Cyclosporiasis in Southeast Michigan: Symptoms, Prevention, and When to Talk With a Clinician

What is cyclosporiasis?

Cyclosporiasis is an intestinal illness caused by the parasite Cyclospora cayetanensis. People can become infected after eating food or drinking water contaminated with the parasite. In the United States, outbreaks have often been associated with fresh produce. [3]

Cyclospora is different from many stomach bugs because symptoms may not start right away. Symptoms usually begin about one week after exposure, but they can appear as soon as two days or as late as two weeks or more after consuming contaminated food or water. [1][2]

Symptoms to watch for

The most common symptom of cyclosporiasis is watery diarrhea. MDHHS describes the diarrhea as frequent, watery, and sometimes explosive. Other possible symptoms include loss of appetite, weight loss, abdominal cramping, bloating, increased gas, nausea, fatigue, low-grade fever, body aches, headache, and vomiting, though vomiting is less common. [1][2]

One of the frustrating things about cyclosporiasis is that symptoms can come and go. Diarrhea may improve for a few days and then return. Without treatment, illness may last from a few days to a month or longer. Fatigue can also linger after the gastrointestinal symptoms improve. [1][2]

Why this outbreak matters locally

MDHHS reported that the largest increase in cases was occurring in Southeast Michigan, with Oakland County listed among the counties where cases remained highest. [1]

That does not mean every stomach illness right now is cyclosporiasis. Many viruses, foodborne illnesses, medication reactions, and other conditions can cause diarrhea. But during an outbreak, sudden and ongoing diarrhea deserves more attention, especially if symptoms are lasting several days, improving and returning, or occurring after eating fresh produce.

How Cyclospora spreads

Cyclospora spreads when people consume food or water contaminated with feces containing the parasite. Direct person-to-person spread is considered unlikely because the parasite needs time in the environment before it becomes infectious. [3]

That is why public-health guidance focuses heavily on food safety, produce handling, and contacting a healthcare provider when symptoms are consistent with cyclosporiasis.

Produce safety steps MDHHS recommends

MDHHS has not identified one specific produce source for the current Michigan outbreak. However, previous Cyclospora outbreaks in the United States and Canada have been linked to foods such as bagged salad mixes, fresh cilantro, fresh basil, raspberries, snow peas, and green onions. [1]

MDHHS recommends extra care with raw produce in Southeast Michigan right now. Practical steps include:

• Choose whole heads of lettuce when possible instead of prewashed bagged lettuce or salad mixes.
• Remove the outer two to three layers of leafy greens and wash the inner leaves under running water.
• Cook leafy greens when that is an option.
• Wash cilantro and basil thoroughly under running water, separating the leaves.
• Trim the root end of green onions, remove the outer layer, and wash thoroughly.
• Wash snow peas under running water and rub the surface.
• Be especially cautious with raspberries because their bumpy surface can make them difficult to clean.
• Cook produce when possible. MDHHS states that heating food to 158°F or higher kills Cyclospora.
• Wash hands with soap and water before and after preparing food.
• Wash and sanitize cutting boards, utensils, refrigerators, display cases, and food-prep surfaces.
• Refrigerate cut, peeled, or cooked fruits and vegetables as soon as possible. [1]

Washing produce is still worthwhile, but it may not eliminate all risk. Cooking is the safer option for foods that can reasonably be cooked. [1]

When to talk with a clinician

MDHHS encourages people with sudden and ongoing diarrhea to contact a healthcare provider and reach out to their local health department, especially if other people in the household are having similar symptoms. [1]

You should consider clinician review if you have:

• Watery diarrhea that lasts more than a couple of days
• Diarrhea that improves and then returns
• Diarrhea with significant cramping, bloating, gas, nausea, or fatigue
• Symptoms after eating fresh produce during the current outbreak
• Difficulty staying hydrated
• A weakened immune system
• Pregnancy or breastfeeding
• Severe abdominal pain, blood in the stool, persistent fever, confusion, dizziness, or inability to keep fluids down

Severe dehydration, blood in the stool, severe abdominal pain, confusion, fainting, or inability to keep fluids down should be treated as urgent symptoms. In those situations, urgent care or emergency care may be more appropriate than a routine virtual visit.

Children with suspected cyclosporiasis symptoms should be evaluated by a pediatrician, urgent care, or emergency care provider.

Concerned about ongoing diarrhea during the outbreak?

Existing purelyIV clients may be eligible for a $50 virtual clinician review for suspected cyclosporiasis symptoms. New clients require a full virtual medical consultation, which is $250 and includes provider review and prescription support if treatment is medically appropriate.

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How cyclosporiasis is treated

Cyclosporiasis is treated with antibiotics along with rest and fluids to maintain hydration. [1]

The CDC lists trimethoprim-sulfamethoxazole, also known as TMP-SMX and sold under names such as Bactrim, Septra, or Cotrim, as the treatment of choice for cyclosporiasis. [4]

That does not mean the medication is right for everyone. People with sulfa allergy, pregnancy, breastfeeding, certain medical conditions, medication interactions, or higher-risk health situations need individualized review before treatment decisions are made. The CDC also notes that no highly effective alternatives have been identified for people who are allergic to or cannot tolerate TMP-SMX. [4]

How purelyIV can help

purelyIV can help adults talk with a clinician about symptoms that may be consistent with cyclosporiasis.

Existing purelyIV clients may be eligible for a $50 virtual clinician review. New clients require a full virtual medical consultation, which is $250. During the visit, a clinician can review your symptoms, timing, risk factors, medical history, allergies, current medications, and whether your situation is appropriate for virtual care.

If prescription treatment is clinically appropriate, our provider can discuss next steps and provide prescription support for the relevant medication.

This type of visit is intended for adults with symptoms that are concerning but not emergent. If you are severely dehydrated, unable to keep fluids down, have blood in your stool, have severe abdominal pain, or feel faint or confused, you should seek urgent or emergency care.

Key takeaways

Cyclosporiasis is now a local concern in Southeast Michigan, including Oakland County. The most common symptom is watery diarrhea, and symptoms can improve and then return. MDHHS has not identified a specific produce source, so extra care with raw produce is recommended. [1][2]

If you have sudden and ongoing diarrhea, especially during this outbreak, it is reasonable to talk with a clinician. When treatment is appropriate, prescription therapy may help shorten the illness and reduce symptom recurrence. [1][4]