Carl Maronich (Host): This is the Kirby Connections Health podcast, where we help you nourish your wellness journey with Kirby Medical Center. I'm Carl Maronich. And with me are Leslie Sheets, Director of Quality and Infection Prevention, and Lisa Castang, Director of Laboratory Services, both from Kirby Medical Center. And today, we're going to be talking about cyclospora, what it is, how it spreads, how it's detected and maybe most importantly, what you can do to protect yourself and your family. Leslie and Lisa, welcome to the podcast.

Lisa Castang, MLT/MBA: Thank you. Thanks for having us, Carl.

Leslie Sheets, RN, BSN, MPH: Thanks, Carl.

Host: Great to see you both. Maybe we should start by kind of explaining what cyclospora is how this parasite differs from other familiar causes of foodborne illness such as salmonella.

Leslie Sheets, RN, BSN, MPH: Yeah. So, I'll take that one. So, cyclospora is a parasite that infects the human through the intestinal tract. It's picked up via environmental factors on fruits, vegetables, food from contaminated water supply. So, what makes cyclospora very interesting and very different from other things, say like salmonella or another parasite, giardia, is that it needs an environmental timeframe about one to two weeks in just the right environmental conditions in order to become infectious.

So, you know, straight from person to person is unlikely to be infectious. But once it gets that time in the environment, those right temperatures between 70 to 90 degrees in the environment, that's when it turns itself into being infectious.

Host: From an infection control perspective, why is cyclospora considered dangerous or particularly problematic compared with other diarrheal infections?

Leslie Sheets, RN, BSN, MPH: It's infectious, just because, you know, it's so easily transmitted through contaminated sources. And then, it makes its way, you know, to the market before anybody realizes. And so, it's just not great in terms of its ability to detect either.

Lisa Castang, MLT/MBA: Right. I was going to say it's hard to detect it on produce or whatever might be contaminated with it. And then, once it's ingested and it gets into the intestinal tract, it lingers. It can be there for a long time. Where other diarrheal infections might be 24 to 72 hours, cyclospora seems to affect people for much longer. It can last for up to a week or weeks before it finally rids itself of the body and/or lasts its life cycle, which that's a long time to be sick and to have diarrhea, and it can just wear people down. People that are immunosuppressed, just it really, really takes them for a toll. And so, I think that's another danger with cyclospora.

.

Leslie Sheets, RN, BSN, MPH: Yeah, it's not something common that we think about either. So, you know, it can be a while before people, you know, actually go and get tested for something and figure out that they have this.

Host: I understand cyclospora can be hard to detect with routine stool samples. What specific laboratory methods or technologies are now available, and how reliable are they?

Lisa Castang, MLT/MBA: There's an ova and parasites test that is done by taking stool and making a slide with it and then staining it with particular stains. And certain parasites can be identified that way rather easily, because those parasites aren't necessarily microscopic. You can see them with the human eye. Cyclospora is a microscopic intestinal parasite. It can be missed on some of those tests where it's just a slide looking at stain. PCR testing is very accurate, and some of the molecular tests that are out there that are running PCR and DNA amplification. It's going to be identified or detected that way.

Host: And Lisa, what is a PCR test exactly? How does that differ from other tests?

Lisa Castang, MLT/MBA: It's actually taking DNA from the organism and amplifying it to a detectable level. And most laboratories nowadays have molecular testing available. So, providers just need to know to order the PCR test if they're often called a GI panel, gastrointestinal panel, that have several targets that are detectable. And the one here at Kirby that we have has Cyclospora as a target. So, it can be identified via that test.

Host: What symptoms should patients and families watch for that would make them suspect cyclospora rather than a simple stomach bug?

Leslie Sheets, RN, BSN, MPH: I think just that persistent watery diarrhea, that's one of its key features is that diarrhea is a really big aspect, because that spore really infects the lining of the intestines and creates the inability to absorb things. And so, water is one of those things that doesn't get absorbed as it should.

