While officials are urging everyone to wash their produce thoroughly, health experts are noting that it may not keep you from contracting cyclosporiasis, the parasitic infection known for causing “explosive” diarrhea.
With an outbreak spreading across dozens of U.S. states, and no official source identified, health experts have been encouraging people to take proper food safety measures like rinsing produce.
“Wash under clean running water, even if you plan to peel it. ‘Pre-washed’ does not guarantee safety and rewashing bagged lettuce is unlikely to remove cyclospora,” Michigan health officials warned. “While washing alone may not fully eliminate cyclospora, it enhances protection when combined with cooking or peeling.”
While health officials noted washing produce won’t eliminate risk, experts have said one strategy will.
“Rinsing with vinegar doesn’t do it, baking soda, those sorts of things,” Dr. Sharon Welbel, chair of infectious diseases for Cook County Health, told NBC Chicago. “Heating to 158 [degrees Fahrenheit] or 70 degrees Celsius will kill it. And that’s really the only way right now to get rid of it.”
Welbel recommended that people with compromised immune systems “highly consider just not eating lettuce or these high-risk, difficult-to-clean fresh produce right now.” That includes things like snow peas, cilantro, basil and other produce items that have sparked cyclosporiasis outbreaks in the past.
So should you still rinse your produce?
“Still do that and it will decrease the load of the parasite,” Welbel said.
What can you do if you fear you may have eaten contaminated produce?
“Unfortunately, there isn’t [anything you can do] and I do want to re-emphasize that, while this is an uncomfortable disease, most people do okay with it and there is treatment for it,” Welbel said.
For those who can tolerate sulfa drugs, there is a medication prescribed to those infected by the cyclospora parasite.
“That works really well, works really quickly,” Welbel said.
But for those allergic to sulfas or those who may be pregnant, there’s no alternative, Welbel said.
What to know about the outbreak
Michigan has seen the most cases of cyclosporiasis of any state in the U.S. so far — and by a large margin.
As of Wednesday, more than 3,700 cases had been reported in the state.
Health officials there have said no exact source has been identified but that “current results point to lettuce or salad greens.” They noted that “other food items cannot be completely ruled out” and “no specific type of produce, grower or supplier has been identified as the source.”
“Although we do not have a definite product identified as the source of the outbreak, we want to let Michiganders know what we have learned so far so they can take steps to protect their families,” Dr. Natasha Bagdasarian, chief medical executive for MDHSS, said in a statement. “Early information has shown lettuce as a common product that regularly comes up during the investigation. We will continue to provide updates as we learn more.”
The Centers for Disease Control and Prevention said it is investigating a cluster of cases in four Midwest states as part of the major outbreak spreading across the U.S. that has left them “concerned.”
According to the CDC, cases in Ohio, Michigan, Kentucky and West Virginia are being investigated together as part of a multi-state cluster.
“Public health officials are interviewing people linked to this outbreak to find out what foods they ate before getting sick,” the CDC said in an alert Tuesday. “A specific food item has not yet been confirmed as the source. Investigators are collecting as much information as they can to solve this outbreak.”
As of July 13, more than 400 people infected with cyclospora have been reported to CDC from those locations, with additional cases under investigation.
Those sickened all reported experiencing symptoms on or after June 22.
“The true number of sick people in this multistate outbreak is likely higher than the number reported, and the outbreak may not be limited to the states with known illnesses,” the CDC noted. “This is because some people recover without medical care and are not tested for Cyclospora. In addition, recent illnesses may not yet be reported as it can take several weeks to determine if a sick person is part of an outbreak.”
The link between the states remains unclear, but officials said the “investigation is showing a likely common source.”
Taco Bell has issued a statement as the fast food chain pulled certain ingredients from some locations amid the outbreak.
“The health and safety of our guests is our top priority,” Taco Bell Corp said in its statement. “Public health officials have not confirmed a link to Taco Bell or any specific ingredient, supplier, restaurant or retailer. While authorities continue their broader review, Taco Bell has voluntarily and temporarily removed limited ingredients at select restaurants as a precautionary measure. We will continue to closely monitor the situation and follow the guidance of public health authorities.”
Gwen Biggerstaff, deputy director of the CDC’s Division of Foodborne, Waterborne, and Environmental Diseases, noted, however, that “there are a lot of cases that are not accounted for as part of that multistate outbreak and there are a number of investigations that are going on.”
