As of September 13, 2017 (1:30pm EDT), CDC has been notified of 988 laboratory-confirmed cases of cyclosporiasis in persons who became ill in 2017. This number includes persons who reported international travel as well as persons who did not report travel. The reports have come from 40 states.

At least 553 (56%) of these persons did not report international travel (i.e., likely were infected in the United States) and became ill on or after May 1, 2017 (a date after which cases tend to increase each year). These 553 persons were from the following 36 states: Arizona (1), California (10), Colorado (6), Connecticut (23), Florida (68), Georgia (10), Illinois (17), Indiana (4), Iowa (14), Kansas (2), Louisiana (7), Maryland (12), Massachusetts (13), Michigan (3), Minnesota (11), Mississippi (1), Missouri (13), Montana (2), Nebraska (5), New Hampshire (4), New Jersey (19), New Mexico (1), New York (excluding NYC) (15), New York City (30), North Carolina (45), Ohio (16), Pennsylvania (2), Rhode Island (2), South Carolina (7), South Dakota (4), Tennessee (3), Texas (163), Utah (1), Virginia (7), Washington (1), West Virginia (2), and Wisconsin (9).

At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source (or sources) of infection are ongoing. It is too early to say whether cases of Cyclospora infection in different states are related to each other or to the same food item(s).

Previous U.S. outbreaks of cyclosporiasis have been linked to various types of imported fresh produce (e.g., basil, cilantro, mesclun lettuce, raspberries, snow peas). Consumers should continue to enjoy the health benefits of eating fresh fruits and vegetables as part of a well-balanced diet.

More information about Cyclospora can be found on CDC’s Cyclospora pages.

Cyclospora cayetanensis is a single-celled parasite that causes an intestinal infection called cyclosporiasis.

Advice for consumers about prevention and recognition of cyclosporiasis can be found here.

According to Food Safety News, Federal health officials are asking health care providers across the country to be on the lookout for foodborne infections from the Cyclospora parasite because more than double the number of cases have already been confirmed this year and the peak season is not yet ended.

From May 1 through Aug. 2 this year in the United States there were 206 confirmed cases of cyclosporiasis, compared with 80 confirmed cases during that time period in 2016, according to an advisory posted Monday by the Centers for Disease Control and Prevention. Such advisories are relatively rare, with Monday’s being only the sixth from the CDC this year.

“At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source of infection are ongoing. It is too early to say whether cases of Cyclospora infection in different states are related to each other and/or to the same food item(s),” according to the CDC advisory.

“Previous outbreaks in the United States have been linked to various types of imported fresh produce — e.g., basil, cilantro, mesclun lettuce, raspberries, and snow peas.”

The CDC advisory did not include a state-by-state breakdown of confirmed infections, but it did report that at least 18 people have required hospitalization. The 206 confirmed infections have been reported from 27 states, most of which have reported relatively few cases, CDC reported.

On Aug. 1 the Texas Department of State Health Services reported confirmed cases in the Lone Star state had more than doubled in the second half of July, increasing from 68 on July 17 to 160 as of Aug. 1.

The NYC Health Department reported on July 24 that it has been tracking an increase of Cyclospora parasite infections there. A total of 27 cases were reported between Jan. 1 – June 30, 2017, compared to 13 cases in 2016, and 21 cases in 2015 during the same time period,” the New York City department reported.

What is Cyclospora?

Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a large form of cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans. The first known human cases of illness caused by cyclospora infection (that is, cyclosporiasis) were first discovered in 1977. An increase in the number of cases being reported began in the mid-1980s, in part due to the availability of better diagnostic techniques. Over 15,000 cases are estimated to occur in the United States each year. The first recorded Cyclospora outbreak in North America occurred in 1990 and was linked to contaminated water. Since then, several cyclosporiasis outbreaks have been reported in the U.S. and Canada, many associated with eating fresh fruits or vegetables. In some developing countries, cyclosporiasis is common among the population and travelers to those areas have become infected as well.  See, www.outbreakdatabase.com for past outbreaks related to Cyclospora cayetanensis.

Where does Cyclospora come from?

Cyclospora is spread when people ingest water or food contaminated with infected stool. For example, exposure to contaminated water among farm workers may have been the original source of the parasite in raspberry-associated outbreaks in North America.