So really, that persistent watery diarrhea, as Lisa said, it can last for, you know, a week to many weeks. They want to look for things like loss of appetite, just not feeling hungry and feeling you know, very poorly. You might find weight loss, you know, have abdominal cramping. You could have some bloating, some excessive gas, nausea and, of course, fatigue or a lot of things that come with just that diarrhea in and of itself.

So, really just, again, the watery diarrhea and it being persistent and it could start. And then, it could seem like it gets a little bit better and then start again. So that's one of those key features is, that, you know, those symptoms can kind of wax and wane. So, you want to get in as soon as possible if you're just not getting a resolve of symptoms within, you know, three to five days or so, you really want to start looking into that.

Lisa Castang, MLT/MBA: The relapse is a big clue that you might be dealing with cyclospora, because terrible for a couple days. And then, it maybe kind of goes away. And then, it relapses. And no other stomach bugs that I know of do that. You're just sick and then you get better. But this one can, like Leslie said, it can wax and wane. And that's when you might want to go get tested.

Host: And for a patient who is diagnosed with cyclospora, what is the standard treatment? How long does it typically last? And when do patients start feeling better in the process?

Leslie Sheets, RN, BSN, MPH: Yeah. Treatment for cyclospora would be antibiotic use. Usually, Bactrim is the most common. There are some other ones that can be used. So usually, antibiotics for about seven to 10 days. Of course, you know, every person might be a little bit different depending on their other conditions that might be impacting their ability and their health. But that's typically antibiotics for about seven to 10 days.

Host: I'll just ask at this point, this is something that standard internal medicine docs, primary care docs can diagnose and treat. This isn't something that folks have to go to the big city to get taken care of. Would that be accurate?

Leslie Sheets, RN, BSN, MPH: Yeah, definitely. This is something that we can treat here at Kirby and use our lab specialties. The state lab will also, you know, can run some tests too if for some reason that needs to be taken to the state lab. But yeah, here at Kirby, we can get you all taken care of.

Host: At home, what are some practical steps that families can take to reduce their risk from fresh produce and other things? Washing certainly. But what would you recommend that families do to kind of, you know, be on the preventative side?

Leslie Sheets, RN, BSN, MPH: The number one thing for me is hand hygiene, right? That's a really important thing, and not only for this. But for, you know, so many other things that can help prevent the spread of illness. So, hand hygiene. If you have produce that you're getting in or fruits and vegetables, you really want to wash them thoroughly. Scrub those as well as you can. If they have a lot of bumps and grooves in their surfaces, I mean, you really want to take extra caution with that. Unfortunately, there's not a lot of washes or anything out on the market that can prevent you from getting sick from this with your fruits and vegetables.

So, you may just want to be a little bit pickier and choosier about what you're eating and what you're serving to your family. Of course, if you're having any of the symptoms that we talked about, you want to avoid food preparation in general. Again, that goes really for any GI symptoms that you're having. But especially for this one, you don't want to be not passing that on through your own illness to your family.

So, hand hygiene and washing your fruits and vegetables and staying knowledgeable about what products are affected by something like this cyclospora outbreak. And then, again, maybe avoid those on the market.

Host: Good advice. And any last words you want to share with folks watching this to make sure they understand clearly what they're up against with cyclospora?

Leslie Sheets, RN, BSN, MPH: Again, I'll just reiterate hand hygiene is just so critically important, especially as we go, you know, school's starting back in . And hand hygiene and just washing things. You just never know what country they've come from or who's touched them. Again, because even just the people who are harvesting the fruits and vegetables, their hands could be unsanitary.

And so, that's a way that, you know, this can get onto fruits and vegetables. So, you should always eat things that you eat raw, wash them very thoroughly before eating them.

Host: Great advice. Leslie Sheets, Lisa Castng, thanks so much for joining us from Kirby Medical Center with a lot of great information.

Lisa Castang, MLT/MBA: Thanks for having us, Carl.

Host: And for more information, go to kirbyhealth.org. If you enjoyed this podcast, please share it on your social channels and check out the entire Kirby Connections Health Podcast library for topics of interest to you. And this is the Kirby Connections Health Podcast. Thanks for listening.