Cyclospora Outbreak : What Is It And Why

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Cyclospora Outbreaks In The USA

There have been a number of food poisoning outbreaks of Cyclospora in the US. We have a look at what this all means:

Firstly, let’s cover the basics. What is Cyclospora?

Cyclosporiasis is an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis. Cyclospora infection (Cyclosporiasis) causes watery, and sometimes explosive, diarrhoea. You can become infected with Cyclospora by consuming food or water contaminated with the parasite.

Fresh produce is mostly the culprit in many cases of Cyclospora infection. This usually occurs because of contaminated water or soil during the farming process.

Why are we talking about Cyclospora?

If you’ve been following the news, there have been a number of food-borne illness outbreaks traced to the parasite Cyclospora. Public health officials have cautioned consumers in the US to not eat certain beef, pork, and poultry salads and wraps sold at many retailers, including Kroger, Trader Joe’s, and Walgreens.

The most recent Cyclospora outbreak appears to have started in early July 2018 and involved salads sold at McDonald’s in the Midwest. In mid-July, McDonald’s announced that it had temporarily stopped selling salads at more than 3,000 outlets. There have been 395 recent cases of Cyclosporiasis in 15 states involving pre-made salads.

Where Do Cyclospora Infections Come From?

Cyclospora is endemic in certain regions, meaning that imports from certain countries are at high risk of causing infections than countries that do not show infections of soil and crop.

If you live or are travelling to developing areas in the tropics and subtropics, you may be at an increased risk of getting Cyclosporiasis infections.

In some regions, infections can be more prevalent in late spring and summer. Which are the months where increased import of fruits and vegetables into the US from the more southern neighbours occur.

“The Midwest is hit with Cyclospora outbreaks every summer, which seems to be connected with produce distribution channels,” says Paul Cieslak, M.D., medical director of communicable diseases at the Oregon Health Authority.

Food Safety Precautions Help To Prevent The Disease

This means following the basic food safety pillars principles when it comes to handling raw fruits and vegetables. Especially those foods that do not require any cooking. 

1. Cleaning: Wash cutting boards, dishes, utensils, and countertops with soap and hot water between the preparation of raw meat, poultry, and seafood products and the preparation of fruits and vegetables that will not be cooked.
2. Personal Hygiene: Wash hands with soap and warm water before and after handling or preparing fruits and vegetables.
3. Food Handling: Wash all fruits and vegetables thoroughly under running water before eating, cutting, or cooking. Fruits and vegetables that are labelled “prewashed” do not need to be washed again at home. 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.
4. Food Storage: Refrigerate cut, peeled, or cooked fruits and vegetables as soon as possible. Within 2 hours of preparation. Store fruits and vegetables away from raw meat, poultry, and seafood.
5. Temperature Control: Cook foods thoroughly, and never leave foods out for no reason.

If you’re travelling to tropical countries, avoid raw produce and don’t drink unfiltered water, the CDC says.

What Are The Symptoms Of Cyclosporiasis?

Because diarrhoea can be caused by a number of food poisoning pathogens (asymptomatic), it can be difficult to diagnose Cyclospora infection unless stool tests are performed. Treatment for Cyclosporiasisinfection is by the use of antibiotics called co-trimoxazole. However, according to the CDC No vaccine for Cyclosporiasis is available.

Most individuals infected with the parasite that causes Cyclospora infection, develop no signs or symptoms. 

For others the signs and symptoms, which usually begin within 2 to 11 days of eating contaminated food or drinking contaminated water, can include:

1. Frequent, watery diarrhoea
2. Alternating bouts of constipation and diarrhoea
3. Loss of appetite and weight loss
4. Bloating, flatulence and burping
5. Stomach cramps
6. Nausea and vomiting
7. Muscle aches
8. Fever

The diarrhoea may end by itself within a few days, or it may last for weeks. If you suffer from a compromised immune system, the infection can last for months if not treated.

When To Seek A Doctor’s Advise!

If you develop persistent diarrhoea that lasts several days or recurs, contact your doctor so that he or she can identify the cause and recommend treatment. If you’ve eaten a food that’s been recalled because of a Cyclospora outbreak or travelled in an area where parasites such as Cyclospora are common, be sure to tell your doctor.

If you experience dehydration due to diarrhoea, see your doctor. 

Warning signs of dehydration include:

1. Sunken eyes
2. Dry mouth and tongue
3. Reduced production of tears
4. Decreased urine output

Traveller’s Risks

Those living or travelling in poorly developed areas in the tropics and subtropics may be at an increased risk of acquiring Cyclospora infections as they are identified as endemic areas.

In some regions, infections tend to be more prevalent at certain times of the year, typically in late spring and summer. In addition, this time of year correlates with the increased import of fruits and vegetables into the US from the more southern neighbours.

Consuming food or water while visiting developing countries is a well-documented way of developing traveller’s diarrhoea.

Holidaymakers are often warned against such actions, but over 70 percent of certain produce items consumed in the US is imported from developing countries, making “traveller’s diarrhoea” possible without international travel.

Regions of Concern

The below regions have reported cases on endemic Cyclospora colonisation and travellers should be cautious of food and water:

1. The Caribbean
2. Central and South America
3. Turkey
4. the Indian subcontinent
5. The Far East

There have been relatively few cases involving people holidaying in Africa.

Catch up on the number of recorded outbreaks in the US since 2013. Each year seems to have continuous outbreaks.