TEXAS DEPARTMENT OF STATE HEALTH SERVICES

KIRK COLE
INTERIM COMMISSIONER

P.O. Box 149347
Austin, Texas78714-9347
1-888-963-7111
TTY: 1-800-735-2989
www.dshs.state.tx.us

Date: June 22, 2015

HEALTH ADVISORY:
Increase of Cyclospora infections in Texas; recommendation to test patients with consistent symptoms

The Texas Department of State Health Services is encouraging healthcare providers to test patients
for Cyclospora if they have diarrheal illness lasting more than a few days or diarrhea accompanied
by severe anorexia or fatigue. Diagnosis of cyclosporiasis requires submission of stool specimens
for “Ova and Parasite” testing with additional specific orders for Cyclospora identification. A single
negative stool specimen does not exclude the diagnosis; three specimens are optimal.
Within the past week, 42 cases of Cyclospora infection have been reported to the Texas Department
of State Health Services. During the past three summers, a large number of cyclosporiasis cases
have occurred in Texas. Rapid reporting to public health enabling prompt investigation to identify
possible common exposures is essential to preventing additional cases this year.
Symptoms of cyclosporiasis usually begin 2 to 14 days after ingestion of oocysts in contaminated
food or water. Profuse diarrhea can last weeks to months, and may relapse. Additional symptoms
may include anorexia, fatigue, weight loss, abdominal cramps, bloating, increased gas, nausea,
vomiting, and low grade fever.
Although no common exposure source for this increase in cases has yet been identified, past
outbreaks in the U.S. have been associated with consumption of imported fresh produce, including
fresh cilantro, pre-packaged salad mix, raspberries, basil, snow peas, and mesclun lettuce.
Thorough washing of fresh produce is recommended, but may not eliminate the risk of transmission
since Cyclospora can be difficult to wash off all types of produce. Infection is generally not
transmitted directly from person-to-person.
Healthcare providers and laboratories should promptly report confirmed cyclosporiasis cases to
their respective local health department or the Texas Department of State Health Services (Phone:
1-800-705-8868, Fax: 512-776-7616).
Information about Cyclospora is available at:
www.cdc.gov/parasites/cyclosporiasis/health_professionals/index.html