A stomach bug that has caused an outbreak spanning more than 40 states is on the rise in Dallas, too, with dozens of cases reported across North Texas and thousands nationwide.
Cyclosporiasis, or cyclospora, is an intestinal infection caused by a microscopic parasite found on fresh produce or in contaminated water.
“Most people with symptoms will have bloating and sometimes explosive diarrhea,” says Leslie Cler, MD, FACP, CPE, internal medicine specialist on the medical staff at Methodist Southlake Medical Center. “While many untreated people recover on their own, some develop chronic diarrhea that may even improve and worsen almost cyclically.”
The one-cell parasite causes infections every summer, but this year’s outbreak is the worst in a decade, and its origins remain unclear, Dr. Cler says.
“Health officials in Michigan are pointing to lettuce or salad greens,” he says of the state hardest hit by the outbreak. “It can be challenging to track because symptoms develop roughly a week after exposure.”
Dr. Cler shares what to watch out for and how to protect yourself from getting sick.
Vulnerable patients should see a doctor, especially if diarrhea persists for more than a week.
THE SYMPTOMS
Diarrhea is the primary symptom of a cyclospora infection, but there are other warning signs to set it apart from a more run-of-the-mill stomach virus:
- Bloating and diarrhea that can last two weeks or longer
- Vomiting may be present in about a quarter of cases
- Fever and chills in about half of infected patients
“Fever can also help distinguish a more serious illness,” Dr. Cler says, “especially if it’s persistent for several days without an identified cause. Viruses rarely cause diarrhea for more than seven days, and most run their course in one to three days.”
That’s why Dr. Cler suggests seeing a doctor if the symptoms last more than a week, especially if it’s difficult to stay hydrated or fully digest meals without another trip to the bathroom.
“People with impaired immune systems and anyone with challenges to keeping enough fluids in their bodies need special attention,” he says.
Raspberries are hard to wash, so play it safe and throw them out or cook them for preserves.
PROTECT YOURSELF
Cyclospora spreads when people consume food or water contaminated with feces containing the one-celled parasite.
“Washing fresh produce under running water is a good idea,” Dr. Cler says, “as is avoiding bagged salad while this seasonal outbreak is present.”
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He suggests buying lettuce by the head, removing the outer leaves, and washing the rest thoroughly. Other produce may also be risky:
- Green onions — cut off the roots, remove the outer layer and wash the rest.
- Basil and cilantro — submerge in cold water, swish, and repeat until the water is clear.
- Sugar snap and snow peas — rinse in a colander and remove the ends of sugar snaps.
- Raspberries — maybe the hardest to clean because of all the nooks and crannies
“Cooking raspberries instead of eating them raw is maybe best if people are concerned,” Dr. Cler says. “In addition, cooking to 160 degrees is a simple approach to killing cyclospora and other foodborne pathogens.”
It’s also possible to catch cyclospora by swimming in contaminated pools or playing on splash pads because the parasite can live for extended periods and is notoriously resistant to chlorine and bleach.
“Some people have said vinegar can kill this parasite, but that is not effective,” Dr. Cler says. “Hand sanitizer also does not kill it, although soap and water remain simple and effective.”
Person-to-person transmission is unlikely because it takes one to two weeks for Cyclospora to become infectious after it’s passed in a bowel movement.
Stay hydrated as much as possible by sipping water or an electrolyte solution like Pedialyte.
HOW IT’S TREATED
Most people who contract a case of cyclosporiasis can safely treat the infection at home. And like most illnesses of its kind, staying hydrated is key, Dr. Cler says.
“The best thing to drink is Pedialyte or a generic version rather than a sports drink,” he recommends. “Sip slowly every 5–10 minutes to match thirst and losses. And always wash your hands with soap and water.”
Managing the symptoms with over-the-counter medications like Imodium or Pepto-Bismol may also help, but Dr. Cler warns against using them for more than 48 hours
“If symptoms are severe, any bleeding is suspected, or any fever is present, it is probably best not to take those medications and see a doctor instead,” he says.
In some cases, a doctor may request a stool sample and send it to a lab for testing. If the test returns positive, an antibiotic may be prescribed.
“For people who are found to have cyclospora, an antibiotic called Bactrim is generally recommended,” Dr. Cler says.
Left untreated, the chronic diarrhea the infection can cause could linger for months, so play it safe and see a doctor, especially with cases at their highest level in years.
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