Alabama health officials are reporting an increase in cases of cyclosporiasis, an intestinal illness caused by the parasite Cyclospora cayetanensis, as investigators continue to trace the source of infestations linked to restaurant outbreaks and contaminated produce.
According to the Alabama Department of Public Health (ADPH), the state had reported 85 cases of cyclosporiasis as of Aug. 3, an increase from the 28 cases reported just two weeks earlier on July 20. Of the 85 cases, 78 have been laboratory confirmed.
Health officials said eight cases involved international travel. Twenty-two illnesses have been linked to two Mexican-style restaurant chains in Alabama. An additional four cases are connected to the multistate Taco Bell outbreak, and four more have been linked to a Mexican-style restaurant chain in Florida.
Northern Alabama continues to account for the majority of illnesses with 61 reported cases. Other cases have been identified in other regions of the state, but in smaller numbers.
Federal health officials, including the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration, have linked a multistate outbreak to certain lots of shredded iceberg lettuce served at Taco Bell restaurants in Indiana, Kentucky, Michigan, Ohio and West Virginia. While Alabama now has four cases associated with that outbreak, investigators are working to determine the source of additional illnesses.
Cyclospora infestations are most commonly reported in the United States between May and August and are typically associated with eating contaminated fresh produce, including basil, cilantro and leafy greens such as lettuce. There is also a risk of infestation associated with snow peas, berries and melons.
Cyclosporiasis is a gastrointestinal illness that commonly causes prolonged watery diarrhea, fatigue and loss of appetite. Other symptoms may include stomach cramps, bloating, nausea and weight loss. Symptoms typically develop about one week after exposure but can begin anywhere from two days to more than two weeks after exposure. Without treatment, illness can last several days to a month or longer.
“If you cannot keep anything down, go to the hospital,” said Dr. Nicolas Bordas, an infectious disease specialist in Gadsden. “The biggest concern is dehydration, especially in infants and elderly individuals. If you notice their eyes are sunken in or their skin stays raised after pinching, seek medical care as soon as possible.”
In addition to young children and older people, Bordas said those most at risk of severe illness are people receiving chemotherapy or immunotherapy treatments, those with HIV and individuals with other immune-compromising illnesses.
The infestation can be treated with trimethoprim-sulfamethoxazole (TMP-SMX), a combination antibiotic medication. The general course of the treatment includes one dose, twice a day, for seven days.
“If you are allergic to sulfa, or cannot take it for some reason or another, the treatment is what is known as ‘supportive care’,” Bordas said. “That includes increased fluids and rest.”
Bordas, an independent member of the medical staff at Gadsden Regional Medical Center, said the hospital has not yet treated anyone diagnosed with cyclosporiasis during this ongoing outbreak.
The ADPH advises anyone experiencing symptoms to contact a healthcare provider and request testing specifically for Cyclospora, as routine stool tests may not detect the parasite. Patients may also be asked to provide information about foods they consumed during the two weeks before becoming ill to assist in tracking the outbreak.
Health officials recommend washing hands thoroughly with soap and water, rinsing fresh fruits and vegetables under running water before eating or preparing them, and avoiding recalled lettuce products. Because washing alone may not eliminate Cyclospora, cooking produce to at least 158 degrees Fahrenheit is effective in killing the parasite.
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