What Is Cyclosporiasis, the Intestinal Illness Linked to Fresh Produce

Most stomach bugs resolve within a few days. But when diarrhea lingers for weeks or seems to disappear and then return, health care providers start looking for causes beyond the typical stomach flu—norovirus—or foodborne illness.

One possibility is cyclosporiasis, an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis. The illness is often linked to contaminated fresh produce and tends to occur most frequently between May and August.

People who become infected may develop watery diarrhea, stomach cramps, nausea, fatigue, and other gastrointestinal symptoms, which can last from several days to more than a month. Some people experience mild symptoms and clear the infection on their own. Others may need antibiotics.  

Here are some of the most common questions about cyclosporiasis, answered.

What are cyclosporiasis symptoms?  

According to the Centers for Disease Control and Prevention, cyclosporiasis symptoms typically begin about one week after exposure, though they can appear anywhere from two days to two weeks later.

The most common symptom is watery diarrhea. Others may include:

• Loss of appetite
• Weight loss
• Stomach cramps
• Bloating
• Increased gas
• Nausea
• Fatigue
• Vomiting
• Headaches
• Body aches
• Low-grade fever

How is cyclosporiasis different from norovirus or food poisoning?

Norovirus and foodborne illnesses typically improve within a few days. Cyclosporiasis symptoms can linger, so one of the biggest clues that you might have something more than the stomach flu or food poisoning is that your symptoms last longer than a few days, or they seem to improve and then return. That stop-and-start pattern is one reason health care providers often recommend testing when diarrhea becomes prolonged or keeps returning.

Can cyclosporiasis spread from person to person?  

Cyclospora is spread by consuming food or water that contains the parasite. Unlike norovirus, cyclospora doesn't usually spread directly from one person to another because it needs time outside the body to become infectious.

What foods are commonly linked to cyclospora?

The specific produce varies among outbreaks, but cyclosporiasis cases have been linked to:  

• Bagged salad mixes
• Cilantro
• Basil
• Raspberries
• Snow peas
• Fresh herbs
• Other imported fresh produce

When is diarrhea serious enough to see a doctor?

Persistent diarrhea isn't something to ignore, especially in young children, older adults, pregnant women, and people with weakened immune systems. Contact a health care provider if:

• Symptoms last more than a few days
• You develop signs of dehydration, such as dizziness or decreased urination
• You're unable to keep fluids down
• Symptoms go away and then come back

How is cyclosporiasis diagnosed?  

If your symptoms have lasted longer than expected, your provider may order a stool test. Because cyclospora doesn't always show up on standard testing, special laboratory tests may be needed.

How is cyclosporiasis treated?

Treatment is available in the form of antibiotics, which your primary care physician can prescribe after your stool test comes back positive for cyclospora.

While antibiotics are used to treat cyclosporiasis, supportive care can help manage symptoms and prevent complications. The most important step is staying hydrated, since ongoing diarrhea can lead to significant fluid loss. Drink plenty of fluids, and consider oral rehydration solutions that replace water and electrolytes lost through diarrhea. Eating small, frequent meals if you can tolerate them may also help. Avoid greasy foods, caffeine, and alcohol, which may make you feel queasy.

Gentle skin care can also help you feel better. Avoid harsh wiping, which can further irritate sensitive skin. Instead, consider using unscented wipes or rinsing the area with warm water and gently patting dry. Applying a protective barrier cream, such as petroleum jelly, can help protect the skin from irritation.

What if I can’t leave home to see the doctor because of symptoms?

Many primary care and urgent care practices offer virtual visits. If you're experiencing severe diarrhea or are worried about dehydration, call ahead to discuss the best way to be evaluated. Don't delay seeking care because you're embarrassed—health care providers see gastrointestinal illnesses every day.

How can I prevent cyclosporiasis?

Preventing cyclosporiasis can be difficult because contamination often occurs before produce reaches your kitchen.  

The CDC recommends:

• Washing your hands before and after handling produce
• Thoroughly washing fruits and vegetables under running water. Washing produce doesn’t kill the parasite, but it can help physically remove it from the food.  
• Cutting away damaged areas of produce
• Refrigerating cut produce promptly

Does heat kill cyclospora?

Cooking your fruits and vegetables may help reduce the risk of cyclospora because many reported outbreaks have been linked to raw fresh produce. However, the CDC does not provide a specific cooking temperature or advise that cooking will eliminate risk. The best ways to reduce your risk are to follow food-safety practices, including washing produce under running water before eating, cutting and preparing it safely, and avoiding food or water that may be contaminated.

Should I avoid fresh produce right now?

Fresh produce is part of a healthy diet. The most important steps you can take to avoid cyclosporiasis are to follow good food-safety habits, pay attention to any public health alerts in your area, and talk to your doctor if you have a health condition that would increase your risk of becoming seriously ill if you experience prolonged diarrhea.

If you’re concerned you have cyclosporiasis, know that cases are treatable. If diarrhea lasts longer than expected or keeps coming back, don't assume it's just a stubborn stomach bug. Getting evaluated can help identify the cause and get you on the road to recovery faster.

Schedule a virtual care appointment.