If your child has had watery diarrhea that just doesn’t seem to be going away, especially after traveling or during the warmer months, a parasite called Cyclospora could be the cause.
Cyclospora can spread through contaminated food or water and is often linked to fresh fruits and vegetables. In otherwise healthy children, the infection may eventually clear up on its own, but symptoms can last for several weeks without treatment.
So, what should parents know about cyclosporiasis? Let’s take a closer look at the symptoms to watch for, how the infection spreads, and when it’s time to call your child’s pediatrician.
Outbreak in the US
Health officials are currently investigating several outbreaks of cyclosporiasis in the United States. As of July 13, the Centers for Disease Control and Prevention (CDC) had reported 1,645 confirmed cases across 34 states.
One multistate outbreak affected people in Michigan, Ohio, Indiana, Kentucky, and West Virginia. Investigators linked that outbreak to contaminated shredded iceberg lettuce distributed by Taylor Farms de Mexico and served at Taco Bell restaurants.
While health officials continue to investigate, families can help lower their risk of foodborne illness by following recommended food-safety practices when handling and preparing fresh produce. If your child develops symptoms that could be caused by cyclosporiasis, contact your child’s pediatrician.
What is Cyclosporiasis?
Cyclosporiasis is an intestinal infection caused by a tiny parasite called Cyclospora cayetanensis. People can become infected by eating or drinking something contaminated with the parasite. Fresh produce—including herbs, berries, lettuce, and other vegetables—has been linked to outbreaks.
The parasite’s eggs, called oocysts, need time outside the body to mature before they can cause an infection. Because of this, cyclosporiasis usually does not spread directly from one person to another.
After someone swallows mature parasite eggs, they travel to the small intestine. There, the parasites leave the eggs and infect the cells lining the intestine, which can lead to illness.
The parasites can then produce new eggs, which leave the body in stool. Once those eggs mature in the environment, the cycle can begin again.
Symptoms
The most common symptom of cyclosporiasis is watery diarrhea. It may be severe, and symptoms can sometimes improve before coming back again.
Other possible symptoms include:
- Decreased appetite
- Nausea
- Stomach cramps
- Bloating
- Increased gas
- Fatigue or low energy
- Weight loss
- Low-grade fever
- Vomiting
- Headache
- Muscle or body aches
For some children, symptoms may come and go over several days or weeks. Without treatment, cyclosporiasis can sometimes last for weeks or even months.
Some people infected with Cyclospora do not have any symptoms at all. However, they may still pass the parasite’s eggs in their stool, which can help spread the infection and contribute to ongoing outbreaks.
How do Kids Get It?
Children can develop cyclosporiasis after eating or drinking something contaminated with the Cyclospora parasite.
Common sources may include:
- Fresh fruits and vegetables
- Fresh herbs, such as basil or cilantro
- Contaminated drinking water
- Food prepared with contaminated water
Many cyclosporiasis outbreaks in North America have been linked to fresh produce imported from other countries. Children may also be at increased risk of infection when traveling to places where cyclosporiasis is more common.
Can it Spread Person-to-Person?
Usually, no. Although the parasite leaves the body in stool, it needs time—typically about 1 to 2 weeks in the environment—before it can infect someone else.
This means a person with cyclosporiasis is not usually directly contagious to others. However, parasite eggs passed in stool can eventually become infectious and contaminate food or water, which can then spread the infection to other people.
When Do Symptoms Begin?
Symptoms of cyclosporiasis usually begin about 1 week after a person is exposed to the parasite. However, symptoms can sometimes start as soon as 2 days after exposure or not appear for 2 weeks or longer.
Because there can be a delay between exposure and the start of symptoms, it is often difficult to determine exactly which food or water source caused the infection.
Cyclosporiasis v. Stomach Bug
Many stomach and intestinal infections improve within a few days, but cyclosporiasis can follow a different pattern. Children may experience watery diarrhea, bloating, and fatigue that continue for weeks. Sometimes, symptoms may improve for a while and then return.
