Fresh Express – McDonald’s Cyclospora Salad Outbreak –As of September 11, 2018, CDC was notified of 511 laboratory-confirmed cases of Cyclospora infections in people from 15 states and New York City who reported consuming salads from McDonald’s restaurants in the Midwest. The Connecticut, New York City, Tennessee, and Virginia case-patients purchased salads while traveling in Illinois; the Florida case-patient purchased a salad while traveling in Kentucky.

Illnesses started on dates ranging from May 20 to July 23, 2018. Ill people ranged in age from 14–91 years with a median age of 52. Among ill people, 66% were female. Out of 472 people with information available, 24 people (5%) were hospitalized. No deaths were reported.

Epidemiologic and traceback evidence indicated that salads purchased from McDonald’s restaurants were one likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate in the 2 weeks before they became ill. Ill people reported eating a variety of McDonald’s salads. Ill people reported buying salads from McDonald’s restaurant locations in the Midwest. The Connecticut, New York City, Tennessee, and Virginia case-patients purchased salads while traveling in Illinois; the Florida case-patient purchased a salad while traveling in Kentucky.

Information collected from restaurant locations where ill people purchased salads indicated that Fresh Express supplied salad mix to these restaurants and that the salad mix was produced by a processor based in Streamwood, IL. On July 13, 2018, McDonald’s voluntarily stopped selling salads in more than 3,000 locations in 14 states (Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Missouri, Montana, Nebraska, North Dakota, Ohio, South Dakota, West Virginia, and Wisconsin) that received salad mix from the Streamwood, IL processing facility.

On July 26, 2018, the FDA completed final analysis of an unused package of romaine lettuce and carrot mix distributed to McDonald’s by the Fresh Express processor in Streamwood, IL. The analysis confirmed the presence of Cyclospora in that sample. On July 27, 2018, FDA informed Fresh Express of these results.

Romaine lettuce from the same lot that tested positive for Cyclospora was distributed in pre-made salads and wraps distributed by Caito Foods, LLC of Indianapolis, IN. Fresh Express reported to FDA that the carrots in the mix went to McDonald’s restaurants only, and that the romaine lettuce was the only ingredient in the mix that was distributed to other locations.

On July 30, 2018, the U.S. Department of Agriculture’s Food Safety and Inspection Service issued a public health alert regarding these pre-made salads and wraps containing the romaine lettuce. The pre-made salads and wraps were shipped to distribution centers nationwide. Read the alert here.

Del Monte Cyclospora Outbreak –As of September 5, 2018, 250 people were infected with Cyclospora reported from 4 states.

Illnesses started on dates ranging from May 14, 2018 to June 20, 2018. Ill people ranged in age from 13–79 years with a median age of 45. Among ill people, 52% were female. Eight people (3%) were hospitalized. No deaths were reported.

Epidemiologic evidence indicated that pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip were the likely source of these infections.

In interviews, ill people answered questions about the foods they ate in the 2 weeks before they became ill. Ill people reported eating pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip. Ill people reported buying pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip in the Midwest. Most people reported buying the trays at Kwik Trip convenience stores

On June 15, 2018, Del Monte Fresh Produce recalled 6 oz., 12 oz., and 28 oz. pre-packaged vegetable trays containing fresh broccoli, cauliflower, celery sticks, carrots, and dill dip. Recalled products were sold in clear, plastic clamshell containers.

Note – it is unclear if some of the following number are included in the above numbers:  As of September 12, 2018, IDPH is reporting 1030 cases of cyclosporiasis in counties across Illinois, with people becoming ill starting in mid-May.  305 Illinois cases reported eating salads from McDonald’s in the days before becoming ill.  162 Illinois cases are linked to a private event held at the Evanston Golf Club.  IDPH continues to investigate additional sources.

As of September 5, 2018, 250 people were infected with Cyclospora reported from 4 states.

Illnesses started on dates ranging from May 14, 2018 to June 20, 2018. Ill people ranged in age from 13–79 years with a median age of 45. Among ill people, 52% were female. Eight people (3%) were hospitalized. No deaths were reported.

