Hawaii Reports Two New Travel-Related Cyclosporiasis Cases

The Hawaii Department of Health (DOH) has confirmed two new cases of cyclosporiasis, an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis. Health officials report that both cases have been linked to recent international travel, emphasizing the ongoing risk for residents and visitors who travel to regions where the parasite is more common.

Cyclosporiasis is a foodborne and waterborne illness that is typically transmitted through the consumption of food or water contaminated with feces. Unlike some other common foodborne pathogens, it is not generally spread directly from person to person. The parasite is most frequently associated with the consumption of fresh produce, particularly imported berries, basil, cilantro, and lettuce, although it can be found in various environments globally.

Symptoms of the infection usually manifest about one week after ingestion of the parasite. The hallmark sign of cyclosporiasis is watery diarrhea, which can be severe and persistent. Other common symptoms include loss of appetite, weight loss, stomach cramps, bloating, increased gas, nausea, and fatigue. Some individuals may experience vomiting or low-grade fever. If left untreated, the symptoms of cyclosporiasis can last for several weeks or even months, often exhibiting a pattern of improvement followed by a recurrence of illness.

Hawaii health officials noted that these recent cases serve as an important reminder for travelers to exercise caution when visiting areas where the parasite is endemic. Cyclospora is most commonly found in tropical and subtropical regions, including parts of Central and South America, the Caribbean, and Southeast Asia. The DOH recommends that travelers be vigilant about what they eat and drink while abroad.

To reduce the risk of infection, health authorities suggest the "boil it, cook it, peel it, or leave it" rule. Travelers are encouraged to consume only bottled or boiled water and to avoid ice in beverages. When eating out, it is safer to choose foods that have been thoroughly cooked and are served hot. Raw produce should be avoided unless it can be peeled by the traveler themselves, such as bananas, oranges, or avocados. Washing produce in tap water does not guarantee the removal of the parasite, as it is notoriously difficult to eliminate through standard washing techniques.

Diagnosis of cyclosporiasis requires specific laboratory testing, as the parasite is not typically detected during routine stool cultures. Healthcare providers must request a specific test for ova and parasites if they suspect an infection. Once diagnosed, the condition is typically treated with a combination of antibiotics, usually trimethoprim-sulfamethoxazole (TMP-SMX). Most patients respond well to treatment and recover fully, provided they follow the prescribed medical regimen.

While these two cases are specifically linked to international travel, the Hawaii Department of Health continues to monitor for any evidence of local transmission. Public health officials are coordinating with medical providers across the islands to ensure that suspected cases are reported and investigated promptly. This surveillance is part of a broader effort to maintain public safety and prevent the spread of preventable diseases throughout the state.

Residents or travelers who experience symptoms of gastrointestinal distress after returning from international travel are urged to contact their medical provider. It is important to inform the doctor about recent travel history, as this information is crucial for an accurate diagnosis and timely treatment. By staying informed and practicing careful food hygiene while traveling, individuals can significantly lower their risk of contracting this parasitic infection.

Consult a healthcare professional.