"Bug" Spread By Food or Water Causes Multi-State Outbreak

3rd update on cyclospora outbreak (August 12):

At least 535 people have now become infected by cyclospora; 32 have been hospitalized.   Cases are still being reported.  The Mexican farm known to have caused the illnesses in 2 states has voluntarily stopped making and shipping bagged lettuce to the U.S. until the FDA approves their resuming shipments.  What caused this same infection in 15 other states is still unknown.

http://abcnews.go.com/blogs/health/2013/08/12/farm-stops-salad-production-over-cyclospora-stomach-bug-outbreak/

Second update on cyclospora outbreak (Aug. 3):

The FDA now has more answers but not all of them. 

Here's what we now know:

• ŸAt least 400 cases of cyclosporiasis have now been reported in the U.S.
• The outbreak in Iowa and Nebraska has been linked to a Mexican subsidiary (Taylor Farms de Mexico) of a California company (Taylor Farms of Salinas, California). 
• The prepackaged salad mix had been served at Olive Garden and Red Lobster restaurants.
• Ÿ None of the bagged lettuce is still on the market.  Taylor Farms says, "Bagged lettuce is safe to eat."

 Here's what we don't know:

• what caused the outbreaks in the other states
• the origin of the contamination of Taylor Farms de Mexico's salad mix

Source(s):

usatoday.com "FDA names Mexican produce supplier in cyclospora outbreak"

http://www.usatoday.com/story/news/nation/2013/08/02/fda-mexico-taylor-farms-de-mexico-cyclospora-outbreak/2613871/

cbsnews.com  "Salads served at Olive Garden, Red Lobster tied to cyclospora outbreak in 2 states, FDA says"

http://www.cbsnews.com/8301-204_162-57596833/salads-served-at-olive-garden-red-lobster-tied-to-cyclospora-outbreak-in-2-states-fda-says/

Update on the multi-state cyclospora outbreak (7/31/13):

The mystery has been at least partially solved.  Investigators have linked the cyclospora cases in Nebraska and Iowa to prepackaged (bagged) salad mixes.  However, so far it's not clear whether the illnesses in the other states were also caused by lettuce, and so far, the CDC has not identified (or not revealed) the particular brand of salad mix.  Nebraska officials said the mix included iceberg and romaine lettuce, red cabbage, and carrots.

On July 31, 2013, the CDC posted the following information on the number of cases nationwide  (378) and the numbers in each state and in New York City:

"A total of 378 cases of Cyclospora infection have been reported from 15 states and 1 city. The number of cases identified in each area is as follows: Iowa (143), Texas (101), Nebraska (78), Florida (25), Wisconsin (9), Illinois (4)†, New York City (5)†, Georgia (3), Kansas (2)‡, Missouri (2)†, Arkansas (1), Connecticut (1), Minnesota (1), New Jersey (1), New York (1)†, and Ohio (1)."

            † Includes one case that was likely acquired out of state.

            ‡ Includes two cases that were likely acquired out of state.

At least 21 people in the affected states have been hospitalized.

In Iowa, the state's top food-safety inspector said that the parasite may have been spread by contaminated floodwater that got onto farm fields. 

Source(s):

cdc.gov  "Investigation of an Outbreak of Cyclosporiasis in the United States Map"

http://www.cdc.gov/parasites/cyclosporiasis/outbreaks/investigation-2013-maps.html

usgovernmentalportal.com "US: Bagged salad mix implicated in Cyclospora outbreak"

http://www.usgovernmentportal.com/salad-pegged-source-cyclospora-outbreak-g700755892?language=en

cbsnews.com  "Bagged salad eyed as source of cyclospora outbreak"

http://www.cbsnews.com/8301-204_162-57596205/bagged-salad-eyed-as-source-of-cyclospora-outbreak/

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Original Article (7/29/13):

If you've been listening to TV news in the past few days, you've probably learned a new word: cyclospora.  It's a type of infection caused by a parasite, and it's spread in food or water (more commonly water). As of July 25, 11 states have reported a total of 285 cases of cyclosporiosis.  The states with the most cases are Iowa (138), Nebraska (70), and Texas (66).   Wisconsin has reported 3 and Georgia 2.  These states reported 1 case each:  Connecticut, New Jersey, Ohio, Illinois, Minnesota, and Kansas.  Some of these cases may have been contracted in another state or even outside the U.S.

