Stomach Bug Outbreak Affects More Than A Dozen US States
July 31, 2013

Stomach Bug Outbreak Affects More Than A Dozen US States

Lawrence LeBlond for - Your Universe Online

A stomach illness linked to the parasite Cyclospora has been on the rise in more than a dozen states across the US, with more than 370 reported cases since the end of June, according to a US Centers for Disease Control and Prevention (CDC) report on Monday.

The CDC was notified on June 28, 2013 of two laboratory-confirmed cases of Cyclospora infection in Iowa. Since that date, the CDC has been working with health officials from 15 states as well as the Food and Drug Administration (FDA) to investigate the root cause of the outbreak, which has so far infected 372 people. Preliminary results from at least two state health departments show that the outbreak may be linked to a bagged salad mix.

"The evidence points to a salad mix containing iceberg and romaine lettuce, as well as carrots and red cabbage, as the source of the outbreak reported in Iowa and Nebraska," Steven Mandernach, chief of the Food and Consumer Safety Bureau of the Iowa Department of Inspections and Appeals, said in an IDPH release on Tuesday.

At least 80 percent of the infections in Iowa and Nebraska have been linked to people eating a prepackaged salad mix, according to health officials. The FDA is currently tracing back where the ingredients in the salad came from.

As of Tuesday, it was not clear if all cases of Cyclospora infection were linked to prepackaged salad mix. Only Iowa and Nebraska had released reports stating cases in their states were associated with contaminated salad mix.

Besides Iowa and Nebraska, the stomach bug has also infected persons in the states of Arkansas, Connecticut, Florida, Georgia, Illinois, Kansas, Minnesota, Missouri, New Jersey, New York, Ohio, Texas and Wisconsin.

Most of the illness onset dates in these cases have ranged from mid-June through early July. Of the 372 cases, 21 have resulted in hospitalizations across three states, according to the CDC.

Although the states of Iowa and Nebraska are potentially linking their outbreaks to bagged salad mix, the CDC said they are still working to determine the actual source. "No food items have been implicated to date, but public health authorities are pursuing all leads," the CDC said in a report. The agency noted that past outbreaks have been linked to tainted produce.

Cyclosporiasis is caused by the single-celled parasite Cyclospora and is known to trigger diarrhea and stomach cramps, explained Dr. Monica Parise, chief of the parasitic diseases branch of the CDC. She maintained that the illness is not transmissible between humans and has to be ingested via contaminated water or food for it to infect humans. Also, the parasite is typically found in subtropical or tropical regions and most cases in the US stem from imported fruits and vegetables.

"It can be pretty miserable, because it can give diarrhea that can last for days," Parise told Dennis Thompson of Health Day.

Dr. Thomas Frieden, director of the CDC, said the agency does expect to "identify the source, but we have not been able to do so yet."

Parise added that no common events have been identified between all reported cases. However, the CDC has confirmed at least 34 of the 372 cases in its laboratories. In Iowa, the largest hit area, at least 140 people have fallen ill, noted Parise. Texas and Nebraska are the next largest hit areas with 92 and 71 cases, respectively.

Frieden is urging people who may be suffering from diarrhea longer than a few days to be tested for Cyclospora. Generally, it takes about a week for people who are infected to become sick. Antibiotics can be administered to treat severe cases of infection.

With fruit and vegetables being the most common source of infection transmission, health officials urge all citizens to thoroughly wash their produce before using them. As well, all cooking surfaces and utensils should be properly sanitized in hot soapy water.

Dr. Bruce Hirsch, an attending physician in the division of infectious diseases at North Shore University Hospital in Manhasset, NY told Health Day that Cyclosporiasis is, for the most part, just a "miserable nuisance." However, he noted, "the concern I have as a doctor is for patients whose immune systems are weakened [and] have a real hard time with this infection."

Hirsch urges extra caution for people who are undergoing cancer treatment, recovering from organ transplant or dealing with HIV infection, as compromised immunities could lead to more serious illness and possibly death.

As the CDC continues to investigate the root cause of this outbreak, it has noted that it has confirmed at least one case through telediagnosis. The agency encourages labs to obtain confirmation using this method as it is extremely reliable and is known for its rapid results. The CDC's DPDx website has instructions for state health departments to submit images for telediagnosis of Cyclosporiasis.