Latest / Culture Positive: An Infection Prevention Podcast / GI Jane vs. Cyclospora
Transcript
- Ally: Thank you for listening to Culture Positive. If you have any questions or ideas for an episode, please send me an email at culturepositivepod at gmail.com. References for the episode can be found in the show notes. Infection prevention is about more than policies and protocols. It's about people. Until next time, stay curious. If you have been listening to the podcast, you might remember that my first job out of grad school was at the Massachusetts Department of Public Health. I applied to so many jobs. I'm talking about 60 jobs before I got an interview and an offer from the state in the Bureau of Infectious Diseases. Welcome to Culture Positive, an infection prevention podcast where healthcare, public health, and real life meet. I'm Allie, and by day I work in infection prevention at an academic hospital, bringing my background in epidemiology and public health into everyday practice. Each episode will dive into healthcare stories. I was so excited to start working in the field and was extremely grateful for the opportunity. Public health conversation, workplace reality, historical context, and the human side of this work. This is a space for curiosity, honesty, and hopefully some inspiration. I'm glad you're here. Stay compassionate and keep building a culture that's truly positive. I was hired as a contractor to focus on foodborne-related illnesses. I would often call individuals who, along with reporting GI symptoms, had also tested positive for a foodborne illness. I'm gonna be honest. I never thought I would talk so freely about diarrhea, but here we are. During my interviews with a member of the public who had contracted a foodborne illness, I would utilize a form specific to that organism to lay the groundwork for a possible epidemiological investigation. Some questions I would ask could be what foods they had eaten in the past two weeks, where they bought their groceries from, any interactions with livestock. recent travel, domestic or abroad, if they went out to eat, you get the gist of the questions. I would then share any findings with the CDC via an online portal and then a task group the CDC would monitor data being submitted from across the country for any trends. I don't want to brag, but This contract position did have a nickname. I was known as GI Jane. I thought I had retired my GI Jane days, but have you heard about the multistate outbreak of cyclospora in the United States? GI Jane reporting back for duty. Let's get into it. Before I start, I want to thank my friend and listener, Emily, for requesting this episode. Friendly reminder, please send any episode ideas, feedback, or questions to culturepositivepod at gmail.com. I look forward to hearing from you. Back to what you came here for, cyclospora. Cyclospora is a parasite that causes a gastrointestinal infection. Like many foodborne illness organisms, symptoms can include abdominal bloating, nausea, fatigue, diarrhea, vomiting, and other flu-like symptoms. Depending on the host, Symptoms are reported to be mild up to severe. In most cases, hosts or individuals who have a weakened immune system have an increased likelihood to experience more severe symptoms. The incubation period for cyclospora has an average of seven days, but can range from two days to two weeks or more. Remember the incubation period is the time between exposure and the first sign of symptoms. For this reason, when we do an investigation on cyclospora, we like to interview cases about their travel and exposure to various food items starting 14 days prior to the first sign of symptoms. In terms of transmission, it is probably no surprise that cyclospora is transmitted via contaminated foods, but it can also be transmitted through contaminated water. When thinking about contaminated food in regards to cyclospora, typically we think about fresh herbs, berries, and leafy greens. With water contamination, This is sometimes linked to drinking untreated water or unintentionally swallowing water from hot tubs, pools, or lakes. Oftentimes, cyclospora is a seasonal illness, with cases usually peaking in the summer months of May to August. In terms of treatment, antibiotics are prescribed and typically individuals feel better after a week or two. If cyclospora goes untreated, symptoms can last for a month or even longer. If you have a patient in the hospital with cyclospora, they do not need to be on isolation while hospitalized. If you do have a patient with cyclospora, I hope it is not hospital acquired or you're about to have a full investigation into the food you provide to your patients. The first documented human cases of cyclospora were recorded in 1979 from a British parasitologist who was working in Papua New Guinea. At the time, under the microscope, the parasite looked similar to fungal spores, so these first cases were initially overlooked. There were a few papers here and there talking about the obscure organism. And an example of this happened during the beginning of the AIDS epidemic. More reports started popping up in the early nineteen nineties with individuals who were well known travelers and also those with AIDS who were reporting large volumes of watery diarrhea. As mentioned earlier, those who are immunocompromised, like patients with AIDS, this parasite can be devastating and can contribute to weight loss and severe dehydration. Initial cases with AIDS patients were misdiagnosed as cryptosporidium to similar and staining characteristics in laboratory testing. Cyclospora was officially classified in nineteen ninety-two and has been a reportable disease in the United States up until 2025. Analyzing Cyclosphora trends over the last several years, we have seen a steep increase in reported cases. Part of that has to do with our advances in testing for various GI illnesses, more specifically, an increase in the use of sensitive molecular diagnostic methods, like the BioFire GI panel, which received clearance from the FDA in 2014. Two key words you will often hear when talking about panels or tests are sensitivity and specificity. Sensitivity is a test's ability to correctly identify people who have the disease, while specificity is the test's ability to correctly identify people without the disease. Going back to the Biofire GI panel. This test has incredible accuracy with around 98% sensitivity and ninety-nine percent specificity. If you come back positive on the GI panel for Cyclospora, say a prayer, you've got cyclo. For several years, cyclospora was a reportable disease. This means an organism that is monitored at a state and federal level. If an agency starts to see an increase in cases, more investigations may take place, especially if there's an outbreak. In the United