Clinical Guidance
Cyclosporiasis should be considered in patients with:- Prolonged or relapsing watery diarrhea
- Recent consumption of fresh produce
- Travel to endemic areas
- Illness associated with a recognized foodborne outbreak
Patients may experience intermittent symptoms if untreated.
A detailed food and travel history should be obtained.
Laboratory Testing
Routine ova and parasite (O&P) examinations may not detect Cyclospora unless specifically requested.
Recommended diagnostic methods include:
- Multiplex gastrointestinal PCR panels that include Cyclospora
- Stool examination using modified acid-fast stain
- Ultraviolet fluorescence microscopy
- Molecular testing (PCR)
Specimen Collection
Because shedding may be intermittent:
- Collect multiple stool specimens (generally three specimens collected on separate days) when clinically indicated.
- Inform the laboratory that Cyclospora testing is requested, as additional methods may be necessary.
Healthcare providers should consult their clinical laboratory regarding available testing methods.
Treatment
The treatment of choice is Trimethoprim-sulfamethoxazole (TMP-SMX).
Typical adult regimen:
- TMP 160 mg / SMX 800 mg (one double-strength tablet) orally twice daily for 7 10 days
Treatment duration may need to be extended in immunocompromised patients.
Patients with Sulfonamide Allergy
No highly effective alternative therapy has been established.
Options that have been used with variable success include:
- Observation with supportive care for mild illness
- Consultation with an infectious diseases specialist for management of patients unable to receive TMP-SMX
Supportive care should include:
- Oral or intravenous fluid replacement as indicated
- Electrolyte management
- Nutritional support when necessary
Antidiarrheal medications may be considered when clinically appropriate.
