Douglas County Health Department

Cyclosporiasis is an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis. People can become infected with Cyclospora by consuming food or water contaminated with the parasite. Cyclospora is not spread person to person. In the United States, foodborne outbreaks of cyclosporiasis, identified since the mid-1990s, have been linked to various types of fresh produce, including raspberries, basil, snow peas, and mesclun lettuce; no commercially frozen or canned produce has been implicated.

2013 Cyclosporiasis Outbreak

On July 2nd and 3rd, Douglas County Health Department (DCHD) was notified of several laboratory confirmed cases of Cyclospora in Douglas County residents. Since then, DCHD has been collaborating with public health officials from multiple states, the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) to investigate this outbreak. If you think you may have Cyclospora infection, please contact your health care provider. However, if illness onset is after July 1, the illness is more likely caused by another pathogen. For healthcare provider information, click here.

Highlights of the Epidemiologic Investigation

A total of 45 Douglas County residents have been reported with laboratory confirmed Cyclospora infection (cyclosporiasis) and linked to this outbreak.
Click here for the state of Nebraska's case count.
The epidemiologic investigation completed by Douglas County Health Department (DCHD) and Nebraska's Department of Health and Human Services, Division of Public Health has linked the outbreak to a salad mix supplied to restaurants in Nebraska and Iowa by Taylor Farms de Mexico, S. de R.L. de C.V. The restaurants in Nebraska and Iowa include Olive Garden and Red Lobster, both of which are owned by Darden Restaurants.
On August 12, 2013, Taylor Farms de Mexico officially informed FDA that, as of August 9, 2013, the company voluntarily suspended production and shipment of any salad mix, leafy green, or salad components from its operations in Mexico to the United States.
This investigation is ongoing and DCHD continues to work with state and federal (CDC and FDA) officials to assist with the trace-back investigation to a source.
It is unknown whether cases reported in other states are part of the same outbreak.
Most of the illnesses occurred in June. It is thought that the contaminated product has expired and is no longer available in our area.
Lettuce, whether bagged or not, is safe to eat. It is always recommended to wash all fruits and vegetables thoroughly before eating.

Cyclospora General Information

What is Cyclospora?Cyclospora cayetanensis is a parasite composed of one cell, too small to be seen without a microscope. This parasite causes an intestinal infection called cyclosporiasis.

How is Cyclospora spread?
Cyclospora is spread by people ingesting something - such as food or water - that was contaminated with feces (stool). Cyclospora needs time (days to weeks) after being passed in a bowel movement to become infectious for another person. Therefore, it is unlikely that Cyclospora is passed directly from one person to another.

Who is at risk for Cyclospora infection?
People living or traveling in tropical or subtropical regions of the world may be at increased risk for infection because cyclosporiasis is endemic (found) in some countries in these zones. In the United States, foodborne outbreaks of cyclosporiasis have been linked to various types of imported fresh produce.

What are the symptoms of Cyclospora infection?
The time between becoming infected and becoming sick is usually about 1 week. Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, with frequent, sometimes explosive, bowel movements. 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.

How long can the symptoms last?

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.

What should I do if I think I might be infected with Cyclospora?
See your health care provider.

How is Cyclospora infection diagnosed?
Your health care provider will ask you to submit stool specimens to see if you are infected. You might be asked to submit more than one specimen from different days. Identification of this parasite in stool requires special laboratory tests that are not routinely done. Therefore, if indicated, your health care provider should specifically request testing for Cyclospora. In addition, your health care provider might have your stool checked for other organisms that can cause similar symptoms.

How is Cyclospora infection treated?

The recommended treatment is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim*, Septra*, or Cotrim*. People who have diarrhea should also rest and drink plenty of fluids.

I am allergic to sulfa drugs; is there another drug I can take?
No highly effective alternative drugs have been identified yet for people with Cyclospora infection who are unable to take sulfa drugs. See your health care provider to discuss potential options.

How is Cyclospora infection prevented?
Avoiding food or water that might have been contaminated with stool may help prevent Cyclospora infection. People who have previously been infected with Cyclospora can become infected again.

Health Care Provider Information:

Additional Resources:

NEBRASKA

Douglas County

Health Department

Cyclosporiasis (Cyclospora infection)