HAN 07/16/26

Consider Cyclosporiasis in Patients Presenting with Prolonged or Relapsing Watery Diarrhea

Summary

On July 14, 2026, the Centers for Disease Control and Prevention (CDC) issued a notice about a significant increase in domestically acquired cyclosporiasis cases in multiple U.S. states. To date, 11 cases have been reported in Alabama. Two are international travel-related, and one is foodborne outbreak-related. No hospitalizations or deaths have occurred.

Cyclosporiasis is a gastrointestinal illness caused by the parasite Cyclospora. Infection occurs when people consume food or water contaminated with the parasite. Symptoms typically begin about one week after exposure and include frequent watery diarrhea, loss of appetite, weight loss, bloating, nausea, and fatigue. Person-to-person transmission is uncommon. Past outbreaks have been linked to contaminated fresh produce, including cilantro, basil, leafy greens, green onions, raspberries, and snow peas.

The Alabama Department of Public Health (ADPH) recommends that healthcare providers test patients with prolonged or relapsing watery diarrhea for cyclosporiasis, especially during cyclosporiasis season (May–August), even without a history of international travel. Clinicians should specifically request diagnostic testing for Cyclospora when clinically suspected.

Recommendations for Clinicians

• Ask patients with suspected or confirmed cyclosporiasis about their recent food and travel history to assist local investigations.
• Request Cyclospora testing on stool specimens, as routine ova and parasite (O&P) exams may not reliably detect the parasite. Consider molecular (PCR-based) testing if available.
• Treat confirmed cases with 7–10 days of trimethoprim-sulfamethoxazole (TMP-SMX) for immunocompetent adults and children over two months old. Consider longer courses for immunocompromised patients. Refer to the current CDC clinical guidance for dosing recommendations.
• Advise patients to stay well hydrated, especially if diarrhea is frequent or severe.
• Report cyclosporiasis cases to ADPH via the REPORT Card for Reportable Conditions.

ADPH Cyclosporiasis Data, 2021-2026 Year-to-Date (YTD*)

This table summarizes cases reported over the last five years, as well as cases reported year-to-date this year, compared with the same period in the previous calendar year.

*Includes data reported through July 15, 2026

For More Information

• Cyclosporiasis | CDC
• Surveillance of Cyclosporiasis | Cyclosporiasis | CDC
• Cyclosporiasis Outbreak with Unknown Source | Cyclosporiasis | CDC
• Clinical Care of Cyclosporiasis | Cyclosporiasis | CDC
• Preventing Cyclosporiasis | Cyclosporiasis | CDC
• REPORT Card for Reportable Conditions