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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: Clinicians should confirm their affiliated labs test for Cyclospora, as it not always included in routine stool panels. Most individuals will clear the infection on their own, but some may require treatment. As a record-breaking cyclosporiasis outbreak continues to surge in the United States, experts warn that failure to suspect the parasite and order the right diagnostic test may be the biggest obstacles to controlling its spread. The CDC\u2019s most recent update includes 6,358 cases and 278 hospitalizations across 15 states, linked to iceberg lettuce sourced from Taylor Farms in central Mexico. Two deaths have been reported in Michigan, which has notified officials of more than 11,000 cases as of July 30.
Tyler B. Evans \u201cThis is the largest [cyclosporiasis] outbreak we\u2019ve ever seen,\u201d Tyler B. Evans, MD, MS, MPH, DTMH, FIDSA, an infectious disease and public health physician, told Healio. During the last major cyclosporiasis outbreak in 2020, only 1,241 cases were reported. Since May, the CDC has received reports of 13,895 laboratory-confirmed cases of cyclosporiasis across 47 states. The agency is aware of more than 10,455 additional cases that require further investigation, a backlog it attributes to a lag in reporting due to the parasite\u2019s incubation period. \u201cThis year\u2019s outbreak is significantly larger than we\u2019ve seen in previous years, and probably represents only the tip of the iceberg because many people may have mild symptoms and not present for care, or may even be asymptomatic,\u201d Kira Newman, MD, PhD, clinical assistant professor of gastroenterology at Michigan Medicine, told Healio. Singling out Cyclospora Evans, who has led global health responses to crises such as the Ebola outbreak and COVID-19 pandemic, emphasized the importance of cross-disciplinary collaboration in cyclosporiasis management \u2014 not only between gastroenterologists, infectious disease specialists and primary care professionals, but also between clinicians and public health officials. \u201cIt\u2019s not just public health explaining where we\u2019re at to clinicians,\u201d he said. \u201cThe clinicians, in many ways, are almost like the hub and spoke. They\u2019re the folks who are in the fields, in the weeds, in the foxholes.\u201d Laboratory testing is crucial, as distinguishing between cyclosporiasis and other causes of acute diarrheal symptoms can be difficult. \u201cStool ova and parasite tests will not routinely detect Cyclospora infection,\u201d Newman said. \u201cEven clinicians who may think they are appropriately testing for it need to confirm with their lab that it\u2019s part of what they are able to detect. \u201cA high degree of suspicion is important,\u201d she added. \u201c[Cyclosporiasis] can look the same as E. coli, Campylobacter, C. difficile, an IBD flare, norovirus or any viral, bacterial or chronic diarrheal condition.\u201d Suspicion should be highest when individuals in outbreak epicenters \u2014 like Michigan \u2014 experience remitting or relapsing course of watery or explosive diarrhea. \u201cIf you are in Michigan, everybody needs to have heightened concern,\u201d Evans said. \u201cIf you are not in a state where there are reported cases, then you can just \u2014 not relax \u2014 but be vigilant, observe and see how it goes.\u201d Access to stool tests, multiplex panels or serology tests to diagnose Cyclospora can vary, depending on the public health or commercial laboratories clinicians work with. \u201cMany GI providers may be used to just ordering a stool PCR panel, or may not have that available,\u201d Newman said. \u201cWorking with their local infectious disease colleagues or public health specialists can help them identify where they should be sending these samples to ensure they\u2019re not ordering tests with a high degree of suspicion and getting insufficient data back.\u201d \u201cStool tests are the most specific,\u201d Evans added. \u201cThe problem with them is the delay. It takes time to get the response back.\u201d Treatment considerations Given the delay with test results, Evans advised clinicians to be comfortable empirically treating patients for cyclosporiasis. \u201cMichigan plus watery diarrhea, slam dunk to treat there,\u201d he said. \u201cIf you\u2019re in California [and see a patient] with watery diarrhea, I would use a degree of caution. But just look at the data and the symptoms.\u201d In addition to watery or explosive diarrhea, symptoms of cyclosporiasis include fatigue and loss of appetite and usually begin within a week of becoming infected, according to the CDC. Affected individuals may also experience bloating, flatulence and weight loss. While most people will clear the infection on their own, children, older adults and those who are immunocompromised may require treatment. \u201cTreatment is not especially difficult,\u201d Newman said. \u201cBactrim, ciprofloxacin or other approved antibiotic courses are effective.\u201d Most individuals with an underlying gastrointestinal condition who contract Cyclospora will respond well to standard courses of antibiotics, she noted. However, those with inflammatory bowel disease may require special consideration. \u201cSome IBD patients who are on multiple types of immunosuppression may need [a referral to] an [infectious disease] colleague, or an alternative regimen to truly clear the infection,\u201d Newman said. Evans also emphasized the importance using risk assessments as a guide for response. \u201c[Lower-risk] is healthy adults and kids older than 5 years,\u201d he said. \u201cModerate-risk would include people with underlying health conditions, particularly in higher-risk areas. The third level of risk would be older adults, immunocompromising conditions, in Michigan; if you\u2019re checking all those boxes, then you should be on highest alert.\u201d For more information: Tyler B. Evans, MD, MS, MPH, DTMH, FIDSA, is CEO, chair and cofounder of Wellness Equity Alliance, former chief medical officer for New York City, adjunct associate professor in population and public health sciences at University of Southern California Keck School of Medicine, and author of \u201cPandemics, Poverty, and Politics: Decoding the Social and Political Drivers of Pandemics from Plague<\/p>\n","protected":false},"author":1,"featured_media":3387,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3386","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3386","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3386"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3386\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/3387"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3386"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3386"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3386"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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