Cyclospora | FDA

Cyclospora is a parasite that is so small it can only be seen under a microscope. When people eat food or drink water that’s contaminated with Cyclospora, they can get an intestinal illness called cyclosporiasis. To date, Cyclospora is believed to only infect humans and spread through human fecal matter. 

Cyclospora is generally transmitted when infected feces (poop) contaminates food or water. It’s unlikely to be transmitted directly from person to person because the Cyclospora parasite needs time (days to weeks) after being passed in feces to become infectious.

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Who Is at Risk?

Anyone can get cyclosporiasis, but people with weakened immune systems (such as those taking immunosuppressive medications or living with HIV), the elderly, or children may experience more severe illness or complications from severe dehydration and may need longer treatment.

People can become infected with Cyclospora if they live or travel to an area where cyclosporiasis is endemic (regularly found) or by consuming food or water that has been contaminated with the parasite. However, there have been illnesses associated with produce grown in the United States in recent years.

What Are the Symptoms?

The time between becoming infected and becoming sick is usually about one week, though it can range from 2-14 days or more. Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, with frequent bowel movements. Other common symptoms include loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, and fatigue. People may also experience vomiting, body aches, headache, low-grade fever, and other flu-like symptoms. However, some people who are infected with Cyclospora do not have any symptoms. If not treated, the illness may lead to dehydration and severe complications that may require higher levels of care. These complications may last from a few days to a month or longer, and can be more severe for those with weakened immune systems. Symptoms may seem to go away and then return one or more times (relapse).

Cyclosporiasis is treatable. A healthcare provider can prescribe the correct antibiotics to treat the infection. It is important to seek care promptly, especially if you are immunocompromised, as longer treatment may be needed.

What Foods and Water Sources Have Been Linked to U.S. Outbreaks of Cyclosporiasis?

Past cyclosporiasis outbreaks in the U.S. have been linked to fresh produce such as raspberries, cabbage, basil, cilantro, parsley, broccoli, snow peas, sugar snap peas, and leafy greens. Cyclosporiasis also can be acquired when people eat or drink contaminated food or water during travel outside the United States. Cases acquired in the U.S. tend to occur between May and August.

What Can Consumers Do?

Consumers should follow these steps:

• In the summer months, consumers should monitor illness reports from their state public health authorities, FDA, and CDC for announcements regarding foods that have been linked to Cyclospora outbreaks that consumers may want to avoid. 
• Consumers should also consider the following when consuming produce during the Cyclospora season: 
  • Discard outer layers.  When possible, discard outer layer of fruits and vegetables. For example, throw away the outer two to three layers of leafy greens. 
  • Rinse produce thoroughly. Rinsing produce is an appropriate first step but may not reliably eliminate the parasite. Rinse all fresh fruits and vegetables under clean running water, including before you peel them.  Use a clean vegetable brush to scrub firm produce. Note that Cyclospora parasites are resistant to standard chlorine-based sanitizers. Consumers should not use soap or bleach to rinse produce.
  • Be cautious with pre-washed or pre-cut produce. Commercial washing processes may not be sufficient to remove the parasite. 
  • Avoid cross contamination. Clean kitchen counter tops, cutting boards, utensils, etc. with hot, soapy water.
  • Prioritize cooking. For any produce that can be cooked, cooking to a temperature of at least 158  °F (70°C) is the safest option, as the parasite is resistant to routine chemical disinfection and washing alone cannot guarantee its removal. Cyclospora cannot survive at these elevated temperatures. 
• As always, wash hands with warm water and soap for at least 20 seconds before and after handling food.

Who Should Be Contacted if You Become Sick?

If you think you have become sick from eating potentially contaminated foods you should consult your healthcare provider, especially if you have diarrhea or other severe symptoms that last for more than three days.

The FDA encourages consumers with questions about food safety to submit an inquiry to www.fda.gov/fcic for additional information.

What Do Restaurants and Retailers Need to Do

Based on current information available, Cyclospora may be resistant to routine chemical disinfection methods such as those using chlorine. However, restaurants and retailers should still follow basic food safety practices:

• Cyclospora generally spreads through human fecal matter, therefore individuals with symptoms of vomiting or diarrhea should not handle food in retail establishments or at home as a way in which to reduce contamination.
• Retailers, restaurants, and other food service operators should always practice safe food handling and preparation measures. It is recommended that they wash and sanitize utensils and surfaces before and after handling food. Wash and sanitize display cases and refrigerators where potentially contaminated products were stored.
• Wash and sanitize cutting boards, surfaces, and utensils used to prepare, serve, or store potentially contaminated products.
• Wash hands with warm water and soap for at least 20 seconds before and after handling food and following any cleaning and sanitation processes.
• Regular frequent cleaning and sanitizing of food contact surfaces and utensils used in food preparation may help to minimize the likelihood of cross-contamination.

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