A primary care physician's guide to cyclosporiasis, with Molly O'Shea, M.D.

Cyclosporiasis presents like a half-dozen other illnesses that turn up in the summer, but it runs about six weeks without treatment, and the routine ova and parasite panel will not find it. Detection requires a specific stain or a PCR, and most labs will not run either unless a physician asks for it by name.

Michigan records roughly 50 cases of cyclosporiasis in an average year. This summer it has counted thousands, putting the state at the center of what federal officials describe as the largest cyclospora outbreak on record in the United States. Investigators have tied a multistate cluster of infections to recalled iceberg lettuce served at Taco Bell locations and sold at retail.

Medical Economics Senior Editor Richard Payerchin sat down with Molly O'Shea, M.D., a pediatrician who has owned an independent practice in Michigan for more than 30 years and who has served as a spokesperson for the American Academy of Pediatrics and Americans for Healthy Communities, an advocacy organization. O'Shea walks through how the infection presents, what to order and how to have that conversation with the lab, when to treat on symptoms alone, and what to tell patients arriving with questions about ivermectin and cleanses.

The CDC has more. The FDA recall notice can be found here.

Infection Control Today, a sister publication of Medical Economics and Physicians Practice, has the latest on the cyclospora outbreak.

Don't miss our recent episodes on Medicare cuts, women physicians, direct primary care and site-of-service pricing.

Music Credits:

Palm Trees in Cyan Glow by KBH Production - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:12 | Cold open. O'Shea previews the episode's central premise: the reported case counts are almost certainly an undercount.

0:12 – 1:36 | Introduction. Austin Littrell introduces the episode, the guest and the scale of the outbreak.

1:36 – 2:00 | Meet Molly O'Shea, M.D. Richard Payerchin introduces the guest and opens at the beginning.

2:00 – 5:11 | What cyclospora is, and how to make produce safer. A parasitic infection contracted from contaminated fresh produce, not spread person to person. O'Shea covers washing technique, a vinegar solution for raspberries and cilantro, and why she still wants patients eating fruits and vegetables.

5:11 – 6:26 | Does buying local help? Not automatically. You still don't know the irrigation system or the equipment that brought it to market.

6:26 – 8:20 | What it looks like in the office. Bloating, cramping and long duration, and how to separate it from Giardia, enteroviruses and norovirus. Why her practice tells families to wait three or four days before coming in.

8:20 – 9:21 | Why the routine stool panel misses it. Detection takes a special stain, and it will not be run unless it is ordered. Talk to your lab about what to send and in what container.

9:21 – 11:43 | The two-week incubation problem. Why the exposure history is nearly impossible to reconstruct, why dose matters and why O'Shea tells parents to stop trying to trace it.

11:43 – 13:40 | Treatment. Bactrim for about a week, false negatives after long symptom duration and when to treat on symptoms alone.

13:40 – 15:20 | Hospitalization, and how badly cases are undercounted. Who gets sick enough to be admitted, and why dehydration is the complication to watch.

15:20 – 16:11 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

16:11 – 17:04 | What to say about ivermectin. The best available evidence supports Bactrim. Ivermectin has not been studied well enough to place in either the treatment or prevention category.

17:04 – 19:29 | Cleanses and other things patients found online. The body is already doing what a cleanse claims to do, and the added physiologic stress is not warranted.

19:29 – 22:00 | Reassuring worried patients without ordering the test. Listen, acknowledge the worry, then give a plan and say exactly where the test fits in it.

22:00 – 24:55 | The federal surveillance gap. O'Shea on what changed at the federal level in July 2025, what states still require and why she argues the national response has been disjointed.

24:55 – 26:05 | This isn't only a Michigan problem. Why Michigan's counts are high, and why other states' may not be.

26:05 – 28:07 | What a fast federal response would look like. An HHS proclamation, a coordinated information effort and an emergency response team.

28:07 – 32:13 | Fragmented care, Medicaid and who never gets diagnosed. Coverage losses, high deductibles and a shift away from prevention.

32:13 – 34:00 | Closing thoughts and outro. Littrell points listeners to current case counts and the recall notice, then wraps the episode.