Cyclospora needs time (one to several weeks) after being passed in a bowel movement to become infectious. Therefore, it is unlikely that Cyclospora is passed directly from one person to another. It is not known whether or not animals can be infected and pass infection to people.

What are the typical symptoms of Cyclospora infection?

Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, bloating, increased gas, stomach cramps, and loss of appetite, nausea, low-grade fever, and fatigue. In some cases, vomiting, explosive diarrhea, muscle aches, and substantial weight loss can occur. Some people who are infected with Cyclospora do not have any symptoms. Symptoms generally appear about a week after infection. If not treated, the illness may last from a few days up to six weeks. Symptoms may also recur one or more times. In addition, people who have previously been infected with Cyclospora can become infected again.

What are the serious and long-term risks of Cyclospora infection?

Cyclospora has been associated with a variety of chronic complications such as Guillain-Barre syndrome, reactive arthritis or Reiter’s syndrome, biliary disease, and acalculous cholecystitis. Since Cyclospora infections tend to respond to the appropriate treatment, complications are more likely to occur in individuals who are not treated or not treated promptly. Extraintestinal infection also appears to occur more commonly in individuals with a compromised immune system.

How is Cyclospora infection detected?

Your health care provider may ask you to submit stool specimen for analysis. Because testing for Cyclospora infection can be difficult, you may be asked to submit several stool specimens over several days. Identification of this parasite in stool requires special laboratory tests that are not routinely done. Therefore, your health care provider should specifically request testing for Cyclospora if it is suspected. Your health care provider might have your stool checked for other organisms that can cause similar symptoms.

How is Cyclospora infection treated?

The recommended treatment for infection with cyclospora is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim, Septra, or Cotrim. People who have diarrhea should rest and drink plenty of fluids. No alternative drugs have been identified yet for people with Cyclospora infection who are unable to take sulfa drugs. Some experimental studies, however, have suggested that ciprofloxacin or nitazoxanide may be effective, although to a lesser degree than trimethoprim-sulfamethoxazole. See your health care provider to discuss alternative treatment options.

How can Cyclospora infection be prevented?

Avoiding water or food that may be contaminated is advisable when traveling. Drinking bottled or boiled water and avoiding fresh ready-to-eat produce should help to reduce the risk of infection in regions with high rates of infection. Improving sanitary conditions in developing regions with poor environmental and economic conditions is likely to help to reduce exposure.

Washing fresh fruits and vegetables at home may help to remove some of the organisms, but Cyclospora may remain on produce even after washing.

peasjpg.jpg.size.xxlarge.letterboxCostco Wholesale Canada is recalling Alpine Fresh brand snap peas in Ontario due to possible Cyclospora contamination.

The Canadian Food Inspection Agency says there have been illnesses connected with the recall, but it was not immediately clear how many people were affected.

The agency issued a news release Saturday that says the product was distributed at Costco outlets across Ontario and contain best before dates from Oct. 15 to 29.

The agency says people infected with Cyclospora can experience a wide range of symptoms including diarrhea, stomach cramps and nausea.

outbreak_map_8_25_2015As of September 14, 2015 (3pm EDT), a total of 546 ill persons with confirmed Cyclospora infection were reported to CDC in 2015. Most of these persons—319 (58%) of 546—experienced onset of illness on or after May 1, 2015, and did not have a history of international travel within 2 weeks before illness onset. These 319 persons were from the following 23 states: 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). Clusters of illness linked to restaurants or events have been identified and investigated in Texas, Wisconsin, and Georgia. Epidemiologic and traceback investigations conducted in Texas, Wisconsin, and Georgia by state and local public health and regulatory officials and the FDA indicated that some illnesses among residents in these states were linked to fresh cilantro from Puebla, Mexico. The vehicle(s) of infection for non-cluster-associated cases has not been identified. The numbers of reported cases of cyclosporiasis in the United States have returned to baseline levels.

Illness onset dates ranged from May 1 to August 22, 2015. Ill persons ranged in age from 15 to 89 years, with a median age of 51 years. Fifty-six percent (56%) of ill persons were female.

The vehicle(s) of infection for non-cluster-associated cases has not been identified.

The numbers of reported cases of cyclosporiasis in the United States have returned to baseline levels.

Previous U.S. outbreaks of cyclosporiasis have been linked to imported fresh produce, including cilantro from the Puebla region of Mexico. Read the related FDA Import Alert.

outbreak_map_8_25_2015As of August 21, 2015, CDC had been notified of 495 ill persons with confirmed Cyclospora infection from 30 states in 2015.

