Cyclospora

Overview

Cyclospora is a tiny living thing (a parasite) that you can't see without a microscope. When it gets into your body through food or water, it settles in the small intestine and causes diarrhoea that can last for weeks. The illness it causes is sometimes called cyclosporiasis (say: sy-klo-spor-eye-uh-sis). It is not caused by poor hygiene on your part, and it does not spread easily from person to person.

Cyclospora is not common in the UK or most of Europe, but outbreaks do happen, usually in spring and summer and often linked to imported fresh produce. It is more common in some tropical and subtropical parts of the world, including parts of Central and South America, South Asia, Southeast Asia and the Middle East. Around the world, it is a recognised cause of travellers' diarrhoea.

Anyone can get Cyclospora — it doesn't choose by age or health status. People who travel to affected parts of the world, or who eat imported fresh produce during an outbreak, are more likely to come across it. Young children, older adults and people with a weakened immune system may become more dehydrated and may need extra care.

Symptoms

Common symptoms

• Watery diarrhoea that may come and go, sometimes in bouts that last days and then return
• Loss of appetite and unintended weight loss
• Stomach cramps, bloating and wind
• Feeling sick (nausea), sometimes with vomiting
• Feeling very tired or washed out
• Low-grade fever in some people
• Generally feeling unwell and lacking energy for weeks

Symptoms in children

• Diarrhoea, which may be harder for a young child to describe
• Being more sleepy or less playful than usual
• Fewer wet nappies or less urine than usual (a sign of dehydration)
• Dry mouth, no tears when crying, or sunken eyes
• Poor feeding or refusing drinks — this needs medical advice quickly

Symptoms in older adults

• Diarrhoea with a higher risk of dehydration and tiredness
• Feeling dizzy or light-headed on standing, which can lead to falls
• Confusion or unusual drowsiness, which can be a sign of dehydration
• Loss of appetite leading to weakness, which can be slower to recover from

Causes

Main causes

• Eating food or drinking water contaminated with Cyclospora. The parasite is passed in human poo and needs time in the environment to become able to infect someone.
• Fresh produce that was grown or washed with contaminated water and eaten raw — for example herbs, berries, salad leaves and fruit. Cooking kills the parasite, so raw produce is the main food risk.
• Drinking untreated water, or using ice made from untreated water, in parts of the world where the parasite is common.
• Less commonly, direct contact with contaminated soil or surfaces, then putting hands near the mouth without washing them.

Risk factors

• Travelling to or living in tropical or subtropical regions where Cyclospora is common
• Eating imported raw fruit, herbs or salad during a known outbreak
• Drinking untreated water or using unwashed ice while travelling
• Having a weakened immune system, which can make the illness last longer
• Being a young child or an older adult, which raises the risk of dehydration

When to see a doctor

See a doctor urgently if:

• Diarrhoea that is not settling after a few days, or that keeps coming back
• Signs of dehydration — very dark urine, little or no urine, dry mouth, dizziness
• Vomiting that stops you keeping fluids down
• A high fever or blood in your stool
• Symptoms in a baby, a frail older adult, or anyone with a weakened immune system

Book a routine appointment if:

• Watery diarrhoea that has lasted more than a week, especially if you have also lost weight or your appetite
• Diarrhoea after recent travel abroad, so your doctor can arrange the right tests
• Diarrhoea that keeps returning in bouts over several weeks
• Ongoing bloating, wind and stomach discomfort with loose stools

Diagnosis

A doctor will talk to you about your symptoms, recent travel and what you have eaten, then may ask for a stool sample. Cyclospora is not always found by routine stool tests, so the laboratory often needs to be told to look for it specifically. Because the parasite can be shed in the stool in varying amounts, you may be asked to provide more than one sample on different days.

Tests that may be done

• Stool (poo) sample tests — the main way to confirm Cyclospora
• Special laboratory techniques requested by your doctor, because standard testing can miss the parasite
• Sometimes more than one stool sample collected on separate days
• A blood test to check for dehydration, kidney function or other causes, if you are unwell
• Tests for other causes of diarrhoea at the same time, such as other stomach bugs

What to expect at your appointment

You will usually be given a container and instructions for collecting a stool sample at home, then asked to drop it off at your GP surgery, clinic or hospital laboratory. Results can take several days, and you may need to provide a second sample. In the meantime, your doctor may suggest ways to stay comfortable and hydrated. Try not to worry if the first test is negative — tell your doctor if symptoms continue, so further testing can be arranged.

