The New York State Department of Health, working collaboratively with the Albany County Department of Health, Montgomery County Public Health, Saratoga County Public Health and Schenectady County Public Health Services, is investigating reports of multiple cases of Cyclosporiasis.
Cyclosporiasis is a gastrointestinal illness caused by the microscopic parasite Cyclospora cayetanensis. People can become infected by consuming food or water contaminated with the parasite. Outbreaks of Cyclosporiasis have often been associated with imported fresh produce. Illness typically results in watery diarrhea, and can include loss of appetite, weight loss, stomach cramps, bloating, nausea and fatigue. These symptoms can appear approximately 1-2 weeks after ingestion of the contaminated source.If untreated, symptoms can last as long as a month or longer and can return one or more times. Infection is generally not transmitted directly from person-to-person.
To date, there are 11 laboratory-confirmed cases of Cyclosporiasis associated with this current investigation with illnesses starting in mid-June. Interviews with all the cases are ongoing to determine if there are commonalities in where they dined and what food they may have consumed. Several of the cases interviewed report they dined at the following establishments:
- The Italian American Community Center in Albany
- A buffet during a private graduation event at Union College in Schenectady
- Prime Life Restaurant at Beltrone Senior Living Community Center in Colonie
There is no indication that the illnesses are related to poor food handling or preparation at these establishments, and each of the establishments is fully cooperating with the investigation.Additional establishments may be identified as this investigation continues. Contamination of produce with Cyclospora often occurs prior to arrival at food distribution centers and restaurants. This type of contamination is not easily removed by standard produce rinsing. The Department is closely monitoring an increase in cases of Cyclosporiasis statewide and nationally, unrelated to the investigation in the Capital Region.
DOH recommends that individuals with diarrhea for three or more days and any of the above symptoms contact their healthcare provider. In addition to providing care for their symptoms, their provider may choose to order tests that can aid in the diagnosis of the cause of their illness. Also, antibiotics may need to be prescribed as a treatment for infected individuals.The Department of Health and our partners in the local health departments have issued a Healthcare Provider Alert to local healthcare providers to notify them of an increase in reports of laboratory-confirmed cases of Cyclosporiasis and to advise of appropriate methods of testing and treatment for people who may present with diarrheal illness consistent with this infection.
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.
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.
Some background from thee CDC:
- Domestically Acquired Cases of Cyclosporiasis — United States, 2019
- Domestically Acquired Cases of Cyclosporiasis — United States, May–August 2018
- Cyclosporiasis Linked to Fresh Express Salad Mix Sold at McDonald’s Restaurants — United States, 2018
- Cyclosporiasis Outbreak Linked to Del Monte Vegetable Trays — United States, 2018
- Cyclosporiasis Outbreak Investigations — United States, 2017
- 2016 Update
- Cyclosporiasis Outbreak Investigations — United States, 2015
- Cyclosporiasis Outbreak Investigations — United States, 2014
- Cyclosporiasis Outbreak Investigations — United States, 2013
Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Cyclospora outbreaks. The Cyclospora Attorneys and Lawyers have represented victims of Cyclospora and other foodborne illness outbreaks and have recovered over $650 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.
If you or a family member became ill with a Cyclospora infection after consuming food and you are interested in pursuing a legal claim, contact the Marler Clark Hepatitis A attorneys for a free case evaluation.