“This is much, much higher than what we’ve seen last year or the year before,” she said. “This is a pretty big shift from what we’ve seen in previous seasons.”
Across the U.S., the CDC said 1,645 cases were confirmed to have been acquired domestically since May, 1 with at least 141 hospitalized as of July 13. Those sickened ranged in ages from 2 to 95 years old, data showed, with cases confirmed in at least 34 states.
Kentucky officials confirmed a larger-than-typically increase in cases, reaching 100 reports, but only 55 confirmed so far. That’s compared to the average of 35 cases reported each year in the state.
Another Midwest state, Illinois, has reported several new infections in recent days as health officials investigate a potential source for the outbreak known for causing “explosive” diarrhea.
According to numbers released by the Illinois Department of Public Health Tuesday, the state has recorded at least 216 cases of the parasitic infection so far. Of those, 18 were hospitalized, health officials said.
Chicago made up as many as 50 of the reported cases, though three remain under investigation.
“At this time, no single source or cause of Chicago cases has been identified, and there is still no evidence of a large outbreak accounting for all or most of these Chicago cases,” the Chicago Department of Public Health said in a statement.
The numbers are some of the highest of the 34 states currently reporting cases, according to the CDC.
What can you do to prevent infection?
While lettuces are being investigated as a potential source, and have been the source for previous cyclosporiasis outbreaks, officials urged anyone eating or preparing lettuce or salad greens in areas where cases have been reported to take added precautions.
That includes:
Purchase whole heads: Buy whole heads of lettuce rather than pre-washed, bagged lettuce or pre-mixed salad kits. Discard outer layers: Before preparation, throw away the outer two to three layers of leaves. Wash inner leaves: Thoroughly wash the remaining inner leaves under clean running water. Prioritize cooking: For any greens that can be cooked, cooking to a temperature of at least 158 F (70 C) is the safest option, as the parasite is resistant to routine chemical disinfection and washing alone cannot guarantee its removal.Other recommendations include:
Cook produce when possible: Heating food to 158 F (70 C) or higher kills cyclospora. Peel produce: Peeling is highly effective for food items with removable skin as the parasite sits on the outer surface. Wash all fresh produce: Wash under clean running water, even if you plan to peel it. “Pre-washed” does not guarantee safety and rewashing bagged lettuce is unlikely to remove cyclospora. While washing alone may not fully eliminate cyclospora, it enhances protection when combined with cooking or peeling.Produce items linked to previous outbreaks
Food items that have been linked to previous cyclospora outbreaks in the U.S. and Canada include:
Bagged salad mixes and kits
Fresh cilantro (coriander leaves)
Fresh basil
Raspberries
Snow peas
Green onions (scallions)
What are the symptoms of cyclosporiasis?
While the most common and notable symptom of the infection is known as “explosive diarrhea,” there are numerous other signs of infection.
“[The diarrhea] can be really frequent, pretty severe. People talk about explosive diarrhea,” said Dr. Kiran Joshi with the Cook County Department of Public Health. “You can get all kinds of other abdominal symptoms as well, including loss of appetite, nausea, vomiting, sometimes a low grade fever. Now, those symptoms can certainly cause quite a bit of distress. The good news is that this is typically not a life-threatening illness, though if untreated, it can last for a month or longer, so it’s really important.”
Experts say diarrhea itself isn’t a distinctive symptom, but knowing the outbreak is growing could lead more practitioners to testing for cyclosporiasis.
One of the larger indications of cyclosporiasis is likely the timing of infection and symptoms.
While many other foodborne illnesses will show symptoms within hours, cyclosporiasis can take days or even up to two weeks to appear. The most common time frame is around one week, according to the Centers for Disease Control and Prevention.
“The first thing is explosive diarrhea, bloating, cramping, loss of appetite,” Dr. Sharon Welbel, chair of infectious diseases for Cook County Health, said. “Some people have a low-grade fever but that’s pretty uncommon.”
The infections can also last much longer than other foodborne illnesses.
“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 notes that the illness can last anywhere from a few days to over a month and, in some cases, may even seem to go away but then return one or more times.
Here’s a look at how it compares to other illnesses.
What to do if you become ill
People experiencing frequent, watery diarrhea are being urged to contact their healthcare provider and “specifically request testing for cyclospora as routine stool tests may miss the parasite,” MDHSS stated.
Treatment for confirmed infections will include antibiotics, but those who contract it should also be prepared to rest and drink fluids to maintain hydration.
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