As of yesterday (August 20, 2013, 5 p.m. EDT), a total of 598 people ill with intestinal Cyclospora had been reported from 22 states. (Illnesses after July 14 may not have appeared yet because of the time it takes between when a person gets sick and when the illness is reported to CDC. This could take up to 5 to 6 weeks.) No documented human-to-human transmission exists.
Most of the illness onset dates have ranged from mid-June through mid-July. The numbers of infected people have been dropping since July (see photo).
From the FDA: Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, with frequent, sometimes explosive, bowel movements. [This may last for up to two months if untreated.] 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). It’s common to feel very tired.
Those sickened in this group of infections by the single-celled parasite Cyclospora cayetanensis range in age from less than one year to 92, with a median age of 51. Women comprise the larger segment by sex: 55% of those ill are female, 45% male. Among people for whom information is available, 9% have been hospitalized. No deaths have been reported.
It is still unclear whether the ill persons from all of the states are part of the same outbreak. Only Nebraska and Iowa, which have had 40% of the Cyclospora infections to date, have concluded investigations (July 30). They linked Cyclospora infection to a salad mix used in restaurants.
There is no word on what is happening with information being collected from other affected states and assessed by the federal government with data provided by the state health authorities in Iowa and Nebraska. They still need to link a specific food item to the illnesses. FDA has a 21-person headquarters team and FDA specialists across the country in 10 field offices working on this.
In a traceback investigation, where a team identifies clusters of ill people in separate geographic areas and traces the path of their food, the Food and Drug Administration confirmed that the salad mix these states linked to the outbreak of cyclosporiasis was supplied to restaurants by Taylor Farms de Mexico, a processor of food service salads.
Restaurants using the salad mix in Iowa and Nebraska include Olive Garden and Red Lobster, both of which are owned by Darden Restaurants. FDA’s investigation has not implicated consumer packages sold in grocery stores. A microscopic organism, Cyclospora does not necessarily make food contaminated look or taste “off.” If you think you may be part of the outbreak, talk with your doctor.
The last date that anyone reportedly became ill in Iowa or Nebraska was July 2. The typical shelf life for a salad mix is up to 14 days. However, other states and the CDC and FDA are still apparently dragging their feet in conducting investigations to determine whether the Iowa/Nebraska conclusion applies to, or helps explain, the cyclosporiasis in other states.
Just over a week ago, Taylor Farms de Mexico officially informed FDA that on August 9, the company had voluntarily suspended production and shipment of any salad mix, leafy greens, or other salad mix components from its operations to the United States. The firm has committed to not produce and ship these products from Mexico without FDA’s approval. The FDA and Taylor Farms will assess the firm's processing facility in Mexico to try to determine why the outbreak occurred and identify preventive controls.
Health personnel have been advised to include Cyclospora infection in their differential diagnosis of prolonged or relapsing diarrhea. If suspicious, they should explicitly request stool examinations for this parasite.
Based in Chicago, Sandy Dechert has been covering science and health for Examiner.com since the webzine's official startup. In the health area, she began investigating MERS before the disease was officially named and H7N9 human influenza on the day the Chinese announced it. She has also followed American seasonal influenza, the cancer diagnoses of public figures like Robin Roberts and Valerie Harper, and the creation, enactment, and progress of the Affordable Care Act (Obamacare). Sandy's science articles appear frequently in Examiner's women's and sexual health columns and under environment and energy, as well as elsewhere in the digital world.
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