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Alert Date: 
Monday, July 23, 2018 - 12:00pm

Current situation

Ontario is experiencing an increase in the number of Cyclospora infections. There have been 36 locally-acquired cyclosporiasis cases reported in the province between April 1 and July 12, 2018. We are requesting your assistance in helping with prompt diagnosis of infected patients. Testing for Cyclospora will support prompt treatment of patients to lessen duration of symptoms, as well as assist with identifying the source of illness.

  • Diagnosis: Cyclospora infection can be diagnosed by a stool ova and parasite (O&P) examination.
    If patients present with cyclosporiasis-compatible symptoms between now and the end of summer, please request testing for stool parasites on the Public Health Ontario Laboratory General Test Requisition form and specify the request is to test for Cyclospora.
  • TreatmentFirst-line treatment is trimethoprim-sulfamethoxazole (TMP-SMX).

What is cyclosporiasis?

Cyclosporiasis is a gastrointestinal illness caused by infection with the parasite Cyclospora cayetanensis. It is commonly characterized by frequent watery diarrhea, as well as other symptoms such as anorexia, fatigue, abdominal cramps, nausea, and myalgia. Left untreated, symptoms typically last 6 to 7 weeks and can wax and wane in intensity. Symptoms typically improve within 2 to 3 days of starting TMP-SMX, the first-line treatment for cyclosporiasis.

How is Cyclospora infection acquired?

People are infected by ingesting food or water contaminated with the parasite. Cyclospora is not endemic in Canada. Most reported cases in Ontario are infected when visiting an endemic country (e.g., in the Caribbean, South and Central America, South and South East Asia). When cases occur in individuals who did not travel (as is currently occurring in Ontario), an investigation is launched to determine potential sources of Cyclospora in imported foods. Most outbreaks in Ontario occur in the spring and summer and locally-acquired infections are likely due to fresh produce such as berries or herbs that are imported from Cyclospora endemic countries. The infection is unlikely to spread from person to person.

Additional Resources on Cyclosporiasis

Please contact your local public health unit if you have any questions about cyclosporiasis