I would hazard a guess that prior to July 28th, most
people had never heard of Cyclospora....unless you've travelled to a tropical
or subtropical destination and gotten "traveller's diarrhea"! A quick Google search this morning resulted
in 53 000 hits with news articles, blogs and updates from all the major media
outlets, and of course the appropriate governmental agencies such as the CDC, FDA,
etc. Of particular interest is how the use of electronic messaging and media
attention in the early stages of this outbreak investigation helped public
health agencies identify cases which might not otherwise have been considered
by health care providers or their patients.
The outbreak has spread through 16 states with a case
count of 466 as of Aug 5th, at least 24 of which have hospitalized in five of
the affected states. Iowa has the most
reported Cyclospora infections with 146 cases, followed by Texas with 113 cases
and Nebraska with 81 cases. Nebraska and
Iowa have concluded that the cause of the outbreak was due to the supply of
pre-packaged salad mix to restaurants in those states by Taylor Farms de
Mexico, a processor of foodservice salads. The FDA
investigation found that illness clusters at restaurants including Olive
Garden and Red Lobster, both of which are owned by Darden Restaurants, were
traced to a common supplier. It has been confirmed that the salad mix linked to
the outbreak is no longer available.
Cyclospora c
ayetanensis is a parasite composed of one
cell and is too small to be seen without a microscope.
Cyclosporiasis occurs in many countries, but
is most commonly found in tropical and subtropical regions.
The risk for infection is seasonal; however
no consistent pattern has been identified regarding the time of year or the
environmental conditions, such as temperature or rainfall.
In the United States, foodborne outbreaks of
Cyclosporiasis since the mid-1990s have been linked to various types of
imported fresh produce, including raspberries, basil, snow peas, and mesclun
lettuce.
No commercially frozen or
canned produce has been implicated.
People become infected with Cyclospora by ingesting fecal
matter contaminated with sporulated oocysts, which are the infective form of the
parasite. This most commonly occurs when food or water contaminated with feces
is consumed. An infected person sheds
unsporulated (non-infective) Cyclospora oocysts in the feces. The oocysts are
thought to require days to weeks in favorable environmental conditions to
become infective; therefore direct person-to-person transmission and
transmission via ingestion of newly contaminated food or water is unlikely.
The time between becoming infected and becoming sick is
usually about 1 week. Cyclospora infects
the small intestine causing watery diarrhea with frequent, sometimes explosive,
bowel movements. Other common symptoms
include loss of appetite, weight loss, stomach cramps/pain, bloating, nausea,
and fatigue. Vomiting, body aches,
headache, fever, and other flu-like symptoms have also been noted as associated
symptoms.
As Cyclospora is transmitted only by ingesting contaminated food, avoiding food or water that may have been contaminated with
feces is the best way to prevent Cyclosporiasis. Although it is prudent to thoroughly wash
produce that will be eaten raw, this practice may not eliminate the risk of
transmission of Cyclospora as treatment with chlorine or iodine is unlikely to
kill the Cyclospora oocysts.
It's summer - our traditional salad season. I can't say I'll stop eating salads over
concern about becoming infected with Cyclospora, but I definitely will try to
buy from local farms and avoid any packaged salad mix from countries with
endemic Cyclospora and poor sanitation programs, THANKFULLY Ohio has only had
one case of Cyclospora, so I should be pretty safe on my trip to Cincinnati
this week!
Bugging Off!
Nicole