Epidemiologic evidence indicated that pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip were the likely source of these infections.

In interviews, ill people answered questions about the foods they ate in the 2 weeks before they became ill. Ill people reported eating pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip. Ill people reported buying pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip in the Midwest. Most people reported buying the trays at Kwik Trip convenience stores

On June 15, 2018, Del Monte Fresh Produce recalled 6 oz., 12 oz., and 28 oz. pre-packaged vegetable trays containing fresh broccoli, cauliflower, celery sticks, carrots, and dill dip. Recalled products were sold in clear, plastic clamshell containers.

As of September 5, 2018, this outbreak appears to be over.

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.

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Cyclospora infections. At this time, there is no evidence to suggest that this cluster of illnesses is related to the  Cyclosporaoutbreak linked to Del Monte fresh produce vegetable trays.

As of August 23, 2018 (12pm EDT), a total of 507 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 15 states and New York City. Note, the Connecticut, New York City, Tennessee, and Virginia case-patients purchased salads while traveling in Illinois; the Florida case-patient purchased a salad while traveling in Kentucky.

Illnesses started on or after May 20, 2018. The median illness onset date is June 29, 2018 (range: May 20 to July 21). Ill people range in age from 14 to 91 years old, with a median age of 52. Sixty-six percent (66%) are female. At least 24 people have been hospitalized; no deaths have been reported.

Illnesses that started after July 12, 2018 might not have been reported yet due to the time it takes between when a person becomes ill and when the illness is reported. For Cyclospora infections, this can take up to six weeks.

Epidemiologic evidence indicates that salads purchased from McDonald’s restaurants are one likely source of these infections. The investigation is ongoing, and FDA is working to determine the sources of the ingredients that were in common to the salads served at McDonald’s.

On July 26, 2018, FDA completed analysis of an unused package of romaine lettuce and carrot mix distributed to McDonald’s by the Fresh Express processor in Streamwood, IL. The analysis confirmed the presence of Cyclospora in that mix. On July 27, 2018, FDA informed Fresh Express of these results.

Fresh Express reported to FDA that the carrots in the mix went to McDonald’s restaurant locations only, and that the romaine lettuce was the only ingredient in the mix that was distributed to other locations. Romaine lettuce from the same lot that was positive for Cyclospora was distributed in pre-made salads and wraps distributed by Caito Foods LLC of Indianapolis, IN. Fresh Express also reported that no romaine lettuce from the lot that was positive for Cyclospora was packaged for direct retail sale to consumers.

On July 30, 2018, The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) issued a public health alert about pre-made salads and wraps containing romaine lettuce that were distributed by Caito Foods LLC of Indianapolis, IN. The pre-made salads and wraps were shipped to distribution centers nationwide. The pre-made salads and wraps were produced July 15 to July 18, 2018 and have a “Best By,” “Enjoy by,” “Best if Sold By,” or “Sell By” date ranging from July 18 through July 23, 2018. See the product labels here. The pre-made salads and wraps have establishment number “EST. 39985” or “P-39985” inside or next to the USDA mark of inspection. See the full list of products, product labels, UPC code numbers, and other identifying information here.

A Third lawsuit was filed today against Fresh Express Incorporated, the produce supplier for McDonald’s, of behalf of Diane Beuhler, who developed a Cyclospora infection after consuming a McDonald’s Southwest salad. Ms. Beuhler is represented by Marler Clark, the Nation’s Food Safety Law Firm, and Wandro and Associates, a respected local Iowa firm. 2018.08.22 Buehler Diane – Complaint

Ms. Beuhler purchased a McDonald’s Southwest salad from the location at 1709 LaPort Rd., Waterloo, Iowa. On July 1, 2018, she began experiencing symptoms of vomiting, diarrhea, stomach cramps, and fever. After 11 days, Ms. Beuhler’s symptoms became so severe that she sought medical attention at Covenant Medical Center. She was admitted to the hospital for overnight monitoring and was discharged the next day. Ms. Beuhler continued experiencing symptoms and sought medical attention again on July 18 and 19. On July 21, the Black Hawk County Health Department informed Ms. Beuhler of her likely connection to the McDonald’s Cyclospora outbreak.

