Increase in Wisconsin Cyclospora Infection Reports
This message is being sent to local public health officers, Tribal health directors, infection preventionists, the Enteric Diseases Program list, and key DPH staff.
In recent weeks, Wisconsin has seen an increase in the number of reported cyclosporiasis cases. Since June 1, 2023, 29 cases have been reported in the state. Each summer, the United States typically experiences an increase in cyclosporiasis associated with produce imported from countries where the parasite is endemic. Wisconsin residents can be linked to local, event- or gathering-associated outbreaks, and/or multistate outbreaks of Cyclospora. Outbreaks in recent years have been associated with fresh, raw produce such as leafy greens and salads, cilantro, basil, berries, and vegetable trays.
At this time, it is unknown if the increase in cases is being caused by one common, widely distributed food item or multiple possible sources associated with seasonal increases. Timely surveillance and thorough investigation are critical to identifying a possible source(s).
Cyclospora background
Cyclospora is a one-celled parasite commonly found in tropical countries. People diagnosed with this infection in the U.S. often report having travelled outside the U.S.; however, during the summer months, outbreaks and illnesses occur after consuming contaminated imported fresh produce. The incubation period is typically 1–2 weeks. Symptoms include watery diarrhea, loss of appetite, weight loss, and abdominal cramping. Persistence of diarrhea for several weeks with remitting and relapsing episodes is typical. Some case-patients report significant weight loss over the course of their illness.
Most cases of Cyclospora infection are diagnosed using one of several multi-target PCR gastrointestinal panels currently being used by clinical labs.
It typically takes at least 1–2 weeks after being passed in a bowel movement for Cyclospora to become infectious for another person. Therefore, it is unlikely that Cyclospora is passed directly from one person to another.
Guidance to local and Tribal health departments
Because of this early increase in reported cases, we are asking local and Tribal health departments to be alert for new cases reported in your jurisdiction and attempt to complete interviews as soon as possible. This will allow DPH and CDC to look for common food items in our state and nationally.
We ask LTHDs to:
- Quickly import cases into WEDSS from staging.
- Conduct interviews using the Wisconsin Cyclosporiasis Interview Worksheet and request assistance from the SOS Team if you are unable to prioritize interviewing or have difficulty reaching someone during the day.
- Enter collected information into the WEDSS tabs and scan the completed interview to the WEDSS file cabinet as soon as it is completed (if available).
- Notify the Enteric Disease epidemiologists as soon as any interviews are completed if you identify any local clusters, or if you would like to request interviewing assistance from the SOS Team.
Guidance to providers and clinical labs
- Consider Cyclospora as a potential cause of illness in persons with persistent diarrhea. If indicated, specifically request testing for Cyclospora. Cyclospora testing is not routinely available from all clinical laboratories.
- Promptly report suspected or confirmed cases of cyclosporiasis to the local or Tribal health department.
- Forward patient specimens positive for cyclosporiasis to the Wisconsin State Laboratory of Hygiene (WSLH) for Cyclospora sequencing. Contact WSLH’s Communicable Disease Division customer service at 800-862-1013 with any submission-related questions.
Cyclosporiasis resources
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