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Friday, August 9, 2013

Cyclospora....the new salad topping?

I would hazard a guess that prior to July 28th, most people had never heard of Cyclospora....unless you've travelled to a tropical or subtropical destination and gotten "traveller's diarrhea"!   A quick Google search this morning resulted in 53 000 hits with news articles, blogs and updates from all the major media outlets, and of course the appropriate governmental agencies such as the CDC, FDA, etc. Of particular interest is how the use of electronic messaging and media attention in the early stages of this outbreak investigation helped public health agencies identify cases which might not otherwise have been considered by health care providers or their patients.

The outbreak has spread through 16 states with a case count of 466 as of Aug 5th, at least 24 of which have hospitalized in five of the affected states.  Iowa has the most reported Cyclospora infections with 146 cases, followed by Texas with 113 cases and Nebraska with 81 cases.  Nebraska and Iowa have concluded that the cause of the outbreak was due to the supply of pre-packaged salad mix to restaurants in those states by Taylor Farms de Mexico, a processor of foodservice salads.   The FDA investigation found that illness clusters at restaurants including Olive Garden and Red Lobster, both of which are owned by Darden Restaurants, were traced to a common supplier. It has been confirmed that the salad mix linked to the outbreak is no longer available.

Cyclospora cayetanensis is a parasite composed of one cell and is too small to be seen without a microscope.  Cyclosporiasis occurs in many countries, but is most commonly found in tropical and subtropical regions.  The risk for infection is seasonal; however no consistent pattern has been identified regarding the time of year or the environmental conditions, such as temperature or rainfall.  In the United States, foodborne outbreaks of Cyclosporiasis since the mid-1990s have been linked to various types of imported fresh produce, including raspberries, basil, snow peas, and mesclun lettuce.  No commercially frozen or canned produce has been implicated.
People become infected with Cyclospora by ingesting fecal matter contaminated with sporulated oocysts, which are the infective form of the parasite. This most commonly occurs when food or water contaminated with feces is consumed.  An infected person sheds unsporulated (non-infective) Cyclospora oocysts in the feces. The oocysts are thought to require days to weeks in favorable environmental conditions to become infective; therefore direct person-to-person transmission and transmission via ingestion of newly contaminated food or water is unlikely.

The time between becoming infected and becoming sick is usually about 1 week.  Cyclospora infects the small intestine causing watery diarrhea with frequent, sometimes explosive, bowel movements.  Other common symptoms include loss of appetite, weight loss, stomach cramps/pain, bloating, nausea, and fatigue.  Vomiting, body aches, headache, fever, and other flu-like symptoms have also been noted as associated symptoms.

As Cyclospora is transmitted only by ingesting contaminated food, avoiding food or water that may have been contaminated with feces is the best way to prevent Cyclosporiasis.   Although it is prudent to thoroughly wash produce that will be eaten raw, this practice may not eliminate the risk of transmission of Cyclospora as treatment with chlorine or iodine is unlikely to kill the Cyclospora oocysts.

It's summer - our traditional salad season.  I can't say I'll stop eating salads over concern about becoming infected with Cyclospora, but I definitely will try to buy from local farms and avoid any packaged salad mix from countries with endemic Cyclospora and poor sanitation programs, THANKFULLY Ohio has only had one case of Cyclospora, so I should be pretty safe on my trip to Cincinnati this week!



Bugging Off!

Nicole




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