This pattern of long-lasting or recurring symptoms can be an important clue that cyclosporiasis may be the cause.
Diagnosis
Your child’s pediatrician may consider cyclosporiasis based on their symptoms, recent travel, and possible exposure to contaminated food or water.
To confirm the diagnosis, your child’s healthcare provider will usually need to test a stool sample for the Cyclospora parasite. Because the parasite can sometimes be difficult to detect, special laboratory testing may be needed. More than one stool sample may also be necessary.
Some laboratories use molecular tests that can check for Cyclospora along with other germs that can cause infectious diarrhea.
Treatment
The usual treatment for cyclosporiasis is an antibiotic called trimethoprim-sulfamethoxazole (TMP-SMX). Treatment typically lasts about 7 to 10 days, although children with weakened immune systems may need treatment for a longer period of time.
If your child cannot take sulfa medications, talk with their pediatrician about other possible treatment options. There are fewer alternatives that work well against Cyclospora, but a healthcare provider can help determine the best approach.
Because diarrhea can lead to dehydration, be sure your child drinks plenty of fluids while they are sick. Your child’s pediatrician can also provide guidance on how to help replace lost fluids and prevent dehydration.
When to Call Your Pediatrician
Contact your child’s pediatrician if your child has:
- Diarrhea that lasts more than a few days
- Severe or ongoing watery diarrhea
- Signs of dehydration
- Unexplained weight loss
- Blood in the stool
- Vomiting that does not improve
- A fever along with diarrhea
- Symptoms that improve but later return
Seek urgent medical care if your child shows signs of severe dehydration, is difficult to wake, or cannot keep fluids down.
Children with High Risk
Most otherwise healthy children recover fully from cyclosporiasis. However, the infection can sometimes be more serious or last longer in children with certain medical conditions or weakened immune systems.
This may include children who:
- Have cancer
- Have received an organ transplant
- Take medications that suppress the immune system
- Have certain conditions that affect the immune system
These children may need closer monitoring and additional medical care while they are sick. If your child has a weakened immune system, talk with their healthcare provider about what to watch for if they develop symptoms of cyclosporiasis.
Prevention
There is currently no vaccine to prevent cyclosporiasis. However, there are several simple steps families can take to help reduce the risk of infection.
Although there is no vaccine to prevent cyclosporiasis, families can take several steps to reduce the risk of infection—especially when traveling or preparing fresh produce.
Use safe water. Drink water from a safe, reliable source, especially when traveling. Avoid food or water that may have been contaminated with stool.
Wash your hands and keep kitchen surfaces clean. Wash your hands thoroughly with soap and water before preparing or eating food. Clean countertops, cutting boards, utensils, and other kitchen surfaces with hot, soapy water to help prevent cross-contamination. Following general food-safety recommendations is also important.
During the typical Cyclospora season, which runs from May 1 through August 31, federal health officials recommend taking extra care when preparing fresh fruits and vegetables:
- Rinse fresh fruits and vegetables thoroughly under clean, running water before eating, cutting, peeling, or cooking them—even if the package says they are pre-washed.
- Scrub firm produce, such as melons and cucumbers, with a clean produce brush.
- Cut away bruised or damaged areas before preparing or eating produce. When possible, remove and discard the outer layers of fruits and vegetables. For leafy greens, this may mean discarding the outer 2 to 3 layers.
- Refrigerate cut, peeled, or cooked fruits and vegetables within 2 hours.
- Cooking produce to an internal temperature of at least 158°F (70°C) is the safest option when possible. Even careful washing may not completely remove Cyclospora.
Remember
Cyclosporiasis can cause watery diarrhea, stomach cramps, fatigue, and weight loss in children. Because symptoms may last for weeks or improve and then come back, it’s important to contact your child’s pediatrician if diarrhea is not getting better.
Getting the right diagnosis and treatment can help your child start feeling better and recover more quickly.