SACRAMENTO, CA — Health officials are baffled by recent cases of a foodborne parasitic illness that has sickened people in 20 states with symptoms that include weekslong bouts of diarrhea. This week, officials have focused on some foods that may be linked to the nationwide outbreak.
According to the California Department of Public Health, at least six cases of cyclosporiasis have been recorded as of May 1, the most recent reporting period. Cyclosporiasis is an intestinal illness caused by Cyclospora, a microscopic parasite.
Federal health officials believe the reported cases are an undercount because not all affected people seek medical treatment.
California health officials said no specific foods have been identified in connection with the cyclosporiasis outbreak in the state this year.
As the outbreak spreads across the nation, state health officials in Michigan released a list of foods that have been linked to previous Cyclospora outbreaks in the United States and Canada:
In 2022, a cyclosporiasis outbreak in Florida was also partially linked to romaine lettuce in a Caesar salad kit, according to the CDC.
"CDPH actively monitors for possible domestically-acquired cases of cyclosporiasis, as well as for possible outbreaks. The majority of cases in California are associated with recent international travel," said Beth Deines, a spokesperson for the CDPH.
"Investigation of these cases is ongoing. At this time, there are no known local outbreaks and no cases are currently known to be linked to multistate outbreaks under investigation by the CDC," she added.
"Numbers will increase over the course of the year as new cases, either domestic or internationally-acquired, are identified and investigated. However, with the significant increase in cases in the Eastern and Midwestern states, we will monitor for cases that may be associated with travel to areas of the country that are experiencing these increases. Similarly, we will look for clusters of cases, which may indicate transmission occurring in California."
Beth Deines, spokesperson for the California Department of Public Health
As of Thursday, more than 400 cases of cyclosporiasis have been officially reported across the U.S., though state-level reporting shows much higher numbers.
Centers for Disease Control and Prevention data shows at least 145 people got sick between May 1 and June 16. None of the people had traveled abroad in the two weeks before they became ill, and local, state and federal health officials are focusing their investigation on clusters of cases in more than one state.
Other states with reported cases are Alaska, Colorado, Connecticut, Florida, Georgia, Louisiana, Massachusetts, New Jersey, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, Virginia and Wisconsin with 1 to 10 cases; Illinois with 11 to 30; and New York with 31 to 80.
Michigan, which was not among the 17 states included in the CDC's recent figures, reported more than 1,200 cases of cyclosporiasis on Thursday.
No deaths have been reported.
The CDC cautioned that cyclosporiasis cases may not be limited to the states with known cases. The agency also said the true number of illnesses is likely higher than the reported count because some people recover without medical care and are never tested for the parasite.
Cyclosporiasis is nationally notifiable and is reportable in 47 states, the District of Columbia, and New York City, according to the CDC.
The CDC said cases typically rise in spring and summer, and the cyclosporiasis season runs from May 1 through Aug. 31.
The 145 people included in the CDC’s current count became sick after eating food in the United States. They ranged in age from 5 to 86, with a median age of 42, and 61 percent were female, the CDC said.
The CDC also reported 45 additional cases among people who became sick after eating or drinking contaminated food or water while traveling outside the United States. Three of those people were hospitalized, and no deaths were reported.
Symptoms usually begin about a week after someone consumes contaminated food or water, though they can appear as soon as two days or more than two weeks later. Watery diarrhea is the most common symptom.
Cyclospora infects the small intestine and typically causes watery diarrhea with frequent, sometimes explosive, bowel movements.
Other symptoms may include loss of appetite, weight loss, cramping, bloating, increased gas, nausea and fatigue. Less common symptoms include vomiting, body aches, headache, low-grade fever and other flu-like symptoms.
Without treatment, symptoms can last from a few days to a month or longer, and diarrhea may go away and return. The CDC advises people with symptoms to see a healthcare provider, who can test for and treat cyclosporiasis.
The CDC said no one fully knows how Cyclospora gets into food and water.
To reduce the risk of illness, the agency recommends:
Michigan health officials also provided some guidance for preparing or processing the known risk foods, as follows:
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