Cyclosporiasis: What Family Physicians Need to Know Now

The AAFP has issued new clinical guidance on cyclosporiasis as summer produce-associated outbreaks continue to affect patients across the country.

Cyclospora infection can be easy to miss. Its symptoms often mimic viral gastroenteritis, food poisoning, or other common GI illnesses, and routine stool culture or ova and parasite (O&P) testing frequently fails to detect it. Physicians should specifically request Cyclospora testing (PCR-based testing or Cyclospora smear) when the parasite is suspected, and be aware that a single negative stool sample doesn't rule it out. Multiple specimens collected on different days may be needed.

Consider Cyclospora when patients present with:

• Watery diarrhea lasting more than 7 days
• Relapsing or intermittent symptoms after initial improvement
• Recent consumption of fresh produce (berries, lettuce, herbs) or other household members with similar illness after eating produce
• Negative initial stool studies
• Illness during spring or summer outbreak season
• Incubation is typically about one week after exposure, with a range of 2 to 14 days. There is no reported human-to-human transmission.

Treatment: TMP-SMX remains the treatment of choice for confirmed cases in immunocompetent adults (standard adult dosing: TMP 160 mg/SMX 800 mg orally twice daily for 7-10 days). Patients with immunocompromising conditions may need longer or more frequent dosing. For sulfa-allergic patients, limited evidence supports ciprofloxacin or nitazoxanide as alternatives.

Physicians should report confirmed cases to their local health department.

AAFP has also released a downloadable clinical reference PDF and offers a livestream CME opportunity, Addressing Reemerging Infectious Conditions, for physicians looking to sharpen their readiness for emerging and reemerging infectious disease threats.