The Poop Problem: Surviving Cyclospora

The Outbreak With over 17,000 cases reported across the U.S., a massive Cyclospora outbreak has taken center stage in public health news, marking it as the third-largest foodborne outbreak in modern American history (behind the 1994 Schwan’s ice cream salmonella outbreak and the 1985 Illinois milk outbreak). Infection causes gastrointestinal symptoms, including diarrhea, bloating, nausea and sometimes vomiting. So, what’s actually driving this surge? Is it safe to eat salad? Pediatric infectious disease expert Dr. Dean Blumberg joins us to break down the science behind the “explosive” symptoms, separate real outbreak epicenters from everyday travel cases, and when to test and treat. Transmission & Geography Mechanism: Cyclospora is a parasite. It is often transmitted via produce contaminated with sewage or irrigation water. Not Person-to-Person: Requires ~1 week in the environment to mature and become infectious. Regional Risk: The epicenter for this outbreak is in the Midwest, related to processed lettuce distribution networks. Outside affected regions, cases remain at expected baseline levels (primarily tied to international travel). Fresh produce consumption remains safe. Pathophysiology & Presentation Cellular Damage: Cyclospora infects and kills small intestine epithelial cells, impairing fluid absorption and causing unabsorbed carbohydrates to ferment into gas. Symptoms: Large-volume, gas-driven “explosive” diarrhea, abdominal bloating, and cramping. Fever is rare; vomiting is variable. Duration: Unlike viral gastroenteritis (1–3 days), untreated Cyclospora can linger for weeks and frequently waxes and wanes. Diagnostic Strategy Routine “O&P x3” tests are obsolete—use multiplex PCR panels (e.g., GI BioFire). When to Test: Symptoms lasting >5–7 days, high-risk patients (infants <12 months, older adults, immunocompromised), fever, bloody stool, or symptoms seriously impacting daily life. (Negative panels can help rule out infectious causes and prompt work up for other etiologies, such as IBD) When to Skip: Patients with 1–2 days of mild symptoms or the “worried well.” Treatment First-Line Agent: Trimethoprim-sulfamethoxazole (TMP-SMX / Bactrim). Indication: Treat anyone who tests positive and remains actively symptomatic to speed recovery and prevent relapses. Reporting: Confirmed cases are automatically reported to public health by the lab. Primary Complication: Severe dehydration and electrolyte derangements (the main drivers of hospitalization). Have you seen many Cyclospora cases? Or an influx of concerned patients with mild GI symptoms? Share your experience with us on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Dean Blumberg, Chief of Pediatric Infectious Diseases at UC Davis Resources: CDC: Cyclosporiasis AAP News: CDC offers guidance on cyclosporiasis outbreaks for clinicians, public July 14, 2026 Melissa Jenco, Senior News Editor *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.