“Being infected with the Cyclospora parasite can take months to combat with power antibiotics that have their own set of complications,” said Marler Clark managing partner, Bill Marler.

According to a press release from Fresh Express, While the company notes Central America has been the origin of vegetables linked to many Cyclospora outbreaks in the past, this is the first time “a possibility exists that a potential source of contamination could be fresh produce grown and harvested in the US.”

On July 13, the CDC announced an investigation into a multistate outbreak of Cyclospora infections. To date, there are 476 confirmed cases across 15 states. 21 people have been hospitalized. The FDA has linked the outbreak to packaged romaine lettuce and carrot mix distributed to McDonald’s by Fresh Express.  Most cases have been reported in Illinois with 246 and Iowa comes in second with 98.  On July 26, 2018, the FDA completed analysis of an unused package of romaine lettuce and carrot mix distributed to McDonald’s by the Fresh Express processor in Streamwood, IL. The analysis confirmed the presence of Cyclospora in that mix.

Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The first Cyclospora outbreak in North America occurred in 1990 in contaminated water. Recently, Cyclospora outbreaks have been associated with imported fresh fruit and vegetables.  For more information on Cyclospora, visit Food Poison Journal.

Marler Clark, The Nation’s Food Safety Law Firm, is the nation’s leading law firm representing victims of Cyclospora outbreaks. The Cyclospora attorneys Marler Clark have represented Cyclospora victims and victims of 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.  Our Cyclospora lawyers have litigated Cyclospora cases stemming from outbreaks traced to a number of food products and restaurants. For further information, please contact Lauren Fricke at lfricke@marlerclark.com or 1-206-346-1888.

As of August 16, 2018 (3pm EDT), a total of 476 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 15 states. Note, the Connecticut, Tennessee, and Virginia case-patients purchased salads while traveling in Illinois; the Florida case-patient purchased a salad while traveling in Kentucky.  Illnesses started on or after May 20, 2018. The median illness onset date is June 29, 2018 (range: May 20 to July 20). Ill people range in age from 14 to 91 years old, with a median age of 53. Sixty-six percent (66%) are female. At least 21 people have been hospitalized; no deaths have been reported.

Epidemiologic evidence indicates that salads purchased from McDonald’s restaurants are one likely source of these infections. The investigation is ongoing, and FDA is working to determine the sources of the ingredients that were in common to the salads served at McDonald’s.

On July 26, 2018, FDA completed analysis of an unused package of romaine lettuce and carrot mix distributed to McDonald’s by the Fresh Express processor in Streamwood, IL. The analysis confirmed the presence of Cyclospora in that mix. On July 27, 2018, FDA informed Fresh Express of these results.

Fresh Express reported to FDA that the carrots in the mix went to McDonald’s restaurant locations only, and that the romaine lettuce was the only ingredient in the mix that was distributed to other locations. Romaine lettuce from the same lot that was positive for Cyclospora was distributed in pre-made salads and wraps distributed by Caito Foods LLC of Indianapolis, IN. Fresh Express also reported that no romaine lettuce from the lot that was positive for Cyclospora was packaged for direct retail sale to consumers.

On July 30, 2018, The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) issued a public health alert about pre-made salads and wraps containing romaine lettuce that were distributed by Caito Foods LLC of Indianapolis, IN. The pre-made salads and wraps were shipped to distribution centers nationwide. The pre-made salads and wraps were produced July 15 to July 18, 2018 and have a “Best By,” “Enjoy by,” “Best if Sold By,” or “Sell By” date ranging from July 18 through July 23, 2018. See the product labels here. The pre-made salads and wraps have establishment number “EST. 39985” or “P-39985” inside or next to the USDA mark of inspection. See the full list of products, product labels, UPC code numbers, and other identifying information here.

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, 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.

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.