States, we unfortunately do not have a ton of data on past outbreaks. From what I was able to gather from my research, a few outbreaks in the last 20 years have had a thousand cases or greater. There are actually a few outbreaks where public health professionals were able to pinpoint a cause for the outbreak. A more recent outbreak in 2019 was linked to basil from Mexico. This outbreak is a great example of the importance of public health surveillance and the incredible work of our partners and laboratories. So, how were they able to link the 2019 outbreak of Cyclospora to basil for Mexico? In late 2019, 2,408 domestically acquired Cyclospora cases had been reported to CDC. That is the largest peak season case total since 1999. Several small clusters were identified. Individuals reported eating at certain restaurants and also public events where food was served. This is when traceback work begins. ⁓ An investigation where epidemiologists or public health professionals trace contaminated food products back to where they came from. Think supply chain. Where was the food distributed from? Was there a processing plant? Or did this food item come straight from a farm? For the 2019 outbreak of cyclospora, public health investigators noted that some restaurants, not all, got their basil from a single distributor. This distributor was an international one that was noted to send products throughout the United States. Around 10% of all US cyclospora cases from the two thousand four hundred and eight cases could be linked back to the international distributor and their fresh basil. Other cases could not be assigned to a specific outbreak due to lack of epidemiological data that CDC had at the time. Part of this investigation is, of course, the interviews and work done by epidemiologists, but lab technicians also played a pivotal role. Speaking of our lab partners, something that was used in the investigation and is currently available is test. ⁓ Known as target amplicon sequencing, also known as TAS. Essentially, TAS is able to look at different genetic markers almost like a fingerprint for the organism. In the case of the 2019 outbreak, different samples that were submitted for further testing were able to be compared to each other in their genetic markers. Similar genetic markers were observed and could be traced back to the basil from Mexico. Science is so cool. Since the FDA's approval of the sensitive molecular test, the bio-fire GI panel I mentioned earlier, we have doubled and sometimes tripled reported cyclospora cases from previous years. The more access there has been across the country for this kind of testing, an increase in reported cases has continued. Even when looking at 2020, We do not see a decrease of cyclospora cases in the United States. With COVID nineteen taking center stage, there was widespread decrease in reports of other foodborne organisms, not cyclospora. This year though, we are seeing more than just an increase due to having more testing available. We have an outbreak on our hands. As of july tenth, 2026, over 3,000 cases of cyclospora across 32 states have been reported when looking at information provided by state health departments. However, the latest from CDC reports that as of July 9th, there are 893 cases. The state of Michigan alone is reporting over 1,200 cases. For just the date of July 8th, Michigan Department of Health and Human Services reported 239 cases. To give some perspective, Michigan typically reports around 50 cases a year of cyclospora. Why are the numbers so different when we look at state health departments and what the CDC is reporting? If you have paid attention to the news at all, you have probably picked up on how much change and chaos has occurred with this current administration. Since this is a healthcare and public health podcast, I'm going to focus on the lack of funding and resources that has occurred for our sectors. One of the several things that has happened is the scaling back of the Foodborne Disease Active Surveillance Network. Also known as FoodNet. FoodNet is a public health collaboration between 10 state health departments, the CDC, USDA, and FDA. FoodNet works to track foodborne illnesses and in case of an outbreak, works to identify the source of the illness. This is an incredible network that allows for public health officials to keep a pulse on trends. in the United States and also promotes collaboration between federal agencies and state governments. FoodNet was established in 1995, and they worked to complete surveillance of eight foodborne pathogens: Campibacter, Cyclospora, Listeria, Shigella, Vibrio, Yersinia, Salmonilla, and Chigatoxin-producing E. coli. However, as of July 1st, 2025, FoodNet was told to scale back. And could only complete surveillance on salmonella and shigatoxin producing E. coli. This was due to lack of funding to the CDC. There were concerns with professionals in the field that with a step back in surveillance, We would lose the ability to compare trends over time, ⁓ not be aware of cases rising, ⁓ and there be a lag in identifying and to future outbreaks. Hitting a little too close to home, no. So while it may seem that Michigan, for example, is at the epicenter, we don't really know a true case count since reporting is no longer required for Cyclospora. For Cyclospora and the five other organisms that CDC now deems as optional to report, we do not have a clear picture of what is currently going on. When it comes to foodborne illness in the United States. As of this recording, this is still an ongoing outbreak investigation, with no clear source reported. So, how can you protect yourself? As always, please wash your hands with soap and water, especially before and after handling any raw vegetables or fruit. Wash your fruits and vegetables thoroughly before cutting. Cook your fresh produce if possible. This is the most effective way to eliminate the parasite. And a personal recommendation, if you have access to a farmers market or local farmers, please support them. Since this is an outbreak occurring across 32 states, it is likely that the source is from a large distributor. So go support those local farmers. For our huddle corner, a section for some takeaways before signing off, Cyclospora is still a relatively new parasite with it being officially classified in 1992 If patient is hospitalized and they have cyclospora, they do not need to be on isolation, but please make sure to wash your hands with soap and water. Although we have improvements in testing, our surveillance for foodborne illnesses in the United States has greatly decreased due to the lack of funding for the CDC and FoodNet. Hopefully this will change in the future, but in the meantime, Please make sure to wash your produce thoroughly and support those local farmers.