Most of these persons—293 (59%) of 495—experienced onset of illness on or after May 1, 2015, and did not have a history of international travel within 2 weeks before illness onset. These 293 persons were from the following 23 states: Arkansas (3), California (2), Connecticut (3), Florida (10), Georgia (23), Illinois (8), Iowa (1), Kansas (2), Maryland (1), Massachusetts (10), Michigan (2), Missouri (1), Montana (3), Nebraska (1), New Jersey (6), New Mexico (2), New York (excluding NYC) (9), New York City (21), North Carolina (1), Texas (168), Utah (1), Virginia (3), Washington (2), and Wisconsin (10).

Clusters of illness linked to restaurants or events have been identified in Texas, Wisconsin, and Georgia. Cluster investigations are ongoing in Texas and Georgia. Cluster investigations in Wisconsin and Texas have preliminarily identified cilantro as a suspect vehicle.

Previous U.S. outbreaks of cyclosporiasis have been linked to imported fresh produce, including cilantro from the Puebla region of Mexico.

The parasite cyclospora has been in the news over the last few months in the U.S. and Canada where it has sickened hundreds, possibly tied to cilantro from Mexico. What is this organism that is a relatively rare but emerging cause of foodborne illness outbreaks? Here’s a little primer:

OLYMPUS DIGITAL CAMERAWhat is cyclospora?

Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a large form of cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans. The first known human cases of illness caused by cyclospora infection (that is, cyclosporiasis) were first discovered in 1977. An increase in the number of cases being reported began in the mid-1980s, in part due to the availability of better diagnostic techniques. Over 15,000 cases are estimated to occur in the United States each year. The first recorded cyclospora outbreak in North America occurred in 1990 and was linked to contaminated water. Since then, several cyclosporiasis outbreaks have been reported in the U.S. and Canada, many associated with eating fresh fruits or vegetables. In some developing countries, cyclosporiasis is common among the population and travelers to those areas have become infected as well.

Where does cyclospora come from?

Cyclospora is spread when people ingest water or food contaminated with infected stool. For example, exposure to contaminated water among farm workers may have been the original source of the parasite in raspberry-associated outbreaks in North America.

Cyclospora needs time (one to several weeks) after being passed in a bowel movement to become infectious. Therefore, it is unlikely that cyclospora is passed directly from one person to another. It is not known whether or not animals can be infected and pass infection to people.

What are the typical symptoms of Cyclospora infection?

Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, bloating, increased gas, stomach cramps, loss of appetite, nausea, low-grade fever, and fatigue. In some cases, vomiting, explosive diarrhea, muscle aches, and substantial weight loss can occur. Some people who are infected with cyclospora do not have any symptoms. Symptoms generally appear about a week after infection. If not treated, the illness may last from a few days up to six weeks. Symptoms may also recur one or more times. In addition, people who have previously been infected with cyclospora can become infected again.

What are the serious and long-term risks of cyclospora infection?

Cyclospora has been associated with a variety of chronic complications such as Guillain-Barre syndrome, reactive arthritis or Reiter’s syndrome, biliary disease, and acalculous cholecystitis. Since cyclospora infections tend to respond to the appropriate treatment, complications are more likely to occur in individuals who are not treated or not treated promptly. Extraintestinal infection also appears to occur more commonly in individuals with a compromised immune system.

How is cyclospora infection detected?

Your health care provider may ask you to submit stool specimen for analysis. Because testing for cyclospora infection can be difficult, you may be asked to submit several stool specimens over several days. Identification of this parasite in stool requires special laboratory tests that are not routinely done. Therefore, your health care provider should specifically request testing for cyclospora if it is suspected. Your health care provider might have your stool checked for other organisms that can cause similar symptoms.

How is cyclospora infection treated?

The recommended treatment for infection with cyclospora is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim, Septra, or Cotrim. People who have diarrhea should rest and drink plenty of fluids. No alternative drugs have been identified yet for people with cyclospora infection who are unable to take sulfa drugs. Some experimental studies, however, have suggested that ciprofloxacin or nitazoxanide may be effective, although to a lesser degree than trimethoprim-sulfamethoxazole. See your health care provider to discuss alternative treatment options.

How can Cyclospora infection be prevented?

