Cyclosporiasis: Think your salad is harmless? Parasite outbreak spreads across Michigan, Pennsylvania, Texas, Ohio, Massachusetts & 15 more states; FDA issues warning

A major cyclosporiasis outbreak in the US linked to iceberg lettuce has expanded to 20 states, with health authorities reporting 11,458 cases and 495 hospitalisations.

The Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) said cases have now been identified in Georgia, Tennessee and Texas, adding three states to the outbreak since the previous update.

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The outbreak has been linked to processed iceberg lettuce sourced from Taylor Farms' operations in central Mexico. Some of the affected lettuce was served at Taco Bell restaurants, prompting a wider investigation into the supply chain.

Which states are affected by the cyclosporiasis outbreak?

The outbreak now includes 20 states: Arkansas, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Maine, Massachusetts, Michigan, Missouri, Nebraska, New Hampshire, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas and West Virginia.

The FDA and CDC have been working with state and local health departments to identify additional cases and determine how the contaminated lettuce entered the food supply.

How is the lettuce linked to the outbreak?

The investigation initially focused on shredded iceberg lettuce served at Taco Bell locations. FDA traceback work subsequently pointed towards Taylor Farms de Mexico as the supplier of the lettuce associated with the outbreak.

Taylor Farms de Mexico announced a voluntary recall on July 17 of iceberg lettuce sourced from central Mexico. The FDA said it remains confident that lettuce covered by the recall has been removed from the market.

The agency is continuing inspections and sampling at iceberg lettuce farms and the processing facility in Mexico, working alongside Mexican authorities.

What is cyclosporiasis?

Cyclosporiasis is an intestinal infection caused by the microscopic parasite Cyclospora cayetanensis. According to the CDC, infections are most commonly reported in the US during spring and summer.

The parasite can contaminate food or water through infected human faecal matter. Unlike some other intestinal infections, direct person-to-person transmission is considered unlikely because Cyclospora needs time outside the body to become infectious.

Fresh produce, including leafy greens, can become contaminated during growing, harvesting, processing or handling.

What are the symptoms of cyclosporiasis?

The most common symptom is frequent, watery diarrhoea, which can sometimes be described as explosive.

Other possible symptoms include:

• Loss of appetite
• Weight loss
• Bloating
• Increased gas
• Stomach cramps or abdominal pain
• Nausea
• Vomiting
• Fatigue or extreme tiredness
• Fever
• Body aches
• Headache

Some people infected with Cyclospora may not develop symptoms. The FDA says untreated infection can result in dehydration and other complications, while symptoms can sometimes improve and then return.

Why can cyclosporiasis symptoms return?

Cyclosporiasis can sometimes follow a relapsing pattern, meaning symptoms may appear to improve before returning. The illness can last for days or even a month or longer in some cases if it is not treated.

People with weakened immune systems may experience more severe or prolonged illness and may require closer medical attention.

Michigan reports thousands of cyclosporiasis cases

Michigan has been particularly affected by the outbreak. The state's health department reported 14,510 cyclosporiasis cases as of August 27, an increase of 233 cases from the previous week.

Two deaths have also been reported in Michigan. Both people had significant underlying health conditions that may have been worsened by the infection and dehydration.

The Michigan figure is a state-level total and should not be added to the FDA's 11,458 outbreak count, as the two figures represent different reporting scopes.

Is the recalled lettuce still on sale?

The FDA said the best-by dates for the recalled Taylor Farms iceberg lettuce have passed and the products should no longer be available in shops or restaurants.

The agency has also said it is confident that recalled iceberg lettuce associated with this specific outbreak has been removed from the market. Taco Bell previously confirmed that it stopped using lettuce from Taylor Farms de Mexico from July 17.

However, consumers who may have eaten recalled lettuce and subsequently developed symptoms should contact a healthcare provider and mention their possible exposure.

US investigates one of its largest cyclosporiasis outbreaks

The CDC and FDA are continuing to collect information from states, interview people who became ill and investigate the lettuce supply chain.

The agencies have stressed that the recalled products are no longer expected to be on the market, while investigations continue in the US and Mexico.


Inputs from agencies