Cyclospora Infections Continue, As Questions Remain Over Sources

A parasitical infection continues to spread throughout much of the UNited States, having affected more than 500 people, as federal and state health officials continue the investigation into the exact cause of a cyclospora outbreak that has stumped investigators because of its origin in many states.

The outbreak first emerged in Iowa at the end of June, after two residents became ill with confirmed cases of cyclospora. The parasite quickly sickened people in 15 more states in the days that followed.

The U.S. Centers for Disease Control and Prevention (CDC) and the FDA are investigating the outbreak in cooperation with other state health officials.

In Iowa and Nebraska, investigators have traced the cause of the illness to contaminated prepackaged salad mixes sold at Red Lobster and Olive Garden restaurants. Both restaurant chains are owned by Orlando-based Darden Restaurants. However it is unclear whether the salad products are the cause of illnesses in other states.

Critics say health officials are mishandling the case, citing how long the investigation has gone on without a determination of the source of the outbreak in the remaining majority of the states. The CDC points to an inability to properly sequence the genome of the organism as the cause for the delay.

The outbreak has sickened 504 people, but federal investigations have not determined whether it is a single outbreak or multiple outbreaks. No deaths have been linked to the illnesses, but the outbreak has hospitalized at least 30 people in five states.

Iowa and Texas were the hardest hit with 153 and 190 confirmed cases, respectively. Other states affected by the outbreak include, Nebraska, Florida, Wisconsin, Illinois, Arkansas, New York, Georgia, Kansas, Louisiana, Missouri, Ohio, Connecticut, Minnesota and New Jersey.

Investigators in Iowa and Nebraska traced the salad mix back to Taylor Farms, a Salinas based processor which has 11 sites in the U.S. and one site in San Miguel, Mexico – the site they believe is responsible for the contaminated salad. Currently, the Taylor Farms salad mix is only being implicated in the illnesses in Iowa and Nebraska. Health officials say it is unclear what is causing the illnesses in the other 14 states.

Taylor Farms opened its own investigation into the tainted produce, finding no confirmed instances of cyclospora during the testing at the company’s facilities. Taylor Farms officials say the tainted salad mixes are no longer in supply and have most likely all been consumed or thrown out.

Some victims in other states allege they ate salad from the restaurants in question. Consumers in Ohio and Texas have filed food poisoning lawsuits alleging they became ill with confirmed cases after eating at an Olive Gardens restaurant in those states.

The CDC remains uncertain if transmission of the parasite is still occurring nationally, but says the outbreak does not appear to affect packaged salads sold in grocery stores.

Taylor Farms passed an inspection conducted by the FDA as recently as 2011 with no “notable issues” concerning health violations. Taylor Farms produced and sold nearly 48 million servings of prepackaged salads to thousands of restaurants in the Midwest and eastern United States.

A rare illness in the U.S.

Cyclosporiasis is an intestinal illness caused by microscopic parasites. The parasites are transmitted when a person consumes food or water tainted with contaminated feces. The illness has an incubation period of a few days to weeks. Health officials say it is unlikely people are passing the parasite to one another. The more likely mode of transmission is consumption of tainted food.

Cyclospora is highly uncommon in the U.S. and not often tested for, factors which health officials say are contributing to the lengthy investigation process and inability to confirm whether these are multiple outbreaks or one outbreak from a single source.

Symptoms of cyclospora include frequent and explosive diarrhea, stomach cramps, fatigue, and other flu-like symptoms such as body aches and headache. Patients are treated with sulfa-based antibiotics, like Bactrim, Septra and Cotrim.