Avoiding water or food that may be contaminated is advisable when traveling. Drinking bottled or boiled water and avoiding fresh ready-to-eat produce should help to reduce the risk of infection in regions with high rates of infection. Improving sanitary conditions in developing regions with poor environmental and economic conditions is likely to help to reduce exposure.

Washing fresh fruits and vegetables at home may help to remove some of the organisms, but cyclospora may remain on produce even after washing.

The Public Health Agency of Canada is collaborating with provincial public health partners, the Canadian Food Inspection Agency, and Health Canada to investigate 92 Canadian cases of Cyclospora infections in Ontario, British Columbia, Alberta, and Quebec. The source of this outbreak is not yet known, and the Agency and its partners continue to investigate.

The risk to Canadians is low, but people with weakened immune systems, young children and older adults are at increased risk for developing complications if they get sick. In Canada and the US, past foodborne outbreaks of Cyclospora have been linked to various types of imported fresh produce.

Cyclospora is a microscopic single-celled parasite that is passed in people’s feces. If it comes in contact with food or water, it can infect the people who consume it. This causes an intestinal illness called cyclosporiasis.

Cyclospora is most common in certain tropical and subtropical countries and regions.

In Canada, non-travel related illnesses due to Cyclospora occur more frequently in the spring and summer months. lllnesses among travellers can happen at any time of year.

In Canada, a total of 92 cases have been reported in British Columbia (4), Alberta (1), Ontario (82), and Quebec (5). Two cases have been hospitalized, and are recovered or recovering. No deaths have been reported. Individuals became sick between May 3 and August 5, 2015. To date, no source has been identified. The investigation is ongoing.

Previous foodborne illness outbreaks of Cyclospora, in Canada and US have been linked to various types of imported fresh produce, such as pre-packaged salad mix, basil, cilantro, berries, mesclun lettuce and snow peas.

To date, no multi-jurisdictional outbreaks have been linked to produce grown in Canada.

As of August 21, 2015, CDC had been notified of 495 ill persons with confirmed Cyclospora infection from 30 states in 2015.

Most of these persons—293 (59%) of 495—experienced onset of illness on or after May 1, 2015, and did not have a history of international travel within 2 weeks before illness onset. These 293 persons were from the following 23 states: Arkansas (3), California (2), Connecticut (3), Florida (10), Georgia (23), Illinois (8), Iowa (1), Kansas (2), Maryland (1), Massachusetts (10), Michigan (2), Missouri (1), Montana (3), Nebraska (1), New Jersey (6), New Mexico (2), New York (excluding NYC) (9), New York City (21), North Carolina (1), Texas (168), Utah (1), Virginia (3), Washington (2), and Wisconsin (10).

  • Clusters of illness linked to restaurants or events have been identified in Texas, Wisconsin, and Georgia.
  • Cluster investigations are ongoing in Texas and Georgia.
  • Cluster investigations in Wisconsin and Texas have preliminarily identified cilantro as a suspect vehicle.
  • Investigations are ongoing to identify specific food item(s) linked to the cases that are not part of the identified clusters.

Previous U.S. outbreaks of cyclosporiasis have been linked to imported fresh produce, including cilantro from the Puebla region of Mexico. Read the related FDA Import Alert.

According to Texas, its count is 243.

Canada counts 87.

outbreak_map_2015bAs of August 17, 2015 (3pm EDT), CDC had been notified of 476* ill persons with confirmed Cyclospora infection from 29 states in 2015.

Most of these persons—282 (59%) of 476—experienced onset of illness on or after May 1, 2015, and did not have a history of international travel within 2 weeks before illness onset. These 282 persons were from the following 22 states: Arkansas (2), California (2), Connecticut (3), Florida (10), Georgia (23), Illinois (7), Iowa (1), Kansas (2), Maryland (1), Massachusetts (9), Michigan (2), Missouri (1), Montana (3), Nebraska (1), New Jersey (6), New Mexico (2), New York (excluding NYC) (8), New York City (21), Texas (162), Utah (1), Virginia (3), Washington (2), and Wisconsin (10).

Clusters of illness linked to restaurants or events have been identified in Texas, Wisconsin, and Georgia.

Cluster investigations are ongoing in Texas and Georgia.