Treatment

The main goals are to replace the fluids and salts you are losing, ease the diarrhoea, and clear the infection if it doesn't settle. Many people improve with fluids and rest, but Cyclospora can linger for weeks, so a doctor may prescribe a course of antibiotics. Always speak to a healthcare professional before taking any medicine, including anything bought over the counter.

Self-care at home

• Drink small, frequent sips of fluids — water is fine, and an oral rehydration solution from a pharmacy can help replace salts
• Keep eating light, simple meals as you feel able; you don't need to starve yourself
• Rest and give yourself time — tiredness is common with this infection
• Wash your hands well with soap and water after using the toilet, and before preparing food
• Avoid preparing food for other people while you have diarrhoea, if you can
• Stay off work or school until you have been free of diarrhoea for at least 48 hours, unless your doctor or workplace advises otherwise

Medical treatments

If your doctor confirms Cyclospora, they may prescribe a course of antibiotics — a type that works against this parasite. Antibiotics for Cyclospora are only available on prescription, and it is important to finish the full course exactly as your doctor explains. Your doctor will also check how hydrated you are and may recommend an oral rehydration solution. If you become very dehydrated, you may need fluids through a drip in hospital. Note that antibiotics used for common stomach bugs don't necessarily work for Cyclospora, which is why getting the right diagnosis matters.

When is surgery considered?

Surgery is not used to treat Cyclospora.

Living with this condition

The tiredness and unpredictable diarrhoea can be frustrating, and it is normal to feel drained while you recover. Plan your days gently, keep fluids close by, and don't push yourself back to full speed too soon. Keep a simple note of your symptoms — how often you go, what your stools look like, and how much you are drinking — as this is helpful information for your doctor.

Lifestyle tips

• Wash your hands thoroughly after the toilet and before handling food
• Clean toilet seats, taps and door handles regularly while you are unwell
• Avoid swimming in pools or open water until at least two weeks after symptoms stop
• Don't share towels or flannels while you have symptoms
• Tell your doctor if symptoms return after treatment — a second course may sometimes be needed

Diet and exercise

There is no special diet that cures Cyclospora, but gentle eating helps. Try plain foods such as rice, pasta, bread, potatoes and cooked vegetables, and drink regularly throughout the day. Some people find very rich, spicy or high-fibre foods make cramps worse for a while. Avoid alcohol until you feel better. Exercise is not advisable while you have active diarrhoea and tiredness — rest first, then return to gentle activity such as short walks as your energy comes back.

Mental health and emotional wellbeing

Long-lasting diarrhoea can be worrying, embarrassing and isolating. It can affect work, travel and social plans, and it is normal to feel anxious or low about it. If these feelings are building up, talk to your doctor — support is available. If you ever feel overwhelmed or in crisis, please contact your local emergency number or a crisis support service in your country straight away.

Prevention

You can greatly lower your risk, though no method is perfect. The parasite is killed by cooking and by thorough washing with safe water, and it is not spread easily from person to person.

Vaccines

There is no vaccine for Cyclospora. Prevention relies on food and water hygiene.

Screening programmes

There is no routine screening test for Cyclospora. Testing is offered when someone has symptoms that fit, especially after travel or during a known outbreak.

Complications

If left untreated

• Diarrhoea that lasts for weeks or months, sometimes with relapses
• Weight loss and malnutrition from poor appetite and ongoing diarrhoea
• Dehydration, which can be serious in babies, older adults and people with weakened immunity
• Tiredness and difficulty concentrating that affect work, study and daily life
• Rarely, gallbladder inflammation, which causes pain under the ribs on the right side

Long-term outlook

The good news is that Cyclospora can be effectively treated. Most people recover fully once they have the right diagnosis and treatment, plus good hydration. Some people feel tired for a while afterwards, and a few need a second course of treatment because symptoms can return. With a bit of patience and support from your doctor, the outlook is generally very good.

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