28 Jul 2017

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].

This is the third successive year since 2015 that cases of Cyclospora infection have been reported in travellers returning from Mexico [2,3].

In 2017 as of 27 July, 78 cases of Cyclospora have been reported in total of which 37 (47%) have travelled to Mexico. Where information is known, cases have stayed at several different hotels in the Riviera Maya region (mostly on an all-inclusive basis), suggesting the source is again likely to be a foodstuff that has been distributed to hotels throughout the region. Investigations are ongoing.

In addition, in 2017, cases in travellers returning from Mexico have also been reported by Belgium and France [4], and outbreaks of Cyclospora have been reported in the United States and Canada, although it is not clear whether any are travel-associated [5,6].

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 with 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. An infographic with more specific advice is available here.

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

After returning from Mexico, if you have any symptoms such as rapid onset of diarrhoea, loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, or fatigue 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, consider protozoan parasites including Cyclospora as a diagnosis. Testing should be arranged through local microbiology laboratories and positive cases reported to your local health protection team.

The usual recommended treatment for Cyclospora infection is co-trimoxazole [4].

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