*Texas reports a recent surge in illnesses due to the parasite Cyclospora has prompted DSHS to investigate the infections in hopes of determining a common source. DSHS has received reports of 243 Cyclosporiasis cases from around Texas this year. Past outbreaks have been associated with cilantro from the Puebla area of Mexico. While the investigation into the current outbreak is ongoing, DSHS has identified imported cilantro as a possible source of some infections.

Cluster investigations in Wisconsin and Texas have preliminarily identified cilantro as a suspect vehicle.

Investigations are ongoing to identify specific food item(s) linked to the cases that are not part of the identified clusters.

Previous U.S. outbreaks of cyclosporiasis have been linked to imported fresh produce, including cilantro from the Puebla region of Mexico.

This update includes 4 additional cases of Cyclospora that have been reported in this investigation.

Why you should take note

The Public Health Agency of Canada is collaborating with provincial public health partners, the Canadian Food Inspection Agency, and Health Canada to investigate 87 Canadian cases of Cyclospora infections in Ontario, British Columbia, Alberta, and Quebec. The source of this outbreak is not yet known, and the Agency and its partners continue to investigate.

The risk to Canadians is low, but people with weakened immune systems, young children and older adults are at increased risk for developing complications if they get sick. In Canada and the US, past foodborne outbreaks of Cyclospora have been linked to various types of imported fresh produce.

Cyclospora is a microscopic single-celled parasite that is passed in people’s feces. If it comes in contact with food or water, it can infect the people who consume it. This causes an intestinal illness called cyclosporiasis.

Cyclospora is most common in certain tropical and subtropical countries and regions. In Canada, non-travel related illnesses due to Cyclospora occur more frequently in the spring and summer months. lllnesses among travellers can happen at any time of year.

Investigation Summary

In Canada, a total of 87 cases have been reported in British Columbia (4), Alberta (1), Ontario (77), and Quebec (5).  Two cases have been hospitalized, and are recovered or recovering. No deaths have been reported. Individuals became sick between May 3 and July 27, 2015. To date, no source has been identified. The investigation is ongoing.

Previous foodborne illness outbreaks of Cyclospora, in Canada and US have been linked to various types of imported fresh produce, such as pre-packaged salad mix, basil, cilantro, berries, mesclun lettuce and snow peas.

To date, no multi-jurisdictional outbreaks have been linked to produce grown in Canada.

Who is most at risk

People living or traveling in tropical or subtropical regions of the world may be at increased risk for infection because the parasite is found in some of these regions.

People with weakened immune systems, young children and older adults are at increased risk for developing complications. Cyclosporiasis infection responds to antibiotic treatment and is not considered to be life-threatening in healthy people.

Most people recover fully, though it may take several weeks to fully recover.

What you should do to protect your health

Although the source of the outbreak has not been identified,  past outbreaks have been associated with imported fresh produce, including pre-packaged salad mix, basil, cilantro, berries, mesclun lettuce and snow peas.

The following general food safety tips are important in reducing the risk of infection from foodborne illnesses:

  • Wash fresh fruits and vegetables before eating them, clean counters and cutting boards and wash your hands regularly.
  • Keep refrigerators clean and at a temperature below 4 °C (40 °F). Install a thermometer in your fridge to be sure.
  • Keep raw food away from other food while shopping, storing, preparing and serving foods.
  • Read labels and follow cooking and storage instructions for all food. When buying food, make sure to check the “best before” date, and if the product has expired, let the store know.
  • Use warm soapy water to clean knives, cutting boards, utensils, your hands and any surfaces that have come in contact with food, especially meat and fish.
  • Refrigerate or freeze perishable food within two hours of cooking.
  • Freeze or consume leftovers within four days of cooking. Always reheat leftovers until steaming hot before eating.

Symptoms

People infected with Cyclospora can experience a wide range of symptoms. Some do not get sick at all, while others feel as though they have a bad case of stomach flu. Few people get seriously ill.

Most people develop the following symptoms within one week after being infected with Cyclospora:

  • Watery diarrhea
  • loss of appetite
  • weight loss
  • stomach cramps
  • abdominal bloating
  • increased gas
  • nausea
  • fatigue

Cyclospora illness can last from a few days to several weeks, if left untreated. Symptoms may seem to go away and then return one or more times.

As with any disease causing diarrhea, people infected with Cyclospora should drink plenty of liquids to replace lost body fluids and prevent dehydration.

People who experience symptoms or suspect they have been infected with cyclospora, should contact their health care providers or local public health.