July 20, 2018

Cyclospora Outbreak in Texas Increases Again

The Texas Department of State Health Services is reporting that the Cyclospora outbreak in that state has increased again. Now 205 people in that state are sickened with cyclosporiasis that is associated with cilantro imported from the Puebla region of Mexico.

Cyclospora OutbreakThe FDA has issued an import alert on cilantro imported from that region in Mexico. That product will be detained if it reaches the border. Annually recurring outbreaks in 2012, 2013, 2014, and this year have prompted an investigation.

FDA investigators found feces and toilet paper in some cilantro fields, and contamination caused by irrigation of fields with water contaminated with sewage. Other issues may include cleaning produce with contaminated water, and lack of adequate cleaning of equipment that is used to process the herb.

This is a critical finding, since the Cyclospora oocysts must sporulate, or become infective, for days or even weeks before another person can be sickened. The oocysts are eliminated in feces, where they grow. Feces in the fields is a pretty clear indicator of contamination.

The investigation is ongoing, but the cilantro has been identified as a possible source of some of the infections. Last year Texas had 200 cases of this illness; some of them were also associated with cilantro from Puebla. The illnesses are seasonal, and this parasite is not endemic to the United States.

Cyclospora is a parasite that gets onto food and is then consumed in the form of an oocyst. That causes watery and explosive diarrhea that can last months. Other symptoms include loss of appetite, fatigue, abdominal and stomach cramps, bloating, increased gas, nausea, vomiting, a low fever, and weight loss.

Unfortunately, it’s difficult to wash this parasite off fresh produce, so thorough rinsing is not enough to eliminate it. Cooking does kill the parasite, but previous outbreaks have been linked to foods that are usually eaten raw, including raspberries, herbs, and lettuce.

This illness is treated with sulfa drugs. Unfortunately, there are no good alternatives to these drugs, so those allergic to sulfa can be sicker longer.

In Texas, most cases are in Travis county, with 77 sick; the second most affected county is Dallas with 17. Williamson county has 10 people sick; Collin and Tarrant counties have 9 people sick, Denton has 8, while Bexar has seven cases.

If you have experienced the symptoms of cyclosporiasis, please see your doctor as soon as possible. Treatment for this illness is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also called  Bactrim, Septra, or Cotrim. Plenty of rest and lots of fluids are also recommended treatments. This illness can suddenly recur without warning. Since the oocysts must mature before it is infectious again, person-to-person contact is rare. Some people who are infected do not have any symptoms at all.

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