10 Aug 2015

Cyclospora in travellers returning from Mexico

A cluster of cases of Cyclospora infection in travellers who have recently returned from Mexico Cyclospora in travellers returning from Mexico

Public Health England (PHE) and Health Protection Scotland (HPS) are investigating a cluster of cases of Cyclospora infection in travellers who have recently returned from Mexico [1].

Since June 2015, an ongoing outbreak of cyclosporiasis has affected a number of UK travellers who have returned from Mexico, of which most have stayed in the Riviera Maya area of Quintana Roo. The cases stayed at several different hotels (mostly on an all-inclusive basis), suggesting the source is likely to be a foodstuff that has been distributed to hotels throughout the region. Investigations are ongoing.

Cyclospora cayetanensis is a protozoan parasite that infects humans and other primates. Infection can cause diarrhoea, abdominal cramping, nausea, flatulence, loss of appetite, fatigue, low-grade fever, and weight loss. Infection without symptoms is also reported. Infections in HIV positive people and those other immune deficiencies can be more severe.

Infection is commonly derived from food or water contaminated by human faeces. There is no evidence of transmission from animals. Oocysts (a hardy form in the lifecycle of this parasite) are not infectious for around 10 days after they are passed in faeces so person-to-person transmission does not occur. The foods commonly involved are soft fruits such as raspberries and salad products such as coriander, basil and lettuce.

Advice for travellers 

Cyclospora is transmitted through consumption of food or drink that is contaminated with human faeces containing Cyclospora. You should ensure that you maintain good food and water hygiene at all times when visiting Mexico even if staying in high-end all-inclusive resorts.

If possible, choose recently prepared food that is thoroughly cooked and served piping hot. Certain foods should be avoided e.g. fresh uncooked berries/unpeeled fruit and salad items that have not been washed in safe water.

See our food and water hygiene advice and travellers’ diarrhoea information sheet for further information on prevention of diarrhoeal illness.

After returning from Mexico if you have any symptoms such as watery diarrhoea, loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, fatigue and other flu-like symptoms seek medical attention and tell your GP about your travel history.

Advice for health professionals

If a returning traveller from Mexico presents with gastrointestinal symptoms after foreign travel, consider protozoan parasites including Cyclospora as a diagnosis. Testing should be arranged in the usual process through local laboratories and confirmed cases reported to the local health protection team.

The usual recommended treatment for Cyclospora infection is co-trimoxazole [2].

Resources

1. Travel and Migrant Health Section at Public Health England, personal communication 24 July 2015. Health Protection Report volume 9 issue 26: news (24 July). Cyclospora outbreak related to travel to Mexico [Accessed 24 July 2015]

2. Beeching NJ, Jones R, Gazzard B. Gastrointestinal opportunistic infections. In: British HIV Association and British Infection Association guidelines for the treatment of opportunistic infection in HIV-seropositive individuals 2011. HIV Med. 2011 Sep;12(Suppl 2):43-54

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