Cyclosporiasis: Information for health care providers

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To: Local Health System Partners

Background

• A cyclosporiasis outbreak is currently under investigation in the United States. Travellers to the United States can reduce their risk of cyclosporiasis by washing their hands before eating and after handling fresh produce, washing fruits and vegetables before eating, cutting, or cooking them, and avoiding lettuce.
• Ontario sees approximately 350 infections per year, concentrated around the summer months. There has been no increase in cyclosporiasis infections within Sudbury and Districts.

Clinical presentation

• Cyclosporiasis is a parasitic gastrointestinal infection caused by Cyclospora cayetanensis.
• Infection occurs following consumption of contaminated water or food. There is no direct person-to-person transmission.
• Its incubation period is approximately 7 days (ranging from 2 to 14 days).
• Symptoms include frequent watery diarrhea, loss of appetite, weight loss, abdominal bloating and cramping, increased flatulence, nausea, and fatigue. A fever is uncommon.
• Infection is usually self-limiting, but symptoms may relapse or persist for up to a few months, if untreated.

Testing

• An infection is confirmed via microscopic demonstration of oocysts or molecular methods. Appropriate samples include fresh or iodine-preserved stool, duodenal aspirates, and small bowel biopsies.
• Cyclospora subtyping is routinely performed on all unpreserved specimens positive for cyclospora in Ontario.
• All infections identified on preserved specimens should undergo repeat collection using unpreserved specimens as soon as possible to assist in public health investigations. Please refer to Public Health Ontario for more information on cyclospora subtyping (Public Health Ontario).

Treatment

Treatment for cyclosporiasis consists of rehydration therapy and Trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 mg PO BID for 7 days. Patients with immunosuppression may need a longer course.

Reporting to Public Health

Laboratory-confirmed cyclosporiasis, identified by stool microscopy or PCR, should be reported to Public Health by faxing or emailing the communicable disease notification form (PDF, 210 KB) to 705.677.9618 or HPT_Fax_Confidential@phsd.ca.

Sincerely,

Original Signed By

Emily Groot, MD, MPH, FRCPC
Associate Medical Officer of Health