Health Care Provider Information on Cyclosporiasis

Required Disease Reporting

• Reporting Cyclosporiasis
  Health care providers and clinical laboratories are required to report cases and suspect cases to the Minnesota Department of Health.
• Illness-related Restrictions for Food Workers and for Children or Staff in a Child Care or Preschool Setting
  Although Cyclospora is not spread directly from person-to-person, cases with diarrhea are still subject to restriction on child care/preschool attendance and food handling until they are 24 hours diarrhea free.

Parasite Information

• Cyclosporiasis (Cyclospora Infection) Parasite Biology
  CDC website about Cyclospora.

Clinical Features

• Infection with Cyclospora results in a range of manifestations, from asymptomatic infections, typically among individuals living in endemic regions, to a prolonged diarrheal illness.
• Watery diarrhea is the most frequent symptom and can be accompanied by abdominal cramps, bloating, nausea, loss of appetite, weight loss, vomiting, low-grade fever, and prolonged fatigue.
• Without treatment, symptoms can persist for a few days to a month or longer and may follow a remitting-relapsing course.
• If symptoms are properly managed, cyclosporiasis rarely results in hospitalization.

Laboratory Diagnosis

• Cyclosporiasis is diagnosed by examining stool specimens. Diagnosis may be difficult because even symptomatic individuals can shed oocysts at low levels that are not readily detected by laboratory examination. Multiple specimens, collected on different days, may be needed.
• Testing for Cyclospora is not routinely conducted on stool specimens and not all gastrointestinal polymerase chain reaction (PCR) panels include a target for Cyclospora. Health care providers should specifically request testing for Cyclospora if indicated.
• Submission of clinical materials from positive Cyclospora specimens to the Minnesota Department of Health Laboratory (MDH PHL) is required in accordance with state communicable disease rules. Additional testing of these submitted materials is performed at the MDH PHL with the results being used to aid public health surveillance.
• Parasites – Cyclosporiasis (Cyclospora Infection) – Diagnosis of Cyclosporiasis
  CDC; Information for health care providers about diagnosis of cyclosporiasis.
• DPDx – Laboratory Identification of Parasitic Diseases of Public Health Concern: Stool Specimens
  CDC; Information about diagnostic procedures for stool specimens.

Treatment

• Trimethoprim/sulfamethoxazole (TMP-SMX), sold under the trade names Bactrim, Septra, and Cotrim, is the treatment of choice.
  • The typical regimen for immunocompetent adults is TMP 160 mg plus SMX 800 mg, orally, twice a day, for 7 to 10 days.
  • People living with HIV may need longer courses of therapy.
  • The safety of TMP-SMX in children has not been systematically evaluated. Use in children less than 2 months is generally not recommended.
• No highly effective alternative antibiotic regimen has been identified yet for patients who do not respond to the standard treatment or have a sulfa allergy. See the CDC website below about cyclosporiasis treatment for potential alternative approaches to consider.
• Diarrhea should be managed by drinking plenty of fluids to prevent dehydration.
• Parasites – Cyclosporiasis (Cyclospora Infection): Treatment for Cyclosporiasis
  CDC; Information about the treatment of cyclosporiasis.