1000 sick: As North America turns to Fall, another bumper crop of Cyclospora

CDC reports that as of September 13, 2017 they have been notified of 988 laboratory-confirmed cases of cyclosporiasis in persons who became ill in 2017. This number includes persons who reported international travel as well as persons who did not report travel. The reports have come from 40 states.

  • At least 553 (56%) of these persons did not report international travel (i.e., likely were infected in the United States) and became ill on or after May 1, 2017 (a date after which cases tend to increase each year). These 553 persons were from the following 36 states: Arizona (1), California (10), Colorado (6), Connecticut (23), Florida (68), Georgia (10), Illinois (17), Indiana (4), Iowa (14), Kansas (2), Louisiana (7), Maryland (12), Massachusetts (13), Michigan (3), Minnesota (11), Mississippi (1), Missouri (13), Montana (2), Nebraska (5), New Hampshire (4), New Jersey (19), New Mexico (1), New York (excluding NYC) (15), New York City (30), North Carolina (45), Ohio (16), Pennsylvania (2), Rhode Island (2), South Carolina (7), South Dakota (4), Tennessee (3), Texas (163), Utah (1), Virginia (7), Washington (1), West Virginia (2), and Wisconsin (9).
  • At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source (or sources) of infection are ongoing. It is too early to say whether cases of Cyclosporainfection in different states are related to each other or to the same food item(s).

Previous U.S. outbreaks of cyclosporiasis have been linked to various types of imported fresh produce (e.g., basil, cilantro, mesclun lettuce, raspberries, snow peas). Consumers should continue to enjoy the health benefits of eating fresh fruits and vegetables as part of a well-balanced diet.

Cyclospora gets around

As summer grinds on in the Northern Hemisphere, Cyclospora is again spreading: at least 78 in the UK; 57 in Canada (which appear to be locally acquired; and, 712 lab-confirmed cases in the U.S.

The Centers for Disease Control reports Cyclospora cayetanensis is a single-celled parasite that causes an intestinal infection called cyclosporiasis.

As of August 16, 2017 (3pm EDT), CDC has been notified of 712 laboratory-confirmed cases of cyclosporiasis in persons who became ill in 2017. This number includes persons who reported international travel as well as persons who did not report travel. The reports have come from 36 states.

At least 347 (49%) of these persons did not report international travel (i.e., likely were infected in the United States) and became ill on or after May 1, 2017 (a date after which cases tend to increase each year). These 347 persons were from the following 31 states: Arizona (1), California (5), Colorado (6), Connecticut (18), Florida (36), Georgia (4), Illinois (11), Indiana (3), Iowa (8), Kansas (2), Louisiana (3), Maryland (3), Massachusetts (11), Michigan (1), Minnesota (10), Missouri (8), Montana (2), Nebraska (5), New Hampshire (2), New Jersey (10), New Mexico (1), New York (excluding NYC) (12), New York City (27), North Carolina (19), Ohio (6), Pennsylvania (1), Rhode Island (2), South Dakota (4), Texas (116), Utah (1), Virginia (2), and Wisconsin (7).

At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source (or sources) of infection are ongoing. It is too early to say whether cases of Cyclospora infection in different states are related to each other or to the same food item(s).

Previous U.S. outbreaks of cyclosporiasis have been linked to various types of imported fresh produce (e.g., basil, cilantro, mesclun lettuce, raspberries, snow peas). Consumers should continue to enjoy the health benefits of eating fresh fruits and vegetables as part of a well-balanced diet.

Cyclospora: Back to the future

During the summers of 2015 and 2016, the United Kingdom experienced large outbreaks of cyclosporiasis in travellers returning from Mexico. As the source of the outbreaks was not identified, there is the potential for a similar outbreak to occur in 2017; indeed 78 cases had already been reported as at 27 July 2017. Early communication and international collaboration is essential to provide a better understanding of the source and extent of this recurring situation.

Cyclosporiasis in travellers returning to the United Kingdom from Mexico in Summer 2017: Lessons from the recent past to inform the future

Eurosurveillance, vol. 22, issue 32, 10 August 2017, DFP Marques, CL Alexander, RM Chalmers, R Elson, J Freedman, G Hawkins, J Lo, G Robinson, K Russell, A Smith-Palmer, H Kirkbride, DOI: http://dx.doi.org/10.2807/1560-7917.ES.2017.22.32.30592

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22854

206 sick: CDC notes increase of Cyclospora cayetanensis infection, United Sates, Summer 2017

Another North American summer, another Cyclospra-induced shit-fest.

