Cyclosporiasis presents like a lot of other summer illnesses, but it runs six weeks untreated and the routine ova and parasite panel will not find it unless you ask your lab specifically.

Molly O'Shea, M.D., has owned an independent pediatric practice in Michigan for more than 30 years, putting her at the center of the largest cyclospora outbreak on record in the United States. She talks with Medical Economics Senior Editor Richard Payerchin about 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. She also explains why she believes reported case counts substantially understate what is happening in the community.

CDC tracking: https://www.cdc.gov/cyclosporiasis/index.html
FDA recall: https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/taylor-fresh-foods-recalls-iceberg-lettuce-central-mexico-because-possible-health-risk

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 walks through 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. How to separate it from Giardia, enteroviruses and norovirus, and 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 requires 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 she 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 isn't 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 What changed in July 2025, what states still require, and why O'Shea says the national response has been disjointed.

24:55 – 26:05 | This isn't only a Michigan problem Why Michigan's counts are high and 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, and wraps the episode.

S1 Ep172: A primary care physician's guide to cyclosporiasis, with Molly O'Shea, M.D.

Off the Chart: A Business of Medicine Podcast

S1 Ep172: A primary care physician's guide to cyclosporiasis, with Molly O'Shea, M.D.