Released July 30, 2026

About the Episode

In this installment, Dr. Auwaerter provides an overview of the largest cyclospora outbreak ever recorded, offering practical guidance on food safety, when and how to test for cyclospora, and treatment options for confirmed cases.

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Episode Summary

In this episode, Dr. Auwaerter discusses an unusually large cyclospora outbreak that has dominated infectious disease headlines this summer. The FDA has confirmed 1,664 cases, while the CDC estimates over 11,000, making it the largest cyclospora outbreak ever recorded. As of late July, the FDA also flagged a new cluster of 72 additional cases. He notes upward trends in salmonella, E. coli, listeria, and botulinum toxin infections as well, raising questions about whether challenges in CDC reporting or budgetary and personnel cutbacks at the federal and state level may be contributing factors.

For clinicians advising patients, Dr. Auwaerter emphasizes basic food safety: washing hands before food handling, rinsing all raw fruits and vegetables, cooking meats to at least 165°F, keeping chilled items at or below 38°F, and using separate cutting boards for meats and produce.

Cyclospora typically presents as watery diarrhea and is often self-limited, though immunocompromised patients and those with significant comorbidities are at greatest risk. Because norovirus and other pathogens are far more common, empiric therapy is generally not advisable—a confirmed diagnosis is preferred. Routine stool testing will not detect cyclospora. Traditional ova and parasite exams can work, but the lab must be notified to use specific staining methods such as safranin dye and UV light. Some institutions also use monomicrobial PCR assays. Dr. Auwaerter’s preferred approach is FDA-cleared multiplex PCR panels, though not all commonly ordered panels include cyclospora. Those that do include the BioFire FilmArray GI Panel, BioFire Mid Panel, Quiostat Panel 2, Signature EasyScreen Multiplex PCR, and the Leozion Gastrointestinal Flex Assay. Notably, the Cepheid GeneXpert GI Panel does not.

Treatment is straightforward: trimethoprim-sulfamethoxazole for seven to ten days. Alternatives with more limited evidence include ciprofloxacin or nitazoxanide. Dr. Auwaerter expects cases to continue through the warmer months ahead.

About the Presenter

Paul Auwaerter, MD, MBA

Paul G. Auwaerter is the Sherrilyn and Ken Fisher Professor of Medicine at the Johns Hopkins University School of Medicine serving as the Clinical Director for the Division of Infectious Diseases and Director of the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases.

He serves as the Executive Director of the Johns Hopkins Point of Care-Information Technology (POC-IT) Center producing the Johns Hopkins Guides – Antibiotic (ABX) (Antibiotic), HIV, Osler, Psychiatry, and Diabetes Guides. In 2018, Dr. Auwaerter served as President for the Infectious Diseases Society of America, the largest professional society worldwide related to infectious diseases.

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