  • COMPLAINT
  • As of August 9, 2018, a total of 436 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 15 states. The investigation is ongoing and the FDA is currently reviewing distribution and supplier information for romaine and carrots.
  • On July 30, 2018, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) issued a public health alert on beef, pork and poultry salad and wrap products potentially contaminated with Cyclospora that were distributed by Caito Foods LLC, of Indianapolis, IN. The products were produced between July 15 and 18, 2018, with either “Best By,” “Enjoy by,” “Best if Sold By” or “Sell By” dates ranging from July 18 through July 23, 2018. Caito Foods had received notification from Fresh Express that the chopped romaine in these products was being recalled.
  • On July 26, 2018, the FDA completed final analysis of an unused package of Fresh Express salad mix containing romaine lettuce and carrots, which had been distributed to McDonald’s. The analysis confirmed the presence of Cyclospora in that sample, though the expiration date for that product, July 19, had already passed. On July 27, the FDA informed Fresh Express of the results.
  • FDA instructed Fresh Express to determine whether potentially contaminated product may still be on the market. Fresh Express reported to FDA that the romaine from the same lot as the positive sample was not packaged for direct retail sale by Fresh Express and had already expired. Fresh Express committed to using recall procedures to inform those companies that received this romaine about the sample result. Fresh Express also reported that carrots used in the mix were only sent to McDonald’s locations.
  • Fresh Express reported to FDA that the romaine from the same lot as the positive sample was not packaged for direct retail sale by Fresh Express and had already expired. Fresh Express committed to using recall procedures to inform those companies that received this romaine about the sample result.
  • Fresh Express reported that the carrots in the mix only went to McDonald’s.
  • As of July 13, 2018, McDonald’s decided to voluntarily stop selling salads at impacted restaurants in IL, IA, IN, WI, MI, OH, MN, NE, SD, MT, ND, KY, WV, and MO. The company has since reported that it has replaced the supplier of salads in those states. More information can be found in McDonald’s Statement.

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.

The Tulsa Health Department (THD) in collaboration with the Oklahoma State Department of Health (OSDH), Acute Disease Service (ADS) are investigating an outbreak of cyclosporiasis among residents of Tulsa and surrounding counties. As of August 1, 24 laboratory-confirmed cases of cyclosporiasis have been reported; symptom onsets have occurred from June 24 through July 26, 2018. The epidemiologic investigation suggests this outbreak is likely ongoing with persons currently experiencing illness and new cases being reported. Case ages range from 27 to 67 years (median = 43 years); 67% of cases are females. Nine (38%) cases are of Hispanic ethnicity. Twenty-one (88%) cases are residents of Tulsa County; although the other three cases are residents of Wagoner, Creek, and Rogers counties, case interviews have revealed at least two of these three individuals shopped and dined at establishments in the Tulsa area.

An investigation is underway to determine the source of this outbreak. Even though the epidemiology of this outbreak suggests a geographic cluster among residents in northeast Oklahoma, it is possible that related cases may not have been identified in other areas of the State as cyclosporiasis is not a notifiable condition. Cases of cyclosporiasis may also be associated with international travel. Public health officials are advising clinicians in Oklahoma to consider cyclosporiasis among patients with an acute, afebrile diarrheal illness, particularly in persons with diarrhea persisting > 1 week, and to report laboratory-confirmed cases with onsets since June 1 to the OSDH ADS epidemiologist-on-call at (405) 271-4060 or via the Public Health Investigation and Disease Detection of Oklahoma (PHIDDO) system.

Cyclosporiasis is a diarrheal illness caused by a single-celled parasite called Cyclospora cayetanensis. It is spread by consumption of contaminated food or water, which becomes contaminated after exposure to fecal matter from ill individuals. Cyclospora is not spread person-to-person. Symptoms of cyclosporiasis include watery diarrhea, loss of appetite, weight loss, bloating, stomach cramps, nausea, vomiting, muscle aches, and fatigue. Symptoms begin an average of 7 days after ingestion of the parasite and may last from several days to several weeks. Weight loss can be significant (exceeding 20 pounds in some cases). Some infected persons may not have any symptoms. Persons of all ages are at risk of infection. Treatment includes Bactrim or Septra (trimethoprim-sulfamethoxazole) and rehydration with fluids.