The U.S. Centers for Disease Control and Prevention (CDC), State and Local Health Departments, and the Food and Drug Administration (FDA) are investigating an increase in reported cases of cyclosporiasis. The purpose of this HAN Advisory is to notify public health departments and healthcare facilities and to provide guidance to healthcare providers of the increase in reported cases. Please disseminate this information to healthcare providers in hospitals and emergency rooms, to primary care providers, and to microbiology laboratories.

Healthcare providers should consider a diagnosis of cyclosporiasis in patients with prolonged or remitting-relapsing diarrheal illness. Testing for Cyclospora is not routinely done in most U.S. laboratories, even when stool is tested for parasites. Healthcare providers must specifically order testing for Cyclospora, whether testing is requested by ova and parasite (O&P) examination, by molecular methods, or by a gastrointestinal pathogen panel test. Cyclosporiasis is a nationally notifiable disease; healthcare providers should report suspect and confirmed cases of infection to public health authorities.

As of August 2, 2017, 206 cases of Cyclospora infections have been reported to CDC in persons who became infected in the United States and became ill on or after May 1, 2017. These cases have been reported from 27 states, most of which have reported relatively few cases. Eighteen cases reported hospitalization; no deaths have been reported. At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source of infection are ongoing. It is too early to say whether cases of Cyclospora infection in different states are related to each other and/or to the same food item(s).

The number of cases (206) reported in 2017, is higher than the number of cases reported by this date in 2016. As of August 3, 2016, 88 Cyclospora infections had been reported in persons who became infected in the United States and became ill on or after May 1, 2016.

Cyclosporiasis – France ex Mexico

This case of cyclospora may have no relation to the Canadian outbreak; or may.

A 64-year-old French [female] with type 2 diabetes mellitus was referred to our department on [Mon 3 Jul 2017] because she was suffering from protracted diarrhea.

Symptoms began on [Sat 10 Jun 2017] as she was just returning from a touristic trip in Cancun (Quintana Roo State, Mexico) where she stayed from [Mon 29 May to Fri 9 Jun 2017] with her husband.

She acknowledged having moderate watery diarrhea with abdominal discomfort, bloating, transient vomiting, 5 kg weight [approx. 11.02 pounds] loss and fatigue. Empiric therapy with oral Metronidazole 500 mg 3 times a day for 7 days she received previously failed to improve her symptoms. Of note, a 1st microscopic stool examination failed to identify parasites and no enteropathogenic bacteria was found by culture on selective media.

Up to 3 extra stool specimens where sent to the laboratory of clinical parasitology in our hospital.

Oocysts of Cyclospora cayetanensis where evidenced by autofluorescence after Bailenger concentration technique.

At least 20 sick with Cyclospora in Canada

Health-types in Canada are investigating locally acquired Cyclospora infections in two provinces. The source of the outbreak has not been identified. Previous outbreaks in Canada and the United States (US) have been linked to imported fresh produce. The investigation is ongoing.

In Canada, a total of 20 cases have been reported in two provinces: British Columbia (5) and Ontario (15). Individuals became sick between May and early June of this year. The majority of cases (60%) are male, with an average age of 53 years. The investigation into the source of the outbreak is ongoing. To date, no multi-jurisdictional outbreaks of Cyclospora have been linked to produce grown in Canada.

The outbreak investigation is active and the public health notice will be updated on a regular basis as the investigation evolves.

People living or travelling in tropical or subtropical regions of the world who eat fresh produce or drink untreated water may be at increased risk for infection because the parasite is found in some of these regions.

Washing is never enough but are they linked? Summer means Cyclospora in Canada, Mexico and Texas

Finally, some decent risk-based advice from a government agency.

Washing will not remove Cyclospora from fresh produce.

pesto.basil_.cyclosporaWashing removes very little of anything from fresh produce.

Canada’s Public Health Agency is investigating 51 cases of people infected with the single-celled parasite Cyclospora cayetanensis between mid-May and late-July. Forty-four of the 51 cases reported so far have been in Ontario.

The infection can cause watery diarrhea, fatigue, stomach pain

Though uncommon in food and drinking water in Canada and the U.S., the parasite often persists on fruit and vegetables even after they have been washed. Public Health Canada recommends that people cook vegetables and fruit imported from Peru, Cuba, India, Nepal, Mexico, Guatemala, Southeast Asia and Dominican Republic.