Contracting this infection can ruin the rest of a person's summer.  The symptoms, which are flu-like, can come and go (relapse) for as long as 59 days. 

The FDA and the CDC (Centers for Disease Control and Prevention) are working with state and local officials to search for the source of this outbreak. Summertime is the most likely time for cyclospora to spread in part because a person can come in contact with the parasite from swimming in water that's been contaminated by feces.  If even a small amount of the parasite enters the swimmer's mouth, he or she can become infected, food scientist Dr. Karin Allen explains. 

According to the CDC, since the 1990s, foodborne outbreaks of cyclosporiasis have been linked to various types of imported produce including fresh raspberries, basil, snow peas, and mesclun lettuce.   No commercially frozen or canned produce has been implicated.

The FDA has posted answers to some FAQs about this condition.  Below are three of them.  

What is cyclospora?

Cyclospora cayetanensis is a parasite composed of one cell, too small to be seen without a microscope. This parasite causes an intestinal infection called cyclosporiasis.

Cyclospora is spread by people ingesting something--such as food or water--that was contaminated with the parasite.  Cyclospora needs time (days to weeks) after being passed in a bowel movement to become infectious for another person. Therefore, it is unlikely that cyclospora is passed directly from one person to another.
For more information on cyclospora, click here: http://www.cdc.gov/parasites/cyclosporiasis/

Who is at risk?

People can become infected with cyclospora by consuming food or water contaminated with the parasite.  People living or traveling in countries where cyclosporiasis is endemic, including certain tropical or subtropical regions of the world, may be at increased risk for infection.

What are the symptoms?

The time between becoming infected and becoming sick is usually about 1 week. Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, with frequent, sometimes explosive, bowel movements. Other common symptoms include loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, and fatigue. Vomiting, body aches, headache, fever, and other flu-like symptoms may be noted. Some people who are infected with cyclospora do not have any symptoms.  If not treated, the illness may last from a few days to a month or longer. Symptoms may seem to go away and then return one or more times (relapse). It’s common to feel very tired.

Precautions:

According to the Food Poisoning Bulletin site, "It can be difficult to wash the oocysts off food, especially soft fresh produce such as lettuce and raspberries. Still, public health officials recommend that you always wash and dry produce before preparing it and eating it. Wash hands, utensils, and surfaces with hot soapy water before and after handling food."

Dr. Allen urges people not to go swimming or allow their children to do so if they have symptoms indicative of this infection. 

Common Treatment:

The CDC has this information about treatment of cyclosporiasis:

Trimethoprim/sulfamethoxazole (TMP/SMX), sold under the trade names Bactrim, Septra, and Cotrim, is the usual therapy for a cyclospora infection. No highly effective alternative antibiotic regimen has been identified yet for patients who do not respond to the standard treatment or who have a sulfa allergy.

The CDC also says that a patient with a healthy immune system will recover without treatment.  Anti-diarrheal medicine may help reduce diarrhea, but it shouldn't be taken without consulting one's physician.

Source(s):

Karin E. Allen, Ph.D., Utah State University, Dept. of Nutrition, Dietetics, and Food Sciences

foodpoisoningbulletin.com  "FDA Investigates Multi State Cyclospora Outbreak"

http://foodpoisoningbulletin.com/2013/fda-investigates-multi-state-cyclospora-outbreak/  

(Note: Links to FDA and CDC pages used as sources are within the article.)