Medicines for Cyclospora

What it is

Cyclospora is a tiny parasite (Cyclospora cayetanensis) that infects the gut and causes an illness called cyclosporiasis, mainly consisting of diarrhoea and other digestive symptoms. It is spread through consuming food or water that has been contaminated with the parasite, and is more common in certain tropical and subtropical regions; in the UK, cases are usually related to travel to areas where the parasite occurs, or occasionally to imported contaminated fresh produce (such as certain fruits, salads, or herbs). It is not spread directly from person to person. The main symptom of cyclospora infection is watery diarrhoea, which can be frequent and, characteristically, can be prolonged or relapse (coming and going) if not treated. Other symptoms can include: tummy cramps and bloating; loss of appetite; feeling sick; tiredness and weakness; weight loss (particularly with prolonged illness); and sometimes a low-grade fever and general aches. The symptoms usually begin a week or so after exposure. A notable feature of cyclosporiasis is that, unlike many causes of travellers’ diarrhoea (which tend to settle by themselves within a few days), it can persist for weeks or come and go if not treated, which can be quite debilitating. Because of this, and because it is diagnosed with specific tests (examining a stool sample for the parasite, which may need to be specifically requested), it is important to consider it and get tested in someone with prolonged or relapsing diarrhoea after relevant travel or exposure. The reassuring point is that cyclosporiasis is treatable: once diagnosed, it is treated with specific antibiotics (a particular combination antibiotic is used), which clear the infection. Staying hydrated is important, as with any diarrhoeal illness. Prevention, when travelling in affected areas, involves being careful with food and water (as for other food- and water-borne infections). The key messages are that cyclospora is a parasite causing watery diarrhoea and tummy upset (usually caught abroad from contaminated food or water), that it can be prolonged or relapse if untreated, and that it is treatable with specific antibiotics once diagnosed.

How it is treated

Cyclosporiasis is treated with specific antibiotics once diagnosed, along with staying hydrated; recognising it depends on considering it in prolonged or relapsing diarrhoea after relevant travel or exposure and getting the right test. Because cyclosporiasis can resemble other causes of diarrhoea but tends to be prolonged or to relapse, and because it requires specific testing and treatment, it is important to consider it in the right context — such as watery diarrhoea that is prolonged (lasting more than a few days to weeks) or comes and goes, particularly after travel to an area where cyclospora occurs, or after consuming potentially contaminated fresh produce. Diagnosis is made by examining a stool (poo) sample for the parasite; because it may not be detected on routine testing, the specific test for cyclospora may need to be requested, so it is helpful to mention relevant travel or exposure and the nature of the illness to the doctor. Once diagnosed, treatment is with a specific antibiotic — a particular combination antibiotic (co-trimoxazole) is the usual treatment, given as a course, which clears the infection; alternatives are used for people who cannot take this. It is important to complete the treatment. As with any diarrhoeal illness, staying well hydrated is important — drinking plenty of fluids, and using oral rehydration solutions where helpful, to replace lost fluids and salts, particularly if the diarrhoea is frequent or prolonged; this is especially important for those more vulnerable to dehydration. Most people recover well with appropriate treatment. Preventing cyclosporiasis, particularly when travelling in areas where it occurs, involves the usual precautions for food- and water-borne infections — being careful with drinking water (using safe water), and with food, particularly raw fruits, salads, and vegetables (washing produce with safe water, or choosing cooked or peelable foods), as the parasite can contaminate fresh produce and water. The reassuring messages are that cyclosporiasis, although it can cause prolonged or relapsing diarrhoea that is debilitating, is treatable with a specific antibiotic once diagnosed, that staying hydrated is important, and that considering it and getting the right test in prolonged or relapsing diarrhoea after relevant travel or exposure is key; so mentioning travel and the nature of the illness to the doctor, and completing treatment, are the keys to managing it.