December 5, 2016

Cyclospora Outbreak Over After Sickening 546 People

The Centers for Disease Control and Prevention (CDC) has stated that the Cyclospora outbreak that has sickened 546 people in 31 states this summer is over. The last illness onset date was August 22, 2015.

cilantroCyclospora cayetanensis is a single-celled parasite that causes an infection in the intestines. Clusters of illnesses were linked to restaurants or events in Texas, Wisconsin, and Georgia. The restaurants and events have not been named.

Some of the illnesses just in those states, but not all, were linked to fresh cilantro imported from Puebla, Mexico. The food or drink that caused non-cluster-associated cases has not been identified.

The FDA issued an import alert on that imported cilantro on August 27, 2015.  In fact, the CDC identified annually recurring outbreaks in 2012, 2013, 2014, and 2015 of cyclosporiasis associated with fresh cilantro imported from that region.

During inspections of the fields, officials found feces and toilet paper in the areas where cilantro was grown and harvested. They also found inadequately maintained and supplied toilet and hand washing facilities with no soap, toilet paper, or running water. Food contact surfaces were visibly dirty and not washed, and water used to wash the cilantro was vulnerable to contamination from sewage and septic systems.

Since this illness is passed through fecal contamination, the FDA decided to refuse import of this product from that region. In fact, the parasite must leave the body via feces and sporulate before it becomes infectious again. Feces in the fields is an ideal way for that to occur.

Import districts were directed by the FDA to detain without physical examination shipments of fresh cilantro from Puebla, Mexico from April 1 through August 31 every year, unless the cilantro comes from a firm listed on the Green List. The alert covers fresh cilantro whether it is fresh or chopped.

The CDC broke down the case count. For 319 of the 546 sickened, the case count by state is: Arkansas (3), California (2), Connecticut (5), Florida (13), Georgia (26), Illinois (9), Iowa (1), Kansas (2), Maryland (1), Massachusetts (12), Michigan (2), Missouri (1), Montana (3), Nebraska (1), New Jersey (7), New Mexico (2), New York (excluding NYC) (10), New York City (22), North Carolina (1), Texas (179), Utah (1), Virginia (3), Washington (2), and Wisconsin (11). Illness onset dates ranged from May 1 to August 22, 2015. Patients ranged in age from 15 to 89 years, with a median age of 51 years.

The main symptom of Cyclospora food poisoning is violent diarrhea, which is watery, frequent, and explosive, that can last for more than a month. Other symptoms include loss of appetite, weight loss, stomach cramps, bloating, nausea, increased gas, fatigue, vomiting, body aches, headache, and fever.

Symptoms may disappear, and then relapse. Treatment for this illness is a combination of two antibiotics, which includes a sulfa drug. Since many people are allergic to sulfa, they cannot be treated. No effective treatment has been identified for patients who don’t respond to standard treatment.

It is difficult to protect yourself from this parasite. Washing fruits, vegetables, and fresh herbs thoroughly can remove some of the Cyclospora, but not all. If produce is crinkled or has a rough surface, it can be impossible to remove all of the parasite. Still, thoroughly rinse fresh fruits, vegetables, and herbs under cool running water before eating or preparing.

Bad Bug Law Team

 

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