Diarrhea

• Watery, loose stools happening three or more times per day.

  • One or two loose stools can be normal due to a change in diet.  

• Diarrhea is a common illness for children.

• It is common for children under 4 to have diarrhea one to two times per year.

• Common causes include:

  • Infections. Usually from a virus. Sometimes other infections.  

  • Food intolerance, food allergy, or food sensitivity.

  • Drinking a lot of juice, soda, or other sweetened drinks.  

  • Antibiotics can cause loose stools. This is a common side effect, not an allergic reaction.  

• Uncontrolled anxiety or recurrent high stress levels can cause diarrhea.

• In addition to frequent, watery stools your child might experience the following gastrointestinal symptoms:

  • Abdominal pain, bloating or increased gas.  

  • Blood or mucus in their stool.

  • Decreased appetite. Increased thirst.

• Depending on what is causing the diarrhea, your child might also experience

  • Fever.  

  • Fatigue, increased tiredness, decreased activity level.

  • Vomiting.

  • Rash

• Anti-diarrhea medications are not recommended. They can be dangerous for children.

Information from Cyclosporiasis in Children: Symptoms, Treatment & Prevention - HealthyChildren.org

Click here for a video on cyclosporiasis from the American Academy of Pediatrics.

What is cyclosporiasis?

Cyclosporiasis is an infection of the intestines caused by the parasite Cyclospora cayetanensis. Infection occurs when a person consumes food or water contaminated with feces containing Cyclospora. Fresh produce, including herbs, berries, lettuce and other vegetables, has been linked to outbreaks of infection.

Cyclospora eggs need to mature in the environment for days to weeks before they can infect someone. This is why the infection is not likely to spread directly from one person to another. When we ingest mature Cyclospora eggs, they go to the small intestine. There, the parasites come out of the egg and infect cells in the small intestine and cause disease.

Some of these parasites form new eggs (called oocysts) that are released in the stool (poop), and this cycle is repeated.

What are the symptoms of cyclosporiasis in kids?

The most common symptom of cyclosporiasis is watery diarrhea. The diarrhea can be severe and may come and go over time. Other symptoms may include:

• Loss of appetite

• Nausea

• Stomach cramps

• Bloating

• Excess gas

• Fatigue or low energy

• Weight loss

• Low-grade fever

• Vomiting

• Headache

• Muscle aches or body aches

Some children develop symptoms that improve and then return days or weeks later. Without treatment, symptoms may last for several weeks or even months.

Not everyone infected with Cyclospora develops symptoms. But they can still pass the parasite's eggs in their stool, which can contribute to a continued outbreak.

How do children get cyclosporiasis?

Children become infected by eating or drinking something contaminated with the parasite.

Common sources of Cyclospora include:

• Fresh fruits and vegetables

• Herbs such as basil or cilantro

• Contaminated drinking water

• Food prepared with contaminated water

Most outbreaks in North America have been linked to fresh imported produce. Children may also become infected while traveling to countries where cyclosporiasis is more common.

Can cyclosporiasis spread from person to person?

No. The parasite is passed in stool, but must remain in the environment for about 1 to 2 weeks before it can cause infection in another person.

While someone with Cyclospora is not directly contagious to others, eggs that are shed in the stool can later infect other people through contaminated food or water.

When do symptoms of cyclosporiasis start?

Symptoms typically begin about 1 week after exposure, although they can start as soon as 2 days or as long as 2 weeks or more after infection.

Because symptoms may not appear right away, it can be difficult to identify the food or water source that caused the illness.

How are symptoms different from other stomach bugs?

Most intestinal infections make children feel miserable for a few days and then gradually get better. Cyclosporiasis is different because children often have watery diarrhea, bloating and fatigue that can linger for weeks. Some seem to recover, only to have symptoms come back again.

That unusually long or relapsing course of symptoms is one of the biggest clues that cyclosporiasis may be the cause.

How is cyclosporiasis diagnosed?

Your child's doctor may suspect cyclosporiasis based on symptoms, recent travel and possible exposure to contaminated food or water.

Diagnosis usually requires testing a stool sample for the parasite. Special laboratory tests may be needed because Cyclospora can be difficult to detect. In some cases, more than one stool sample is needed to confirm the diagnosis. Many laboratories now use molecular testing panels that can identify Cyclospora along with other causes of infectious diarrhea.

How is cyclosporiasis treated?

The recommended treatment for cyclosporiasis is an antibiotic medication called trimethoprim-sulfamethoxazole (TMP-SMX). This medication can be used in children age 2 months and older.

Treatment usually lasts 7 to 10 days, although some children with weakened immune systems may need longer treatment.

Children who cannot take sulfa medications should discuss alternative treatment options with their doctor. There are fewer effective alternatives, but other medications may sometimes be considered.

Your child should also drink plenty of fluids to help prevent dehydration from diarrhea.

When should I call the pediatrician?

Contact CPCMG if your child has:

• Diarrhea lasting more than a few days

• Severe or persistent watery diarrhea

• Signs of dehydration

• Unexplained weight loss

• Blood in the stool

• Persistent vomiting

• Fever with diarrhea

• Symptoms that improve and then return

Seek urgent medical care if your child has severe dehydration, is difficult to wake or cannot keep fluids down.

Are some children at higher risk for complications?

Most healthy children recover fully. However, cyclosporiasis can be more serious in children with underlying medical conditions or weakened immune systems, including those who:

• Have cancer

• Received an organ transplant

• Take medicines that suppress the immune system

• Have certain immune disorders

These children may have more severe or prolonged illness and may need closer medical supervision.

How can families prevent cyclosporiasis?

There is no vaccine to prevent cyclosporiasis, but there are steps you can take to help prevent infection.

Steps to reduce your family's risk of Cyclospora infection:

• Use safe drinking water, especially when traveling, and avoid any food or water that may be contaminated with feces.

• Wash hands with soap and water before preparing or eating food.

• In addition, follow food safety recommendations when preparing produce. The CDC advises families to:

• Rinse fresh fruits and vegetables thoroughly under running water before eating, cutting or cooking them.

• Wash produce even if its package label says it is pre-washed.

• Scrub firm fruits and vegetables, such as melons and cucumbers, with a clean produce brush.

• Cut away any damaged or bruised areas on fruits and vegetables before preparing and eating them.

• Refrigerate cut, peeled or cooked fruits and vegetables as soon as possible (within 2 hours).

• Even careful washing of produce may not completely remove Cyclospora, but it can help reduce risk.

Remember

Cyclosporiasis can cause prolonged watery diarrhea, stomach cramps, fatigue and weight loss in children. Because symptoms can last for weeks or come and go over time, it is important to contact your pediatrician if diarrhea does not improve. Prompt diagnosis and treatment can help your child recover more quickly.

• Keep your child up to date with vaccines.

• Encourage frequent hand washing.

• Avoid sick contacts.

• Clean high touch surfaces regularly.

• Avoid sharing food, drink, or utensils.

• Avoid unpasteurized products or contaminated foods.

• Limit or avoid sweetened drinks as a regular part of your child’s diet.

• Your child’s symptoms are getting worse, or your child is having severe abdominal pain.  

• You cannot keep your child hydrated.

  • Your child is urinating less than 3 times every 24 hours.  

• Your child has a fever for five days.

• Your child has blood in their stool.

• Your child has a rash with the diarrhea.  

• Your child has diarrhea for 14 days (about 2 weeks).

• You have noticed your child has diarrhea with a specific food/drink or food group.  

• Your child is having trouble breathing.  

• You think your child symptoms might be related to anxiety or uncontrolled stress.

• You think your child needs to be seen.