CYCLOSPORINS UNLOCKED!
JULY 2026
*THIS INFORMATION IS QUOTED FROM THE FOLLOWING: 
https://www.pa.gov/agencies/health
https://www.cdc.gov/index.html
https://www.jeffersonhealth.org/home


Centers for Disease Control is investigating a multi-state outbreak of cyclosporiasis which is a gastrointestinal infection caused by the parasite Cyclospora cayatenensis. Cases have been reported in 27 states, including Pennsylvania. The number of cases reported in Pennsylvania remains very low. The states linked to the outbreak are Michigan, Ohio, Kentucky, Indiana, and West Virginia. The outbreak has been linked to lettuce from Taylor Farms sourced from Mexico. Taylor Farms has initiated a recall of affected lettuce from restaurants and retail locations. 

 

Symptoms of cyclosporiasis include watery diarrhea, fatigue, and loss of appetite. Symptoms usually begin 1 week after consuming contaminated food, but the incubation period can range from 2-14 days. Spread is through contaminated food (usually produce), and person to person spread is uncommon. As of now, approximately 9% of cases have required hospitalization and there have been no deaths.

 

Testing:

Routine testing of stool for cyclospora is not recommended for most patients. Please see the attached testing algorithm for testing in diarrheal illness. Consider testing for Cyclospora in the following patients:

1. Patients with unexplained watery diarrhea that persists for greater than 1 week

1. Immunocompromised patients with severe diarrhea

1. Patients with symptoms of cyclosporiasis and a suspected exposure to contaminated food within 2 weeks of symptom onset (see attachment)

 

Cyclospora is usually not detected on the ova and parasite test. The comprehensive stool PCR panel includes cyclospora. However, the test is expensive and often not covered by health insurance, which can lead to high out-of-pocket costs for outpatients. Health Network Laboratories (HNL) can send stool to a reference laboratory for cyclospora testing.  Stool for testing should be sent in a Para-Pak and ordered as a miscellaneous test with the test listed as "Cyclospora."  

 

Treatment:

Cyclosporiasis resolves in most patients, but symptoms may be prolonged in some patients.

All patients with symptoms should be treated with supportive care including oral or IV hydration as needed. Antibiotic therapy should be reserved for patients with severe disease requiring hospitalization, immunocompromised patients, and those with symptoms that persist for more than 1 week. The recommended treatment regimen is sulfamethoxazole-trimethoprim DS 1 PO BID for 7 to 10 days. For immunocompromised patients, a longer course of treatment or higher dose may be required. Consider Infectious Diseases consultation. For patients allergic to sulfa drugs, the alternative is ciprofloxacin 500 mg PO BID.  Please see the attached pediatric guidance which includes specific dosing guidance.