Imagine the following scene: a Brazilian woman who has been living in Florida for three years arrives at a consultation visibly distressed and embarrassed as she describes what she is experiencing: "Doctor, for two days I haven't been able to leave home, the diarrhoea comes suddenly, very liquid and severe, I barely have time to reach the bathroom. I have cramping, nausea, no strength for anything. I saw on the news that there's an outbreak happening there. Could it be that?" It's not the first time. With the number of Brazilians living in the United States today, it's natural that this type of news reaches us doctors who attend to this community from a distance. And yes, there is a real outbreak happening there right now. I'll explain everything you need to understand, without alarmism, but with the attention this topic deserves.

What is happening in the United States

Since May, the CDC (Centres for Disease Control and Prevention of the United States) has been monitoring a significant increase in cases of cyclosporiasis, an intestinal infection caused by the parasite Cyclospora cayetanensis. There are already more than 300 confirmed cases spread across several states, with at least 20 people hospitalised. New York accounts for the highest number of reported cases, but there have also been notifications in Michigan, Pennsylvania, New Jersey, Florida, Texas, Colorado and other locations. Michigan, in particular, drew the attention of authorities by recording, in just a few days, more than 170 cases across seven counties, a number well above the state's historical average.

The important point: the majority of patients had not travelled outside the United States in the weeks before symptoms appeared, which indicates that contamination is occurring within American territory itself. The authorities' main suspicion is the consumption of contaminated fresh vegetables and fruits, probably from water or soil with faecal residue during cultivation, transport or handling of food. So far, the CDC and FDA have been unable to identify a single source to explain all cases, and the investigation continues.

Why this parasite causes "explosive" diarrhoea

The name drew attention because it is exactly how the health authorities themselves describe the main symptom: watery, frequent evacuations and, in many cases, very intense. I'll explain the reason in simple terms: Cyclospora settles in the wall of the small intestine and inflames the mucosa responsible for absorbing water and nutrients. When this "sponge" stops functioning properly, the intestine begins to eliminate much more liquid than it should, and that's where the urgency and volume of evacuations come from.

In addition to diarrhoea, the most common symptoms are:

  • Abdominal cramping
  • Nausea and, in some cases, vomiting
  • Loss of appetite and weight loss
  • Intense fatigue
  • Low-grade fever and headache, in some cases

A detail I usually emphasise to patients: symptoms can come and go in cycles, disappearing for a few days and returning later, which confuses those who are trying to understand whether they have already recovered or not.

Is there a risk of this arriving in Brazil?

Here is the information that matters most for those reading from Brazil or planning to travel: cyclosporiasis is not a new disease nor exclusive to the United States. It is already known and occurs sporadically in various countries, including Brazil, generally linked to the consumption of contaminated water or raw food, especially leafy greens, fresh herbs and imported fruits. In other words, we are not talking about a completely new agent that will "arrive" by plane, but rather a parasite that already circulates in our environment on a smaller scale.

What can happen, yes, is the following scenario: a Brazilian who was in the United States, ate something contaminated there, enters the incubation period (which can take one to two weeks) and only develops symptoms after already being back in Brazil. This does not characterise the spread of the American outbreak here, but rather an isolated imported case. Person-to-person transmission is rare, because the parasite needs time in the environment to become infectious after being eliminated in faeces. This greatly reduces the risk of an outbreak spreading like a respiratory virus, for example.

How to prevent it, especially if you are in the United States right now

For those living or travelling in the United States at this time, some measures make all the difference:

  • Wash your hands thoroughly before eating and after using the bathroom, with water and soap, scrubbing for at least 20 seconds
  • Carefully wash raw fruits and vegetables, even those that look clean, before consuming
  • Prefer well-cooked food when eating at restaurants or events with large crowds
  • Prefer filtered water or from safe sources, avoiding ice of dubious origin
  • Be alert to recall alerts for leafy vegetables and fruits issued by local health authorities

What to do if symptoms appear

If you are Brazilian and are in the United States and start experiencing persistent watery diarrhoea, the first care is hydration. Drinking water, oral rehydration solution or liquids with electrolytes is essential, because the greatest risk of this disease is not the parasite itself, but the dehydration it can cause. Rest and a light diet, avoiding dairy products, fried foods and very fatty foods while the intestine is inflamed, also help a lot in recovery.

Seek medical attention or go to a hospital when:

  • Diarrhoea lasts more than two or three days without improvement
  • There are signs of dehydration, such as dry mouth, dizziness, dark urine or absence of urine for several hours
  • Blood appears in the faeces
  • The fever is high or persistent
  • You are part of a risk group, such as pregnant women, the elderly, small children or people with low immunity

Diagnosis is made by stool examination, and treatment is usually done with a specific antibiotic, generally effective and with good response when started promptly. In most cases, with adequate hydration and correct treatment, recovery is complete and without complications.

What I, as a physician, want you to take from this news

It is not a reason for panic, but it is a reason for attention. Outbreaks like this remind us that food hygiene and hand washing remain, decades later, one of the most powerful measures in preventive medicine. If you are outside Brazil, especially in the United States at this time, it is worth redoubling care with what you eat and drink. And if you return from a trip with gastrointestinal symptoms that do not go away, do not dismiss them: seek medical evaluation.

This content is exclusively informative and educational in nature, based on the most recent data released by the CDC (Centres for Disease Control and Prevention of the United States). It does not replace a medical consultation. If you are experiencing symptoms, seek medical attention for an individual evaluation.

Dr Rebeca Soares Andrade CRM - GO 39335