A total of 122 cyclosporiasis cases have been reported to the Jefferson County Health Department as of mid-August.
As of Aug. 12, Brianne Zwiener, the department’s spokesperson, said 116 cases were reported in July, with six more in August. Eleven patients were treated at Mercy Hospital Jefferson, said Dr. Michael Pajor, an emergency medicine physician at the hospital.
“Those numbers are conditional and may change as more reports come in,” Zwiener said.
Statewide, 1,950 cases have been reported as of Monday, according to the Missouri Communicable Disease Report.
The nationwide cyclosporiasis outbreak began in May and has been linked mainly to shredded iceberg lettuce from central Mexico produced by Taylor Farms, which was sold to businesses including Taco Bell restaurants and Walmart stores in the United States.
As of Aug. 11, the Centers for Disease Control and Prevention (CDC) has received reports of 13,895 laboratory-confirmed cases in the United States with at least 10,445 additional cases that are not lab-confirmed. Only about half of the confirmed cases have been linked to the recall. The two deaths – reported in Michigan – were linked to the recall.
Cyclosporiasis is an intestinal illness caused by a microscopic parasite. When people ingest food (fresh produce such as lettuce, fresh herbs or berries) or water contaminated with the parasite, it infects the small intestine, leading to digestive symptoms like watery diarrhea, officials with the Missouri Department of Health and Senior Services (DHSS) said.
According to DHSS, symptoms usually start a week after consuming contaminated food or water, but the incubation period can range from two to 14 days. Without treatment, symptoms can last from several days to a month or longer.
The Health Department said symptoms are similar to many other stomach illnesses. Besides diarrhea, symptoms include loss of appetite and weight, abdominal cramping, bloating, fatigue and low-grade fever.
According to the Food and Drug Administration, anyone who has symptoms should contact a health care provider and seek antibiotics especially if that person consumed shredded iceberg lettuce in the two weeks before symptoms.
“Symptomatic patients who consumed contaminated produce should reach out to their primary care provider to obtain testing and treatment,” Dr. Pajor said. “Unlike most cases of diarrheal illness, cyclosporiasis is usually treated with a seven- to 10-day course of antibiotics. Cyclospora is not transmitted from person to person, so exposure to an infected individual alone is not a reason to obtain testing and treatment.
“Individuals who have severe symptoms, are unable to keep any foods or liquids down, have symptoms of high fever, abdominal pain, dizziness or lightheadedness or other signs of dehydration should come to the emergency department. This especially applies to higher risk individuals such as small children, elderly and immuno-compromised patients.”
Cyclosporiasis is not a new illness, but typically Jefferson County has two to four cases a year.
Last month, Sarah Bressie, the Health Department’s communicable disease supervisor, said staff are really just data collectors in a nationwide outbreak, asking patients for a detailed food history of the two weeks before the symptoms hit. For a cyclosporiasis case, she said, it is 12 pages of questions while a salmonella case is two pages of questions.
She said DHSS and CDC use the data collected to “connect all the dots” about what food might be the source or what location might be the source of the outbreak.
“The interview process remains the same,” Zwiener said on Aug. 12. “We have trained a few more staff members from other departments to help with the interviews.”
When asked if there was an increase of other intestinal illnesses this year, Zwiener said, “We look at the year to date total of each condition and compare it to the average of the previous five years in order to see if any of our conditions are experiencing an increase. Numerous other enteric (intestinal) conditions are elevated compared to the previous five years. None as much as cyclospora, though.”
She said no Jefferson County cases of salmonella have been linked to the national outbreak at this time.
On Aug. 9, the Food and Drug Administration announced a recall of jalapenos and products containing jalapenos from Mexico distributed by Coast Circus Distributors and Taylor Fresh Foods to businesses such as Chipotle, Qdoba, Walmart, Target, Whole Foods and Trader Joe’s.
Salmonella illness usually occurs 12-72 hours after eating contaminated food and symptoms usually last up to a week. Symptoms include diarrhea, fever and abdominal cramps. Children younger than 5, the elderly and people with weakened immune systems are more likely to have severe infections.
