FDA, CDC, state, and local partners are currently investigating several Cyclospora illnesses associated with recalled Del Monte 6oz and 12oz vegetable trays containing broccoli, cauliflower, carrots and dill dip that were sold by Kwik Trip/Kwik Star locations in IA, MN, and WI. Additionally, Del Monte is recalling “small veggie trays,” which are 28oz and include broccoli, cauliflower, carrots, celery and dill dip that were distributed to Illinois and Indiana.
As of June 15, 2018, CDC has reported 78 laboratory-confirmed cases of cyclosporiasis in persons from IA, MN, WI and MI who reportedly consumed the vegetable trays. The two cases from Michigan reportedly purchased the vegetable tray in Wisconsin and therefore Michigan is not impacted from this outbreak.
On June 8, 2018, Del Monte withdrew their 6oz and 12oz vegetable trays from retail market locations, and they are not currently available for purchase. However, consumers who purchased these trays before the withdrawal may still have product in their homes since the expiration date is June 17, 2018 or earlier. The 28oz vegetable trays that were distributed to IL and IN are being recalled as of June 15, 2018. Del Monte reports the recalled products were distributed to: Kwik Trip, Kwik Star, Demond’s, Sentry, Potash, Meehan’s, Country Market, FoodMax Supermarket and Peapod in Illinois, Indiana, Iowa, Michigan, Minnesota, and Wisconsin and have “Best If Enjoyed By” date of June 17, 2018 or earlier.
FDA has not identified which of the ingredients is the vehicle for this outbreak; each component of these vegetable trays is under consideration. FDA is currently reviewing distribution and supplier information related to the vegetable trays; the investigation is ongoing
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.