A Parasite Strikes the Lone Star State

Cyclospora infection cases in Texas cause concern

(RxWiki News) An outbreak of the foodborne illness cyclosporiasis has caused over 45 infections in Texas.  The public needs to be on alert for digestive symptoms.  Meanwhile, Texas health officials are on the hunt for a cause.

The outbreak has sparked concern because more cases have already been seen in the first half of 2013 than the total seen in previous years.

Dallas County health officials are urging people to wash fruits and vegetables thoroughly. 

"Wash fresh produce carefully."

NBC 5, the Dallas-Fort Worth NBC affiliate station, reported that over 45 cases of cyclosporiasis have been identified in Texas so far this year. This number has alarmed officials, as the state saw a total of 44 cases during the entire year of 2012, 14 cases during 2011 and nine cases during the whole of 2010. 

Cyclosporiasis is an intestinal illness caused by a parasite called Cyclospora cayetanensis, according to the Centers for Disease Control and Prevention (CDC). The parasite is transmitted through contaminated food or water. 

According to NBC 5, most of the Texas cyclosporiasis cases have occurred in North Texas counties. Dallas County has identified 10 cases, Tarrant County has identified 11, six have been discovered in Denton County and Collin County has reported 14 infections. 

Cyclospora attacks the small intestine, causing symptoms like watery diarrhea, appetite loss, weight loss, stomach pain, bloating, nausea and fatigue. The symptoms usually develop a week after the infection actually occurs, according to the CDC.

Dallas County Department of Health and Human Services (DCHHS) reported that the outbreak is an ongoing investigation and that no source has been found. Similar cases have been seen in Iowa and Nebraska. It remains a possibility that a common source is responsible for all these US infections.

"Past outbreaks in the United States have been associated with consumption of imported fresh produce," DCHHS noted.

In a statement released by DCHHS, Christopher Perkins, MD, DCHHS medical director, urged careful handling of produce as a good preventive measure, though not a fail-safe one. 

“To decrease the risk of eating fresh produce, it is important to thoroughly rinse your fruits and vegetables several times," said Dr. Perkins. "Even when cooking vegetables, it is critical to clean them beforehand."

When a cyclosporiasis infection does occur, a combination of two antibiotics —trimethoprim-sulfamethoxazole (Bactrim, Septra or Cotrim) — make up the CDC-recommended treatment. However, these sulfa medications are also common allergens.

"No highly effective alternative drugs have been identified yet for people with Cyclospora infection who are unable to take sulfa drugs," the CDC explained.

In an interview with NBC 5, Shawn Mitchell, MD, medical director of Premier Urgent Care in Colleyville, Texas, highlighted this issue. 

"It's a catch-22 for sure. It's effective — it's the only effective antibiotic that we know of right now for cyclosporiasis. The hitch with it is, many people are allergic to it," said Dr. Mitchell.

According to the CDC, if cyclosporiasis is not treated, symptoms may linger anywhere from a few days to a month, sometimes improving only to return again during a relapse phase. Patients and doctors have to work together to manage symptoms in the case of a sulfa medication allergy.

Review Date: 
July 19, 2013