May 26, 2024

Cyclospora: 398 sick, Bagged Salad Source of Multi-State Outbreak

Cyclospora, a rare parasite usually found in tropical or sub-tropical regions, has sickened 398 people in 15 states, hospitalizing 21 of them. Most, but not all, of these illnesses are part of a multi-state outbreak linked to contaminated bagged salad mix sold at grocery stores and served at restaurants.

cyclospora-outbreak-384“The evidence points to a salad mix containing iceberg and romaine lettuce, as well as carrots and red cabbage as the source of the outbreak reported in Iowa and Nebraska,”  said Steven Mandernach, chief of the Food and Consumer Safety Bureau of the Iowa Department of Inspections and Appeals (DIA).  Food Poisoning Bulletin has been reporting restaurant lettuce as a source of Cyclospora illness for weeks.  Nebraska’s Department of Health and Human Services reported that the  pre-packaged, pre-washed salad mix “came through national distribution channels.” The tainted produce was not grown in a garden or commercial field  in Nebraska or Iowa, health officials said.

Cases in Iowa and Nebraska make up 55 percent of Illnesses reported. Other states have have confirmed that some of their cases are linked to these outbreak cases.

There are a total of 398 cases from 15 states. They reported the following totals to Food Poisoning Bulletin today: Iowa (143), Texas (122), Nebraska (76), Florida (24), Wisconsin* (10), New York (5), Illinois* (4) Georgia (3), Connecticut (2), Missouri (2),  Arkansas* (1), Kansas *(1), Minnesota (1), New Jersey (1), Ohio (1), (*Notes: Arkansas health officials do not believe their case is part of the outbreak based on information from an interview with the patient. Florida has not found a common restaurant or food exposure among its case patients.  One of the cases in Illinois was likely exposed while visiting Iowa. The case in Kansas was likely exposed while visiting Nebraska. In Wisconsin, eight of the 10 cases are linked to the outbreak, one is not and one is pending test results.  The total number of cases in this story is current per each state today and therefore exceeds the number on the CDC’s most recent update.)

Fewer than 150 Cyclospora cases are reported nationwide each year. In the past, outbreaks in the U.S. have been linked to travel or imported produce including mesclun lettuce, basil, snow peas, and raspberries. People become infected with Cyclospora when they eat or drink food or water containing microscopic amounts of fecal matter contaminated with the parasite.Symptoms of an infection, called cyclosporiasis,  can take up to two weeks to develop and last for as long as two months. They include: explosive diarrhea, nausea, vomiting, bloating, gassiness, abdominal cramps, weight loss, loss of appetite, low-grade fever, fatigue and malaise. Anyone experiencing these symptoms for more than a few days should see a doctor, especially if your eyes have a sunken look, a dry mouth and tongue, or you have reduced urine output and tear production which are all symptoms of dehydration.

Cyclospora infections are treated with an antiobiotic that contains sulfa called Trimethoprim/sulfamethoxazole (TMP/SMX) which is sold under the brand names Bactrim, Septra and Cotrim. There is no effective alternative to these drugs. Patients with a sulfa allergy can have supportive care of symptoms.


  1. I’m in Topeka, KS, and I experienced these exact symptons last week.

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