Multistate cyclosporiasis outbreak infects 230 people

July 23, 2013

The source of the infection is still not known but investigators believe that vegetables, most likely imported, are to blame for the outbreak.

An intestinal infection has affected more than 230 people in Texas and the Midwest since June, according to the latest update by the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota. The source of the infection is still not known but investigators believe that vegetables, most likely imported, are to blame for the outbreak.

Without having identified the source, there can be no firm evidence that the two regional outbreaks are related but this is one possibility that authorities are investigating. The number of sickened people is growing rapidly, as more than 50 new cases were reported at the end of last week.

The foodborne illness is caused by the parasite Cyclospora cayetanensisw and is transmitted through food and water contaminated with fecal matter. Symptoms of the disease include watery diarrhea, loss of appetite, nausea, fatigue, bloating and cramping, the Centers for Disease Control and Prevention said. It is possible that a low fever will also appear, although this is relatively rare. People who have been infected can expect the first symptoms two days after infection at the earliest.

Cyclosporiasis is not life threatening but it can remain in the body for a long time if left untreated. The main problem is that cyclosporiasis cannot be 100 percent confirmed by tests, which makes diagnosis harder, and the most effective treatment is difficult to determine, CIDRAP said on its website.

As of July 19, Iowa had the highest number of reported cases of cyclosporiasis — 109, up 22 from two days before that. At least six people have been hospitalized in the state, CIDRAP said. Nebraska reported 63 cases, while the figure reached 56 in Texas. Christine Mann, a spokeswoman for the Texas Department of State Health Services (DSHS), commented that these 56 cases represent the total reported in the state in 2013. However, Mann pointed out that it was too early to link the Texas cases to those in Iowa and Nebraska.

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Meanwhile, four cases of the disease were reported in Wisconsin, with officials suspecting that they are connected to the same outbreaks. The Wisconsin Department of Health Services (DHS) said in a statement that the four cases were reported within week compared to just five identified between 2008 and 2012. Illinois and Kansas reported two and one cases respectively, but one of these has been linked to a journey overseas, CIDRAP pointed out.

Iowa and Nebraska health officials commented that the outbreak could have started from vegetables grown overseas. Their suspicion is in line with previous cyclosporiasis outbreaks in the United States which have been linked with traveling abroad or with imported agricultural products. The biggest multistate cyclosporiasis outbreak was reported in 1996 and was traced to raspberries grown in Guatemala. More than 1,460 cases in 20 states were associated with the outbreak, which also stretched to two Canadian provinces, a report in the New England Journal of Medicine found in 1997.