An outbreak of a parasitic infection that causes “explosive” diarrhea is sickening many in the Midwest and it can spread through contaminated produce and water, sparking a warning from health officials as they search for a source.
While an investigation into what is causing the latest outbreak continues, health experts are urging residents to wash fresh produce thoroughly. And certain types of produce could be riskier than others.
The U.S. Centers for Disease Control and Prevention reported in June that 145 cases of cyclosporiasis have been confirmed in people in the U.S., with Illinois and Wisconsin among the states reporting cases.
Then, Michigan health officials reported Wednesday a serious outbreak impacting more than 100 others in just nine days.
“Outbreaks of cyclosporiasis have been occurring across the United States and now here in Michigan,” Dr. Natasha Bagdasarian, chief medical executive for Michigan Health and Human Services, said in a statement. “Based on the unusual number of cases we have identified in a little over a week, we anticipate additional cases of illness being reported. We recommend Michiganders contact their health care provider if they experience sudden, ongoing diarrhea and reach out to their local health department if additional members of their family are suffering from the same symptoms.”
The infections are caused by cyclospora, “a one-celled parasite too small to be seen with the naked eye,” according to the Illinois Department of Public Health. Cyclosporiasis is a form of food poisoning tied to the parasitic infection.
While not usually life-threatening, the parasite infects people via contaminated food or water.
Health officials said the parasite is most common during the spring and summer months, often leading to a potential spike in cases.
The parasite “spreads from ingesting food or water contaminated with infected stool (feces)” and is most commonly found in fresh produce like raspberries, snow peas, mesclun lettuce, basil, and cilantro.
It does not spread from human to human, however.
“In recent years, outbreaks have occurred in the U.S. as a result of eating contaminated fresh produce, especially during the summer months,” the Michigan health department warned.
Dr. Sharon Welbel, chair of infectious diseases for Cook County Health, told NBC Chicago “fragile” produce has previously been of highest risk with such infections.
“Some of the common things that have been implicated in the past are certain herbs like garlic, cilantro, probably because it’s harder to clean those,” Welbel said. “Berries, particularly raspberries, again harder to clean them because they’re so fragile, as well as mixed greens.”
Officials urged residents to use food safety practices to limit spread.
“MDARD is committed to ensuring food safety across the state and is working in partnership with local health departments to identify the source of the outbreak and keep consumers safe,” Jennifer Bonsky, director of the Human Food Division at the Michigan Department of Agriculture and Rural Development, said in a statement. “In these moments, it becomes even more important to follow all of the essential food preparation guidelines, such as washing your hands before and after preparing food and washing produce before it is consumed.”
Bonsky and the health department recommended the following tips:
Wash all fruits and vegetables thoroughly under running water before eating, cutting or cooking. Scrub firm fruits and vegetables, such as melons and cucumbers, with a clean produce brush. Cut away any damaged or bruised areas on fruits and vegetables before preparing and eating. Refrigerate cut, peeled or cooked fruits and vegetables as soon as possible.Welbel suggested “delicate things” like basil or cilantro should soak “for a while.”
What do we know about the U.S. cases so far?
As of June 16, the CDC reported 190 cases in total. Of those, 145 were infected in the U.S., while 45 reported traveling outside the country before becoming ill.
Those sickened in the U.S. ranged in ages from 5 to 86 years old, with 61% of them female. Dates of illness ranged from May 1 to June 6. At least 20 were hospitalized, but no deaths have been reported so far.
“Local, state, and federal (CDC, FDA) public health authorities are investigating several clusters of cases in more than one state. Investigations to identify potential sources are ongoing,” the CDC stated.
More than 17 states have reported cases of the parasitic infection so far, including Illinois and Wisconsin. Illinois is among the states reporting the most cases as of the CDC’s June update.
IDPH confirmed it was aware of the latest CDC numbers, noting that it is “high season” for “this common pathogen.”
“The Department will continue to work with local and federal partners to monitor cases that are domestically acquired to determine a potential source,” the department told NBC Chicago.
Federal health officials noted that the confirmed cases are not limited to these regions, however, and the true number of cases is likely higher than what’s been reported.
On July 1, Michigan health officials released information on a recent rush of cases with several local health departments “actively investigating a large and growing outbreak.”
According to Michigan’s Health and Human Services department, more than 170 cases were reported in just nine days across seven counties, including Monroe, Lenawee, Washtenaw, Wayne, Livingston, Shiawassee and Jackson.
Officials said it was not immediately clear if all cases reported in the last nine days were a part of the outbreak, but an investigation is underway as they try to identify a potential cause.
Here’s a county-by-county breakdown of cases in Michigan as of Wednesday:
Monroe: 70 Lenawee: 33 Washtenaw: 21 Wayne: 12 Jackson: 7 Shiawassee: 7 24 cases in 11 other counties and the City of DetroitWhat are the symptoms of cyclosporiasis?
Symptoms can appear between days and weeks of ingesting infected water or food.
The main symptom is watery, or “explosive” diarrhea, the Cleveland Clinic reports, noting that other stomach issues can also be reported.
“The first thing is explosive diarrhea, bloating, cramping, loss of appetite,” Dr. Sharon Welbel, chair of infectious diseases for Cook County Health, told NBC Chicago. “Some people have a low grade fever but that’s pretty uncommon.”
Symptoms include:
Watery diarrhea (most common) Loss of appetite Weight loss Cramping Bloating Increased gas Nausea FatigueLess common symptoms may include things like vomiting, body aches, headache, low-grade fever and other flu-like symptoms, the CDC reported.
When compared to other stomach bugs, experts said the hardest part of cyclospora is the timing.
“The symptoms are a bit less, but they go on longer. Noroviruses kind of hits you hard and then it’s done. This kind of just drags on for a longer period of time,” Dr. Irfan Hafiz, an infectious disease physician at Northwestern Medicine, told NBC Chicago.
The CDC also added that without treatment, symptoms can last even longer, or potentially return.
“Without treatment, symptoms can last anywhere from a few days to a month or longer,” the CDC stated. “Some symptoms, such as diarrhea, may go away and then return. Other symptoms, such as fatigue, may continue after the gastrointestinal symptoms have stopped.”
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