Recommendations for clinicians and laboratories

  • Clinicians should consider cyclosporiasis in patients presenting with an acute diarrheal illness with persisting watery diarrhea.
  • Laboratory testing for suspected cyclosporiasis includes gastrointestinal polymerase chain reaction (PCR) and/or ova and parasite (O&P) fecal examination.
  • Notify the clinical diagnostic laboratory about suspicion of Cyclospora disease to determine what testing is available, instructions for specimen collection and submission, and whether Cyclospora must be specified on the test order.
  • If ordering a gastrointestinal PCR panel, clinicians need to assure the PCR panel includes a target for Cyclospora.
  • If microscopic examination is ordered, stool specimens are typically submitted in an O&P collection kit. Stool specimens should be obtained early in the course of illness; optimum time is 1-3 days after onset of illness, during the early morning hours when the parasite(s) should be present in the greatest numbers. Many parasites are shed intermittently during the course of an infection; therefore, for initial detection,
  • 3 separate specimens should be collected on separate days, at a minimum of 24 hours apart – one every other day (over 5 days) is optimal but collection should not exceed 10 days.

The CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Cyclospora infections. As of August 9, 2018 (11am EDT), a total of 436 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 15 states. Note, the Connecticut, Tennessee, and Virginia case-patients purchased salads while traveling in Illinois; the Florida case-patient purchased a salad while traveling in Kentucky.

Illnesses started on or after May 20, 2018. The median illness onset date is June 29, 2018 (range: May 20 to July 20). Ill people range in age from 14 to 91 years old, with a median age of 53. Sixty-six percent (66%) are female. At least 20 people have been hospitalized; no deaths have been reported.

On July 26, 2018, FDA completed analysis of an unused package of romaine lettuce and carrot mix distributed to McDonald’s by the Fresh Express processor in Streamwood, IL. The analysis confirmed the presence of Cyclospora in that mix. On July 27, 2018, FDA informed Fresh Express of these results.

Fresh Express reported to FDA that the carrots in the mix went to McDonald’s restaurant locations only, and that the romaine lettuce was the only ingredient in the mix that was distributed to other locations. Romaine lettuce from the same lot that was positive for Cyclospora was distributed in pre-made salads and wraps distributed by Caito Foods LLC of Indianapolis, IN. Fresh Express also reported that no romaine lettuce from the lot that was positive for Cyclospora was packaged for direct retail sale to consumers.

On July 30, 2018, The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) issued a public health alert about pre-made salads and wraps containing romaine lettuce that were distributed by Caito Foods LLC of Indianapolis, IN. The pre-made salads and wraps were shipped to distribution centers nationwide. The pre-made salads and wraps were produced July 15 to July 18, 2018 and have a “Best By,” “Enjoy by,” “Best if Sold By,” or “Sell By” date ranging from July 18 through July 23, 2018. See the product labels here. The pre-made salads and wraps have establishment number “EST. 39985” or “P-39985” inside or next to the USDA mark of inspection. See the full list of products, product labels, UPC code numbers, and other identifying information here.

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, 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.

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.

SIOUX CITY, Iowa – The first lawsuit was filed today against Fresh Express Incorporated, the produce supplier for McDonald’s, on behalf of Kellie McCall, who developed a Cyclospora infection after consuming a McDonald’s salad. Ms. McCall is represented by Marler Clark, the food safety law firm, and Wandro and Associates, a respected Iowa law firm.  complaint McCall

On June 26, 2018, Ms. McCall began experiencing symptoms of diarrhea, stomach cramps, fever, and severe gas. The symptom onset was within 14 days of purchasing and consuming a McDonald’s salad on or about June 18, 2018. On June 26, her symptoms became so severe that she was forced to see emergency medical attention at Burgess Hospital in Onawa, Iowa. Medical professionals preformed a stool test that tested positive for Cyclospora. Ms. McCall continues to suffer from fatigue and stomach cramps and has missed a significant amount of work as a result of her Cyclospora infection.

Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The first Cyclospora outbreak in North America occurred in 1990 in contaminated water. Recently, Cyclospora outbreaks have been associated with imported fresh fruit and vegetables.  For more information on Cyclospora, visit Food Poison Journal.

“Although not all Cyclospora outbreaks have been linked to imported fresh fruit and vegetables, most have been,” said Marler Clark managing partner, William Marler.  “Importers and manufacturers of imported produce must take precautions against introducing parasites like Cyclospora into the stream of commerce.

On July 13, the CDC announced an investigation into a multistate outbreak of Cyclospora infections. To date, there are 395 confirmed cases across 15 states. 16 people have been hospitalized. The FDA has linked the outbreak to packaged romaine lettuce and carrot mix distributed to McDonald’s by Fresh Express.  Most cases have been reported in Illinois with 202 and Iowa comes in second with 87.  On July 26, 2018, the FDA completed analysis of an unused package of romaine lettuce and carrot mix distributed to McDonald’s by the Fresh Express processor in Streamwood, IL. The analysis confirmed the presence of Cyclospora in that mix.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Cyclospora outbreaks. The Cyclospora attorneys Marler Clark have represented Cyclospora victims and victims of 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.  Our Cyclospora lawyers have litigated Cyclospora cases stemming from outbreaks traced to a number of food products and restaurants.

If you or a family member became ill with Cyclospora after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Cyclospora attorneys for a free case evaluation.

For further information, please contact Lauren Fricke at lfricke@marlerclark.com or 1-206-346-1888.

The CDC reports that 395 people in 15 states have become ill. There have been 16 hospitalizations and no deaths. The FDA, CDC, along with state and local officials are investigating a multi-state outbreak of cyclosporiasis illnesses likely linked to salads from McDonald’s restaurants. FDA, CDC, state, and local partners are currently investigating several Cyclospora illnesses associated with McDonald’s locations in IA, IL, IN, KY, MI, MN, MO, NE, OH, SD, and WI.

On July 26, 2018, the FDA completed final analysis of an unused package of Fresh Express salad mix containing romaine lettuce and carrots, which had been distributed to McDonald’s. The analysis confirmed the presence of Cyclospora in that sample, though the expiration date for that product, July 19, had already passed. On July 27, the FDA informed Fresh Express of the results.

FDA instructed Fresh Express to determine whether potentially contaminated product may still be on the market. Fresh Express reported to FDA that the romaine from the same lot as the positive sample was not packaged for direct retail sale by Fresh Express and had already expired. Fresh Express committed to using recall procedures to inform those companies that received this romaine about the sample result. Fresh Express also reported that carrots used in the mix were only sent to McDonald’s locations.

On July 30, 2018, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) issued a public health alert on beef, pork and poultry salad and wrap products potentially contaminated with Cyclospora that were distributed by Caito Foods LLC, of Indianapolis, IN. The products were produced between July 15 and 18, 2018, with either “Best By,” “Enjoy by,” “Best if Sold By” or “Sell By” dates ranging from July 18 through July 23, 2018. Caito Foods had received notification from Fresh Express that the chopped romaine in these products was being recalled.

The investigation is ongoing and the FDA is currently reviewing distribution and supplier information for romaine and carrots.

As of July 13, 2018, McDonald’s decided to voluntarily stop selling salads at impacted restaurants in IL, IA, IN, WI, MI, OH, MN, NE, SD, MT, ND, KY, WV, and MO. The company has since reported that it has replaced the supplier of salads in those states.

Consumers who have symptoms of cyclosporiasis should contact their health care provider to report their symptoms and receive care. Most people infected with Cyclospora develop diarrhea, with frequent, sometimes explosive, bowel movements. Other common symptoms include loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, and fatigue. Vomiting, body aches, headache, fever, and other flu-like symptoms may be noted. Some people who are infected with Cyclospora do not have any symptoms. If not treated, the illness may last from a few days to a month or longer. Symptoms may seem to go away and then return one or more times (relapse).

At this time, we do not have evidence to suggest that this cluster of illnesses is related to the ongoing Cyclospora outbreak linked to Del Monte vegetable trays.

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, 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.

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.