Federal health officials are asking clinicians to order specialized testing for patients with prolonged watery diarrhea as investigators examine whether contaminated lettuce or salad greens are contributing to outbreaks across several states.
By yourNEWS Media Newsroom
The Centers for Disease Control and Prevention issued a nationwide health alert July 14 after confirmed cases of cyclosporiasis rose above normal seasonal levels, prompting federal and state investigators to search for the contaminated food or water source behind the increase.
The CDC had received reports of 1,645 laboratory-confirmed cases as of Tuesday and was aware of more than 5,100 additional suspected cases. Approximately one in 10 patients has required hospitalization, though no deaths have been reported.
Most confirmed infections have been concentrated in four Midwestern states. Federal officials said available evidence indicates that cases reported in Kentucky, Michigan, Ohio and West Virginia may share a common source.
Other states, including Connecticut and New York, have also recorded more cases than typically expected.
Cyclosporiasis is an intestinal illness caused by the microscopic parasite Cyclospora. Infection most commonly occurs when people consume food or water contaminated with feces.
Direct person-to-person transmission is considered unlikely because the parasite generally must spend time in the environment before becoming infectious.
The CDC’s alert urged doctors and other health professionals to consider cyclosporiasis when evaluating patients with prolonged gastrointestinal symptoms, particularly persistent watery diarrhea.
“This goes out to clinicians and public health partners nationwide, reminding them what we want to look for in patients with prolonged gastrointestinal illness, and encouraging them to specifically request Cyclospora testing, since it isn’t part of routine school testing panels,” Gwen Biggerstaff, deputy director of the CDC’s Division of Foodborne, Waterborne, and Environmental Diseases, told reporters during a call.
Routine stool panels do not always test for Cyclospora, meaning clinicians may need to specifically request the appropriate laboratory examination.
The CDC advised health care providers to order stool testing when patients present with prolonged watery diarrhea or other symptoms consistent with the illness.
Patients should also be instructed to remain hydrated, particularly when diarrhea is frequent or severe, because substantial fluid loss can lead to dehydration.
Medical personnel should use standard precautions, including gloves, whenever direct contact with fecal material is possible.
Symptoms typically begin between two days and two weeks after exposure.
Watery, loose diarrhea is the primary symptom, but infected people may also experience appetite loss, abdominal cramping and fatigue.
People who develop prolonged watery diarrhea accompanied by other gastrointestinal symptoms should contact a health care provider and ask whether specialized Cyclospora testing is appropriate, according to the CDC.
Michigan has reported an especially large number of illnesses. State authorities said Tuesday that health care providers there had submitted reports involving 3,309 cases.
That total includes suspected illnesses and is larger than the CDC’s nationwide count of laboratory-confirmed cases.
The Michigan Department of Health and Human Services said the outbreak may be associated with contaminated lettuce or salad greens. Investigators, however, had not identified a particular variety of produce, farm, grower, distributor or supplier.
The CDC and the Food and Drug Administration are working with state health departments to determine whether the illnesses came from one product or several separate sources.
Donald Prater, the FDA’s acting deputy commissioner for food, said the outbreak likely consists of multiple clusters rather than a single nationwide chain of transmission.
Biggerstaff said evidence collected so far nevertheless points toward a common source for infections in Kentucky, Michigan, Ohio and West Virginia.
The investigation remains complicated because fresh produce may pass through multiple growers, processors, distributors and retailers before reaching consumers.
The delay between infection and symptom onset can also make it difficult for patients to remember every food they consumed during the relevant exposure period.
Until investigators determine the source, federal officials are recommending basic food-safety precautions.
Consumers should wash their hands before and after handling fresh produce and rinse fruits and vegetables thoroughly before eating, cutting or preparing them.
Officials also advised cooking produce to a temperature of at least 158 degrees Fahrenheit when appropriate.
Washing can reduce contamination but may not eliminate every Cyclospora organism from affected produce. Cooking provides greater protection when the food is suitable for heat preparation.
The CDC did not announce a recall or identify a specific product that consumers should avoid.
The alert instead focuses on early recognition, testing and supportive care while investigators work to determine which foods or water sources may be responsible.
With thousands of confirmed and suspected illnesses under review, federal officials are urging clinicians not to dismiss persistent diarrhea as an ordinary stomach illness and to request Cyclospora-specific testing when symptoms and exposure histories warrant it.
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