U.S. health officials are continuing their investigation into an intestinal illness that leads to “explosive” diarrhea; this outbreak has already sickened over 1,700 confirmed cases nationwide, with approximately 1,500 more under review. The largest number of cases has been reported in Michigan.
The illness, known as cyclosporiasis, is triggered by a parasite called Cyclospora cayetanensis. Infection occurs through the ingestion of food or water tainted with the parasite. Symptoms, which can be similar to other food-related illnesses such as norovirus, E. coli, or salmonella, tend to last longer and can alternate between getting better and then worsening again, as noted by Dr. Jade Le, an infectious disease expert.
Michigan alone has confirmed over 1,562 cases according to state health officials, with 36 individuals hospitalized to date. For context, Michigan usually only reports about 50 cases of cyclospora annually.
Other states also have seen significant case counts. Ohio’s counties bordering southeast Michigan have noted more than 500 cases, including 306 in Lucas County. New York has tallied 394 confirmed cases since May, while North Carolina has reported 110, and local reports from Illinois indicate about 150 cases.
These numbers are separate from the latest data from the CDC, which shows 843 cases across 31 states since May 1, with 86 hospitalizations reported. The CDC is aware that state reports may indicate higher counts of cyclosporiasis than what is currently reflected in their data and is working collaboratively to reconcile numbers as more cases are verified.
The median age of those affected is 44, with ages ranging from 5 to 88. Interestingly, about 59% of the cases involve women, and the median onset of illness began on June 18. Health officials still have yet to pinpoint a specific food item, supplier, or grower linked to this outbreak. The leading theory points toward contaminated produce, yet the parasite’s slow incubation period of about one to two weeks complicates tracing it back to a single meal or farm.
How do people get sick from it?
Imported fresh produce, including items like raspberries, basil, snow peas, mesclun lettuce, and cilantro, have previously been associated with cyclosporiasis outbreaks, according to the CDC. However, the original source of the parasite is often contaminated water. As Dr. Le highlighted, produce can become tainted via fecal contamination if the water supply for a farm is contaminated, or if farmworkers do not wash their hands properly after using the restroom.
Once ingested, this can lead to severe diarrhea, which may be accompanied by fever, cramping, nausea, and vomiting. Dr. Le also emphasized that cyclosporiasis is not a communicable disease; it cannot spread from person to person directly, even if someone doesn’t wash their hands after using the bathroom.
According to the CDC, the parasite requires time—at least one to two weeks—after being shed in a bowel movement to become infectious. This means that contamination can happen through indirect contact; for example, if someone does not wash their hands after using the restroom and then handles produce, that could lead to someone becoming sick after consuming the contaminated items.
Should I be worried?
“This diarrhea makes you feel terrible,” Dr. Le commented. While individuals in outbreak states should be cautious, she ranked the overall worry level as not critical, possibly around a five out of ten. The primary risk posed by gastrointestinal diseases like this is severe dehydration, which may require hospitalization. But typically, unless symptoms are neglected, death from this illness is unlikely.
Do I need to throw out my produce to avoid getting sick?
No need to panic and discard all your fresh produce, according to Dr. Le. However, there are measures you can adopt to safeguard your food at home.
Cooking thoroughly can effectively kill any parasites. While that might ease concerns when preparing certain items, washing fruits and vegetables remains essential. Even items labeled as “prewashed” should still be rinsed before consumption, as this practice helps eliminate most parasites.
The CDC advises that the best way to clean produce is to rinse it under running water, without using additional chemical cleaners like bleach, which can be harmful and isn’t effective against these parasites. Dr. Le recommends steering clear of such harsh chemicals when cleaning your fruits and vegetables.
Knowing the sources of your produce is also helpful. If dining out or attending events, being conscious of what you’re eating is wise, especially in outbreak areas while waiting for health authorities to identify the source.
Both the CDC and Cleveland Clinic suggest a few practical steps:
- Avoid food or water that may be contaminated.
- Steer clear of untreated water.
- Wash hands with soap after using the restroom and before and during food prep.
- Wash and peel vegetables; scrub items like melons well, and remove damaged areas.
- Follow safe food handling and preparation recommendations.
Taking precautions against infection is crucial, but eating fresh produce is also important. Dr. Le encourages people to enjoy salads and fresh vegetables while being mindful of any outbreaks in their regions.
What if I do get sick?
Dr. Le advises being aware of symptoms. If you experience severe diarrhea accompanied by stomach cramps or a mild fever, it’s best to contact a healthcare provider promptly.
Diagnosis typically involves testing stool samples, but multiple samples collected over several days may be necessary to detect the parasite accurately.
It’s vital to ask your doctor for a specific test for cyclospora, as not all standard stool tests will detect it. If symptoms persist for more than a few days or worsen over a week, it’s worth prompting your doctor for further evaluation.
In cases where individuals are immunocompromised, antibiotics might be prescribed; however, for most others, adequate rest and fluids are the general course of treatment. Dr. Le cautioned against using over-the-counter medications before diagnosis, particularly against using ivermectin, a medication misused for COVID-19, which isn’t effective for treating this particular infection.
