The next time you think about ordering or making a salad, you need to know that federal health officials are investigating a multi-state outbreak of a parasitic intestinal illness—one that's already sent dozens of Americans to the hospital—and the number of cases appears to be climbing fast.
The Centers for Disease Control and Prevention (CDC) has confirmed at least 145 cases of cyclosporiasis have been reported in 17 states in recent weeks.
That's the bad news; the good news is that of the 20 people hospitalized, no deaths have been reported. But that official count is almost certain to be an undercount—and it doesn't include a major new cluster that emerged after the data was collected.
The source of the contamination has not yet been identified.
What Is Cyclospora — and Why Haven't I Heard of It?
Cyclosporiasis is a severe intestinal infection caused by the microscopic parasite Cyclospora cayetanensis. People typically catch it by eating or drinking fresh produce or water contaminated with infected feces. It frequently triggers watery, sometimes explosive diarrhea, stomach cramps, nausea, vomiting, and profound fatigue.
The tricky X factor is the timeline. Once someone eats food contaminated by the parasite, it can sit there anywhere from two to 14 days before any symptom shows up. And for those of us who can't remember what we had for breakfast yesterday, we could have absolutely no idea what you ate that caused you to be sick.
Doctors are clueless, too
Reports suggest that illness can be missed by doctors, too, since cyclospora is not part of a standard stool culture, and most clinical labs do not routinely test for it unless it is specifically requested.
This means many (if not most) cases are never diagnosed, leaving patients and their doctors scrambling for a reason behind the illness when a treatable parasitic infection is actually the cause.
What Foods Are Suspect?
Unlike bird flu or salmonella or other foodborne illnesses, no one can point to a specific food product or any that have been recalled or publicly identified as the source of this outbreak.
However, health officials have previously traced similar infections to items such as cilantro, basil, raspberries, snow peas, mesclun lettuce (commonly sold in grocery stores as "spring mix"), and bagged salads.
Clues are starting to appear, though
Dr. Wesley Long, medical director of diagnostic microbiology at Houston Methodist, says the multi-state spread is a telling clue.
"Historically, these outbreaks have often been associated with fresh produce such as herbs, leafy greens and berries," Dr. Long said. "Because cases are being reported across multiple states, investigators will likely focus on foods that were distributed nationally and may have become contaminated during harvesting, processing or packaging."
Herbs present a special challenge.
"Herbs can be particularly challenging to trace because they're frequently used as ingredients in prepared foods, sauces and restaurant dishes," Dr. Long said.
Washing lettuce may not do anything
In similar situations, washing your produce may be enough, but not here.
"Cyclospora is resistant to the chlorine-based sanitizers commonly used in produce processing," Dr. Long said, "which means contaminated produce can sometimes reach consumers despite routine washing and sanitation measures."
Why Seniors Need to Pay Extra Attention
Confirmed cases run the gamut—from age 5 to 86. But it's seniors who could have a fight on their hands. Especially seniors who are immunocompromised—including those managing diabetes, cancer, or autoimmune conditions or taking medications that suppress the immune system. The CDC says that age group is more susceptible to prolonged or severe illness.
Things could take a detour if someone is dehydrated because older bodies are less efficient at retaining fluids. At an even greater risk are those who are already managing kidney or heart conditions that complicate fluid replacement.
But that's not the end of it. Reports note that symptoms can disappear and reappear if the parasite is not treated, meaning seniors who feel better for a few days may not be out of the woods.
How Is It Treated?
Cyclosporiasis is treatable. The infection is typically treated with the antibiotic combination trimethoprim-sulfamethoxazole (aka Bactrim), which the CDC says is highly effective. There is no proven alternative treatment for people who cannot take sulfa drugs.
What You Should Do Right Now
Even though there are question marks all over this situation, the CDC and FDA have yet to issue a recall or advise avoiding any specific food.
In the meantime, here's the practical guidance:
- Wash all fresh produce thoroughly under running water before eating, even pre-washed or bagged items — while understanding that washing alone cannot eliminate all risk.
- Scrub firm produce such as melons and cucumbers with a clean brush.
- Tell your doctor specifically to test for Cyclospora if you develop prolonged diarrhea after eating fresh greens, herbs, or salads. Don't assume a simple stool test will catch it because it won't unless your doctor orders it by name.
- Seek care promptly if you experience severe diarrhea, signs of dehydration (extreme thirst, dark urine, or dizziness), or symptoms that seem to improve then return.
Smart Senior Daily will update this story as new information becomes available. The CDC's current outbreak data can be found at cdc.gov/cyclosporiasis.
