SPECIAL NOTICE
CYCLOSPORA TESTING TURNAROUND TIME NOTICE
Due to the current Cyclospora outbreak and the resulting increase in testing volume, turnaround times (TAT) for Cyclospora stool testing have been temporarily extended. Testing remains available at Michigan Medicine Laboratories. Please anticipate a turnaround time of approximately 2 days from specimen receipt in the laboratory, compared with our usual TAT of 1 day. This timeframe is subject to change and may be further affected by increases in testing demand, as well as supply chain availability of collection materials and testing reagents. We appreciate your patience and understanding during this period and will provide updates as soon as testing volumes return to normal and standard turnaround times resume.
CYCLOSPORA TESTING GUIDANCE: HOW MICHIGAN MEDICINE CLINICIANS ARE NAVIGATING CYCLOSPORA
Cyclospora stool testing remains available at Michigan Medicine Laboratories; however, to help improve testing availability and access to treatment Michigan Medicine is recommending the following temporary guidance for our adult patients (>= 18 years). For pediatric patients, clinicians should follow existing test then treat guidance.
Test the following groups:
- Immunocompromised patients*
- Patients with relative or absolute contraindications to TMP/SMX (trimethoprim-sulfamethoxazole; Bactrim; Septra), including patients with allergies, significant interactions, risk of hyperkalemia
- Pregnant individuals
- Other pathogens are likely / highly possible based on risk factors and differential diagnosis (e.g., bloody diarrhea)
- Anyone where a second-line agent (nitazoxanide, ciprofloxacin) would be used for treatment
Empirically treat the following groups if meeting ONE MAJOR and ALL MINOR criteria**
Major criteria
- Symptomatic with similar dietary exposures to a symptomatic meal companion who has already tested positive for Cyclospora
- Symptomatic with GI symptoms > 48 hours***
Minor criteria
- No contraindication to TMP/SMX
- No likely alternative diagnosis
*Immunocompromised patients may receive empiric therapy in addition to testing, immuno-competent patients who are receiving empiric therapy should not concurrently have testing sent in order to preserve testing supplies.
**Patients who receive empiric therapy should be counseled that they are being treated without a confirmed diagnosis. They should have follow up, particularly if symptoms do not resolve, to evaluate for alternative causes of ongoing symptoms. Symptoms from Cyclospora expected to resolve within 1-3 days with treatment.
***Clinicians can utilize clinical judgement to consider empiric therapy for patients with shorter duration of symptoms but severe presentation
TESTING NOTES
The Mid Gastrointestinal Pathogen Panel (order code MIDGI) is the preferred diagnostic test if cyclospora infection is suspected. Alternatively, a Cyclospora (Cystoisoporiasis / Isosporiasis) Exam (order code OPC) is also appropriate for patients with a high suspicion of cyclosporiasis.
Full Ova and Parasite exam (OPE) is currently available only by special order. If OPE is needed, please contact MLabs or note confirmation of international travel on the test requisition.
See https://mlabs.umich.edu/news/cyclosporiasis-cases-increase-southeast-michigan-testing-guidance-mlabs-clinicians for additional information.
SUPPLY REQUESTS
Due to the current testing demand, supply requests for Stool Culture (Cary-Blair) transport (orange top container) and Ova and Parasite (EcoFix) transport (green top container) may be delayed and/or reduced.