Let Us Avoid Cyclosporiasis

**Amina Serna** (0:10)
It's The Brian Lehrer Show. I'm producer Amina Serna, filling in for Brian today. Now we turn to Cyclospora, a parasite going around the summer, and it has a lot to do with what's in your salad. New York City has counted over 400 cases so far since May, many times what it usually sees by midsummer. And more than 30 states are now reporting infections.
And as cases climb, there's still no clear federal guidance on which food to avoid. Our next guest put it even more bluntly. She called the whole situation, and I'm quoting her, a real S show. You can fill in the blank.
With me now to answer your questions and help us stay safe through this Cyclospora outbreak is Katelyn Jetelina, founder and author of the newsletter, Your Local Epidemiologist. Dr. Jetelina, welcome back to WNYC.

**Katelyn Jetelina** (1:05)
Thank you for having me, happy to be here.

**Amina Serna** (1:07)
So, let's start with the basics. What is Cyclospora and just how big is this outbreak right now?

**Katelyn Jetelina** (1:13)
Yeah, Cyclospora is this microscopic parasite and it spreads through food or water that is contaminated with human feces. This parasite doesn't live in other animals, just humans, so we know it comes from that. And once you ingest it, the parasite lives in the gut and our human gut and then is shed through stool. And it's this tough, thick walled shell parasite, which makes it survive on produce for a long time and then also resists simple washing, as well as other sanitizers. Now, we see Cyclospora every year.
In the United States, typically around 3,000 to 4,000 cases for the entire year. And so this single outbreak, which is now depending on where you get your numbers, you know, close to, I think, 7,000, is much more abnormal than usual, and it's still climbing.

**Amina Serna** (2:15)
There's a lot of talk about something that I thought I would never say on air, quote, explosive diarrhea.
But can you talk to us about what Cyclosporiasis actually feels like? I think you were getting to the point that it was, it is shedded in stool. How would someone know if they've got it or not just a regular sort of stomach bug or food poisoning from a local restaurant?

**Katelyn Jetelina** (2:43)
Yeah, it's a really good question because many bugs can cause diarrhea. The most common right now is actually norovirus, and this is spread year round, and it causes similar symptoms, but there are ways to differentiate between the two just through symptomology.
So, cyclospora, what makes it pretty unique is, yes, you're right, you have the watery diarrhea, the cramping, the bloating, the fatigue, but typically you don't get vomiting and a fever is far less common. What's more of a pain with cyclospora is that how long it lasts. So, it will last weeks if untreated and it can relapse. So, symptoms fade and then come back again. There was this outbreak in Nepal and one poor soul had this symptoms for 107 days. And so, it's just it can last a very long time compared to other viruses like norovirus that hits hard and fast, but it's gone in about one to two days.

**Amina Serna** (3:46)
Dr. Jetelina, we have a listener who is diagnosed currently with cyclosporiasis. Jessica, in Ackard, New York.

**Katelyn Jetelina** (3:55)
Hi.

**Amina Serna** (3:57)
Thank you so much for calling in. I hope you're doing all right.

**Jessica** (4:01)
Oh, thank you so much.

**Katelyn Jetelina** (4:01)
I really appreciate it. What's going on?

**SPEAKER_5** (4:04)
I just wanted to comment. I wanted to comment that I've been dealing with this for over two months.

**Jessica** (4:10)
And I've doctor, I've gone to the ER twice.

**Katelyn Jetelina** (4:14)
And it's been just so hard to make this because of course I thought it would be hard. Oh, shoot.

**Amina Serna** (4:20)
Let's see if we can maybe get Jessica to fix her line because I would love to ask her a follow up question. But yes, Dr. Jetelina right there. I mean, as you were saying, but now we have also a personal account. Jessica says she has been dealing with this for two months.

**Katelyn Jetelina** (4:40)
Yeah. I mean, that's pretty normal for this parasite. It is, it comes and goes. It's not very fun.
And now that the outbreak has made a lot of national attention, I hope that more clinicians are aware of it and then can order that test. It also sounded like she went to a lot of clinicians and they didn't know what was going on. And there is a test, unfortunately, is a bit expensive, but hopefully, that there's more education around that. The other thing with cyclospora is that severe cases can actually be treated with antibiotics. There was this randomized control trial that showed that after treatment, the parasites were only detected in 6% of patients compared to 88% in the placebo group. So there is help out there, especially for severe cases. And patients can always ask their clinical care team for their thoughts on those antibiotics.