers, with a clean produce brush. Cut away any damaged or bruised areas on fruits and vegetables before preparing and eating.
• Store: Refrigerate cut, peeled, or cooked fruits and vegetables as soon as possible, or within 2 hours. Store fruits and vegetables away from raw meat, poultry, and seafood.