New York City clinicians should be on the alert for patients with diarrhea due to Cyclospora infection. We have noted an increase in 2019 compared to previous years. Over 90 cases have been reported between January 1 – July 15, 2019 compared to 56 cases in 2018, and 43 cases in 2017 during the same time period. Since July 1, 2019 alone there have been 40 cases diagnosed and reported to the NYC Health Department. Approximately 30% of patients have reported travel outside of the United States in the two weeks prior to symptom onset, primarily to Latin America. Epidemiologic investigations are ongoing to determine if there is a possible common food source for cases with no travel outside of NYC. Additionally, we are confident that increasing use of syndromic multiplex PCR diagnostic panels is leading to identification of disease that would have previously been overlooked.

Cyclospora is a coccidian parasite that causes watery diarrhea, nausea, loss of appetite, abdominal cramping and fatigue. Untreated, diarrhea and other symptoms may persist for weeks. Diarrhea may become intermittent and other symptoms may predominate. People become infected by ingesting food or water contaminated with fecal matter.

Person-to-person transmission does not occur, because the parasite requires time (days to weeks) after it is excreted to sporulate in the environment before it is infectious again.

The incubation period is approximately 1 week, but can range from 2 – 14 days or more.

People living or traveling in tropical or subtropical regions of the world may be at risk due to endemic cyclosporiasis. In the United States, prior foodborne outbreaks of cyclosporiasis have been linked to various types of imported fresh produce (including raspberries, lettuce, and cilantro).

Diagnosis: If patients present to you with persistent watery diarrhea (more than 5 days) and/or abdominal cramping, nausea, anorexia, or fatigue, please consider Cyclospora as a possible cause. Routine ova and parasite tests usually do not include examination for Cyclospora. When ordering stool microscopy, please specifically request testing for Cyclospora. When ordering a GI syndromic multiplex panel, please confirm that Cyclospora is part of the panel.

Treatment: Treatment with trimethoprim-sulfamethoxazole (also known as Bactrim®, Septra®, or Cotrim®) is recommended.

Laboratory Testing: Laboratory diagnosis of Cyclospora may be aided by staining with modified acid-fast or modified safranin techniques. The cell wall of Cyclospora oocysts are auto fluorescent (blue-green) and detecting oocysts in stool may be helped by viewing samples under an ultraviolet microscope. Most laboratories require that a health care provider specifically request testing for Cyclospora when submitting stool for laboratory diagnosis. When ordering stool microscopy, please specifically request testing for Cyclospora. When ordering a GI syndromic multiplex (PCR) panel (e.g., Biofire®), please confirm that Cyclospora is part of the panel. Send positive specimens directly to the New York State Wadsworth Center Laboratory – Parasitology Laboratory for confirmation of testing. Samples should be submitted in Cary-Blair or an ethanol-based preservative.

Cyclospora:   Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Cyclospora outbreaks. The Cyclospora Attorneys and Lawyershave represented victims of Cyclospora and other foodborne illness outbreaks and have recovered over $650 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.

If you or a family member became ill with a Cyclospora infection after consuming food and you are interested in pursuing a legal claim, contact the Marler Clark Hepatitis A attorneys for a free case evaluation.