Last week, health officials in Texas also reported a major outbreak of the disease, and are continuing an investigation into fresh produce as a possible source. After a series of outbreaks linked to imported produce from Puebla Mexico in 2015, the U.S. Food and Drug Administration banned imports from the region during summer months.

Previous outbreaks of Cyclospora have been linked to pre-packaged salad mix, basil, cilantro, raspberries, blackberries, and snap-peas.

At the same time, 148 British tourists have been confirmed with Cyclospora after visiting 24 luxury hotel complexes most of which are in the Riviera Maya resort near Cancun in Mexico.

Public Health England  are now warning UK tourists to be wary of travelling to Mexico and the Foreign Office have updated their website to include a warning from health authorities about travelling to the region.

On the toilet 30X a day: UK couple’s Mexico holiday hell after contracting Cyclospora

Tony Larner of the Mirror reports a British couple’s dream Mexican holiday was left in tatters after they were struck down Cyclospora.

hanging.on.in.quiet.desperationSandra and Lee Harper splashed out £3,700 on an all-inclusive Thomson break to Riviera Maya resort, near Cancun.

But the couple, from Birmingham, were unable to leave their room for almost a week after falling ill with Cyclospora and needing the toilet up to 30 times every day.

The pair claim they complained about their illness and hygiene issues at their hotel to Thomson, but did not got a reply until after they arrived home, the Birmingham Mail reported.

UK Health officials have issued warnings about visiting the area after almost 100 Brits were struck down with the bug since the outbreak began in June.

A spokesthingy for Thomson said: “Public Health England has advised us of a number of sickness cases associated to an issue called Cyclospora in the Riviera Maya region of Mexico.”

An issue called Cyclospora?

“Hanging on in quiet desperation is the English way.”

14 sick with Cyclospora in (North) Texas

Frank Heinz of NBC DFW 5 cited health officials as saying more than a dozen cases of cyclosporiasis have been confirmed in North Texas’ four major counties and that the source is likely contaminated food.

pesto.basil.cyclosporaThe Texas Department of State Health Services said Wednesday the parasite was found in Dallas, Tarrant, Collin and Denton counties and that the origin may be linked to a fresh produce item.
County officials told NBC 5 there have been four cases recorded in Dallas County, three in Collin County, four in Denton County and seven in Tarrant County. The Denton County cases and at least four of the Tarrant County cases had recently traveled out of the country — calling into question the point of origin.

Across the state, there are currently 66 confirmed cases of cyclosporiasis — though the sources of infection haven’t been confirmed. For most people, the symptoms are serious. “But for those who are very young and those who are older, or those who have a suppressed immune system, this illness can cause major problems,” said Dr. Khang Tran, chief medical officer at The Medical Center of Plano. 

In recent years, 2012-2015, cyclospora outbreaks were associated with fresh cilantro imported from Puebla, Mexico. Since the summer of 2015, the Food and Drug Administration has instituted ban on imports from that region between from April through August.
In 2015, the DSHS said there were 316 cases of cyclosporiasis in Texas.

Cyclosporiasis Case Counts and Incidence Rates in Texas, 2001-2014

Year | Case Count | Incidence Rates

2014* | 200 | 0.7
2013* | 351 | 1.3
2012* | 44 | 0.2
2011* | 14 | 0.1
2010 | 9 | 0.0
2009 | 10 | 0.0
2008 | 6 | 0.0
2007 | 2 | 0.0
2006 | 1 | 0.0
2005 | 1 | 0.0
2004 | 4 | 0.0
2003 | 1 | 0.0
2002 | 1 | 0.0
2001 | 0 | 0.0

IR=incidence rate per 100,000 *incidence rates are bases on projected census data obtained from the DSHS Center for Health Statistics. 

Cyclospora cluster reported in UK travelers to Mexico

Outbreak News Today reports UK health officials are seeing an increase in the parasitic infection, cyclosporiasis, in travelers returning from Mexico, according to Travel Health Pro report.

love.boat.cyclosporaThe cluster has been seen since June and many of the travelers stayed in Riviera Maya, the same place where some 80 travelers contracted Cyclospora last summer.

Cyclospora has been implicated in numerous outbreaks with contaminated fruits and vegetables being the common culprits (raspberries, basil and lettuce all washed with contaminated water), especially those imported from developing nations.

All fruits and vegetables should be thoroughly washed before eating though this does not guarantee safety. Cyclospora is resistant to chlorination.

Treatment is usually successful after a course of the antibiotic Septra.