A nationwide outbreak of cyclosporiasis that began in May has spread to Maryland in recent weeks, with nearly 150 cases confirmed throughout the state as of July 28.
Cyclosporiasis is an illness caused by a single-celled parasite called cyclospora, which is most commonly transmitted through fresh produce and water. The parasite creates a thick-walled cyst that can survive in food, and when consumed by humans, the active cell moves into the intestine and causes diarrheal disease in the bowel, said Cynthia Sears, a Johns Hopkins University professor who specializes in foodborne illnesses and infectious diseases.
In the United States, 6,707 laboratory-confirmed cases of cyclosporiasis have been reported across 45 states from May 1 to July 28, according to the Centers for Disease Control and Prevention. More than 11,500 additional cases requiring further investigation or laboratory confirmation have been reported, according to the CDC.
So far, the Maryland Department of Health has reported 148 laboratory-confirmed cases of cyclosporiasis in Maryland. Forty-eight of those cases were acquired domestically, 54 were acquired internationally and 46 are pending further investigation, the department shared in a July 29 statement to The Diamondback. No “common link” had been identified between the cases, the department said.
As cyclospora makes its way through Maryland, here are some key details about the parasite.
Symptoms
Sears, a medical doctor and professor at the Johns Hopkins University School of Medicine, said cyclosporiasis shares similar symptoms with other digestive illnesses.
“Nearly all foodborne digestive infections like this cause bloating, abdominal discomfort, cramping, diarrhea that can be unpredictable and happen day or night, or after meals, and can be what we call very, very urgent,” Sears said.
Sears noted that cyclosporiasis can also cause vomiting, though the symptom only occurs in a small number of individuals.
Other symptoms include extreme fatigue, loss of appetite, substantial weight loss and low-grade fevers, according to the Maryland Department of Health.
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Taking daily precautions
This year’s cyclosporiasis outbreak is the worst on record in the U.S., with the first two deaths resulting from the illness confirmed Monday in Michigan, the Associated Press reported.
The outbreak has been linked to iceberg lettuce produced by Taylor Farms, whose popular bagged salad kits can be found in many grocery stores. On July 17, the company announced a voluntary recall on all iceberg lettuce grown in central Mexico.
As the outbreak continues to grow, experts recommend staying away from leafy greens and bagged lettuces, as well as berries, which contain small pits that the cyclospora parasite can stick to.
“Lettuce and even the bagged lettuces that are theoretically triple-washed may still be a problem,” Sears said. “The other foods that have been frequently involved are fresh berries, particularly raspberries and blackberries.”
Sears also recommended practices like thoroughly cleaning and cooking vegetables and rewashing or only eating the inner leaves of lettuce.
University of Maryland Dining Services said the outbreak has not impacted their operations at this time, according to a July 31 statement to The Diamondback.
“We continue to follow the same rigorous food safety and sanitation protocols that are in place every day,” the statement read. “We continue to monitor the situation closely.”
Both Sears and Holley Meers, medical director of the emergency departments at the University of Maryland Bowie Health Center and Laurel Medical Center, advised relying on local networks such as farmers markets for produce during the outbreak.
“The farmers markets have gotten to be a great source for fruits and vegetables for people who have concerns,” Meers said.
She added that simple practices such as cleaning your hands before preparing foods and washing fruits and vegetables are ways to maintain safety.
“Use those kindergarten rules of washing your hands after going to the bathroom and before you prepare foods. It’s pretty simple things to try to help prevent problems,” she said.
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Contagion Risks
Unlike with other severe illnesses, when someone contracts cyclosporiasis, infection does not immediately become a threat for other individuals nearby or in their household.
The virus can “mature into something that is infectious,” but only after “one to two weeks in certain conditions,” Sears said.
Individuals who suffer with autoimmune diseases, cancer or inflammatory bowel disease are most vulnerable to the infection, according to Sears.
Meers said older patients, children and those who suffer from chronic illness are also more at risk from contracting the parasite.
Seeking medical intervention
If someone is showing symptoms of cyclosporiasis, the Maryland Department of Health urges them to contact a healthcare provider.
Additionally, individuals experiencing intractable — or hard to control — nausea and are unable to maintain enough fluids should go to the emergency department, Meers said.
“If people feel lightheaded, if they feel super dehydrated to the point that they’re dizzy and lightheaded when they move around, they need to seek care,” she said.
Cyclosporiasis can be treated with an antibiotic called trimethoprim-sulfamethoxazole, also known as Bactrim, according to Sears.
“That particular antibiotic, which is only taken twice a day, can pretty quickly decrease-to-eradicate the infection in many people,” Sears said.
The antibiotic is not an over-the-counter medication and requires a doctor’s prescription, she added.
Contact junior staff writer Johana Gonzalez-Cruz at jglez11@terpmail.umd.edu.
