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 feeling: "Doctor, for the past two days I haven't been able to leave home, diarrhea comes suddenly, very liquid and strong, I barely have time to get to the bathroom. I have cramps, nausea, no strength for anything. I saw on the news that there's an outbreak here. 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 serve this community from a distance. And yes, there is a real outbreak happening there right now. I will 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 (Centers for Disease Control and Prevention of the USA) 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 hospitalized. New York has the highest number of 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 registering, in just a few days, more than 170 cases across seven counties, a number well above the state's historical average.

The important point: most patients had not traveled 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 fresh vegetables and fruits contaminated, probably by water or soil with fecal residue during cultivation, transport, or handling of food. So far, the CDC and FDA have not been able to identify a single source to explain all cases, and the investigation continues.

Why this parasite causes an "explosive" diarrhea

The name caught attention because that is exactly how the health agencies themselves describe the main symptom: watery, frequent evacuations and, in many cases, very intense ones. 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 working 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 diarrhea, the most common symptoms are:

  • Abdominal cramps
  • 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 emphasize to patients: symptoms can come and go in cycles, disappearing for a few days and returning later, which confuses those trying to understand whether they have already improved or not.

Is there a risk of this reaching Brazil?

Here is the information that matters most for those reading from Brazil or thinking about traveling: cyclosporiasis is not a new disease or exclusive to the United States. It is already known and occurs sporadically in various countries, including Brazil, generally linked to consumption of contaminated water or raw food, especially leafy greens, fresh herbs, and imported fruits. In other words, we're not talking about a completely new agent that "will arrive" by plane, but 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 characterize 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 feces. 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 USA now

For those living or traveling 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 appear clean, before consuming
  • Prefer well-cooked foods when eating at restaurants or events with large crowds
  • Prefer filtered water or from safe sources, avoiding ice of questionable origin
  • Pay attention 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 begin experiencing persistent watery diarrhea, the first concern is hydration. Drinking water, oral rehydration solution, or fluids 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 greatly with recovery.

Seek medical attention or go to a hospital when:

  • Diarrhea 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 stool
  • Fever is high or persistent
  • You are part of a risk group, such as pregnant women, elderly people, small children, or people with low immunity

The diagnosis is made through a stool test, and treatment is usually done with a specific antibiotic, generally effective and with good response when started in time. In most cases, with adequate hydration and correct treatment, recovery is complete and without lasting effects.

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

It is not cause for panic, but it is cause 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 away from Brazil, especially in the United States at this time, it is worth taking extra care with what you eat and drink. And if you return from a trip with gastrointestinal symptoms that don't go away, don't ignore it: seek medical evaluation.

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

Dr. Rebeca Soares Andrade CRM - GO 39335