In late June, Cleveland Clinic’s parasitology lab was screening one or two specimens a day for cyclospora. On July 15, it processed a peak of roughly 400 in a single day.
The surge — which has since averaged to 250 to 300 tests daily — has forced the health system to rebuild how its parasitology section runs, moving to 24/7 operations and training microbiologists from other departments to read slides, according to Anisha Misra, PhD, medical director of mycology and parasitology at Cleveland Clinic.
The lab has confirmed more than 1,000 positive cyclospora tests, according to the system. Cleveland Clinic’s laboratories process more than 20 million tests a year with about 2,200 staff, and the health system says it is often cited as the largest-volume hospital lab in the U.S.
Nationally, the CDC had confirmed 4,940 cyclosporiasis cases and 341 hospitalizations across 41 states as of a July 21 update — the largest outbreak of the cyclospora parasite-caused infection on record in the U.S. Approximately 7,400 additional cases have yet to be confirmed, according to the CDC.
Federal officials have linked an outbreak cluster to now-recalled iceberg lettuce, and the surge has strained hospital labs nationwide. In neighboring Michigan, the hardest-hit state with 7,171 cases as of July 22, some hospitals have pulled leafy greens from their cafeterias.
Ohio has reported 1,246 confirmed cases in 2026, though the counties with a majority of cases are in the state’s northwest region — Lucas County with 272 and Wood County with 132. Cuyahoga County, home to Cleveland, has reported 43.
Cleveland Clinic’s lab first suspected a cyclosporiasis outbreak when cases flagged by its AI platform climbed from one or two a day to five or six after June 26, alongside a rise in positives on its molecular stool panel. The team sent a notice to clinicians, and more testing took off.
Rebuilding the bench around the clock
Cleveland Clinic typically staffs two parasitologists a day, Dr. Misra said. Amid the outbreak, testing is running 24/7.
Much of the stool pre-processing — labeling, centrifuging and concentrating specimens — now happens overnight, handled by the lab’s processing team rather than parasitologists. That way, when parasitologists arrive at 6 a.m., they can move straight to staining and reading.
The lab went from one reader to as many as three to seven a day, Dr. Misra said. To fill the gap, she and other operational leaders trained medical laboratory scientists from sections such as bacteriology and mycology to identify cyclospora and put them through competency testing.
Dr. Misra, who does not usually read clinical slides, has been reading them herself to keep pace.
The work is slow. Each slide takes two to 10 minutes, and negative slides take roughly twice as long as positives. Scaling from about 20 slides a day across the entire section to 400 required more people and significant overtime.
‘Hard times can make you’
To protect testing capacity, new trainees shadowed experienced readers at the scope, then tested themselves against batches with known results before reading independently.
Staff have volunteered for weekend shifts and given back paid time off, and colleagues outside parasitology have covered other benches so trained scientists could shift over.
“Hard times can break you, or hard times can make you,” Dr. Misra said. “I feel like I’ve seen at Cleveland Clinic everyone come together.”
The outbreak also inverted the lab’s usual math. Cleveland Clinic’s overall parasitology positivity rate normally sits at about 2%, rising to roughly 30% for all parasites in the summer. Cyclospora positivity is now running 35% to 40%.
That unusually high rate made shadowing practical, Dr. Misra said: With nearly every other slide positive, trainees encountered real cases fast rather than wading through long stretches of negatives.
Microscopy over molecular
Cleveland Clinic’s expanded stool panel includes a molecular target for cyclospora, but the lab chose to run the outbreak through microscopy instead. The reasoning was connected to cost and stewardship, Dr. Misra said: most patients are seen in outpatient settings, where the molecular panel raises insurance-reimbursement concerns that microscopy does not, sparing patients large bills. Microscopy also insulates the lab from molecular-test supply shortages.
AI also made the microscopy strategy workable. The lab’s platform, originally validated on a different stain, can detect cyclospora’s faint, “ghost-like” forms by size. After confirming the outbreak, the team validated the tool on the modified acid-fast stain designed for cyclospora, running more than 600 specimens to set a threshold above which the AI’s positive calls are trusted; anything below it is reviewed manually.
The approach lets experienced readers focus on ambiguous cases rather than obvious positives, Dr. Misra said, helping the lab hold most results within about 48 hours against a standard four-day turnaround.
Coordinating beyond the lab
The response has reached well past the bench. The lab now voluntarily batches and sends all positives to the Ohio Department of Health; alerted emergency, urgent and express care sites and family health centers; built a webpage tracking testing and positivity; and sends updates to clinicians about three times a week. It coordinates daily with a broader team, and has leaned on supply chain for materials, courier services for timely specimen delivery and extended family health center hours, including weekends, so patients can drop off samples.
For hospital leaders, Dr. Misra said the current outbreak underscores the value of laboratory medicine.
“Behind every diagnosis is this team of professionals who are working tirelessly to deliver these very accurate results that guide clinical care,” she said. “This is the team that’s working in the background to make sure that we provide accurate results, even during an outbreak. We’re double-checking our results, we’re working overtime, and [the outbreak is] showing the value of that.”
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