Got cyclosporiasis? How to take care of yourself and others

A tiny parasite has made summer a hot mess for thousands of Americans.

Few of them knew its name, Cyclospora, before it launched them into weeks of its namesake disease: cyclosporiasis, which causes recurring diarrhea, nausea, stomach cramps and fever.

Public health detectives in Michigan and other states have used clues from some of those patients to figure out that the infections stemmed from contaminated lettuce supplied to many restaurants and stores.

But even as the investigation continues into the origin of the outbreak, and the suspected lettuce is recalled or expires, many more people could still get sick.

That’s because Cyclospora’s hard microscopic cells can take weeks to “hatch” in your gut, and start to wreak havoc.

It can take weeks to get rid of, even with antibiotic treatment.

Mark Ealovega, M.D., and other primary care clinicians across University of Michigan Health clinics, have helped hundreds of patients cope with cyclosporiasis in recent weeks.

And they expect more to come.

Ealovega, a member of the faculty in the U-M Medical School’s Division of General Medicine in the Department of Internal Medicine ,who sees patients at the Brighton Health Center, shared key insights for anyone affected by cyclosporiasis from the experience of the outbreak so far.

An expert's 8 tips if you have cyclosporiasis

1. Got symptoms that might be cyclosporiasis?

“While frequent, watery diarrhea is the most notorious symptom, cyclosporiasis can also cause abdominal cramping, low grade fever, and nausea,” said Ealovega.

“Most cases will eventually get better on their own, but the symptoms can last for a month or longer if untreated.”

That prolonged misery is reason enough to reach out for care for any child or adult who develops symptoms.

But he emphasizes that the infection can be especially dangerous for people who are older, immunosuppressed or immunocompromised, pregnant, or have other chronic health problems.

Reporting symptoms can also help with tracking the size of this outbreak.

So, no matter what the person’s age or health status, call the person’s primary care doctor's office, preferably by phone, to report the symptoms as soon as possible.

Don’t send a patient portal message, which can take longer to get an answer.

The clinic will guide you on whether they will want to see the patient in person or virtually, if they will have you come in to get a stool (poop) test kit, if the patient qualifies for antibiotics even before a test is done, or if they need to go to an urgent care center or emergency department.

2. Which symptoms of possible cyclosporiasis should make you seek emergency care?

If it’s hard to reach a primary care clinic by phone during nighttime hours or a weekend, or if the person doesn’t have a regular primary care provider, Ealovega says, it can be difficult to know what to do.

“You should seek emergency care if you or your loved one have severe symptoms such as very bad abdominal pain, high fever, or signs of severe dehydration such as severe dizziness or passing out,” he said.

3. Cyclospora poop tests must be handled carefully

To find out if Cyclospora is causing a person’s diarrhea, and not some other cause, doctors can send a sample of the person’s stool (poop) to a clinical laboratory such as Michigan Medicine’s MLabs to be tested.

MLabs, for instance, runs tests for many clinics and health systems, and can detect Cyclospora’s genetic material through sophisticated rapid tests.

But these tests only work if the stool sample is in a special container that comes from the doctor’s office, is sterile until it is opened to put in the sample, and contains a substance that stabilizes the stool until it can be examined in the lab.

Do not bring a stool sample to your clinic in any container other than one given to you for the purpose.

If your clinic gives you a stool test kit, follow the instructions carefully and make sure to handle the sample according to instructions, including getting it back to the clinic within the time limit.

If multiple people in your home are sick and are giving stool samples, make sure each person uses the kit with their name on it.

If your clinic doesn’t order a stool test for you, that’s OK – the outbreak is so widespread that many doctors have started assuming that most people with diarrhea lasting more than 48 hours have cyclosporiasis.

4. Hydrate, hydrate, hydrate

“You can become dehydrated very quickly from Cyclospora infection, and it is very important to focus on excellent hydration,” said Ealovega.

The best drinks to choose are water, juice (diluting them with water), broth or sports drinks, he says.

For people whose diarrhea is especially frequent, an oral rehydration solution such as Pedialyte and Liquid IV may be helpful.

SEE ALSO: The hidden life of parasites like Cyclospora | Michigan Medicine  

Keep in mind that sports drinks such as Gatorade aren’t the same as oral rehydration solution.

You can also make a homemade oral rehydration solution using a recipe available in the Michigan Medicine patient education library’s diarrhea nutrition therapy handout.

5. Don’t use anti-diarrhea medication for suspected or known cyclosporiasis unless a health care provider says OK

If your clinician is ordering a stool test, some medications can interfere with the results of one type of test, which looks for signs of parasite cells.

Also, diarrhea is your body’s way of getting rid of the parasite.

That’s why it’s important to call the clinic when symptoms start to determine your course of action, and “hold off on any anti-diarrheal medications unless instructed to take it by your healthcare provider,” said Ealovega.

If they say it’s OK to take medications such as loperamide (sold as Imodium or store brand), bismuth subsalicylate (sold as Pepto-Bismol, Kaopectate or store brand), follow the instructions on the label carefully.

Probiotic supplements have not been shown to help with diarrhea caused by an infectious parasite.

6. Antibiotics can help, but you must follow the instructions

Because of the cyclosporiasis outbreak, the U-M Health Infectious Disease Division has put together comprehensive guides for clinicians about testing and using antibiotics in children and adults with infectious diarrhea, which they’ve made available for any clinician to use.

In general, most children and adults with diarrhea during a cyclosporiasis outbreak can receive an antibiotic combination called Bactrim, or TMP/SMX (trimethoprim/sulfamethoxazole).

Even though antibiotics are usually used against bacteria, not protozoa (which is what Cyclospora is), the drug combination works.

“TMP/SMX works by sequentially blocking the parasites’ ability to make folate, and since it can’t use the host’s folate, it dies,” explained Lindsay Petty, M.D., Clinical Associate Professor in the Division of Infectious Diseases.

If a health care provider prescribes Bactrim to you or a loved one, it is very important to take it for the entire seven days of the prescription.

Do not stop early, even if symptoms go away before the last dose.

And do not share pills with anyone else.

People who are immunocompromised may need to take Bactrim for more than seven days.

Children over the age of 1 and adults who are allergic to sulfa drugs, which Bactrim contains, can take a different antibiotic, which may be somewhat effective.

7. If you're contacted by a public health agency, answer!

The probable source of the summer 2026 cyclosporiasis outbreak was found because people who got sick answered calls and texts from ‘disease detectives’ at the state health department.

This kind of sleuth work is critical to tracing outbreaks to their source, so that food producers, distributors, restaurants and stores can pull the contaminated product and prevent more illness.

Michigan’s public health department was able to contact individuals because clinics like Ealovega’s, and hospitals, are required to report positive tests for cyclosporiasis to the health department in their county, which are then required to report them to the state.

But if people don’t respond to calls and texts in outbreaks like this one, it can take longer to find the source of the problem.

The state health department continues to share updated data on cyclosporiasis cases every weekday, and county-level breakdowns weekly.

Although the source of this outbreak may be mostly solved, this is a good reminder of the importance of testing, reporting, and cooperation with public health “contact tracing” for all kinds of infectious diseases.

8. Don’t take food safety for granted