# 7517
In early July (see Iowa & Nebraska Report Cyclospora Outbreak) we began to see reports of a relatively rare (at least in the United States) outbreak of Cyclosporiasis – due to infection with a (usually food or water borne) protozoan called Cyclospora cayetanensis.
Since then, this outbreak investigation has grown to include more than 280 cases across 11 states (although some of these cases may have been acquired via international travel).
Thus far, no source of this outbreak has been identified.
Infection with this parasite is characterized by prolonged bouts of watery diarrhea, which may persist or reoccur over a period of weeks. According to the CDC, Trimethoprim/sulfamethoxazole (TMP/SMX), is the recommended treatment, although they state:
Most people who have healthy immune systems will recover without treatment. If not treated, the illness may last for a few days to a month or longer. Symptoms may seem to go away and then return one or more times (relapse).
Anti-diarrheal medicine may help reduce diarrhea, but a health care provider should be consulted before such medicine is taken. People who are in poor health or who have weakened immune systems may be at higher risk for severe or prolonged illness.
The CDC updated their epidemiological investigation webpage yesterday (July 25th), with the following information:
Investigation of an Outbreak of Cyclosporiasis in the United States
Updated: 7/25/13
On June 28, 2013, CDC was notified of 2 laboratory-confirmed cases of Cyclospora infection in Iowa residents who had become ill in June and did not have a history of international travel during the 14 days before the onset of illness. Since that date, CDC has been collaborating with public health officials in multiple states and the US Food and Drug Administration (FDA) to investigate an outbreak of cyclosporiasis. Preliminary details of the ongoing investigation are highlighted below.
Highlights
Epidemiologic Investigation
- As of July 24, 2013 (5pm EDT), CDC has been notified of 285 cases of Cyclospora infection in residents of multiple states, including Iowa
, Nebraska
- Most of the illness onset dates have ranged from mid-June through early July.
- At least 18 persons reportedly have been hospitalized in three states.
- No food items have been implicated to date, but public health authorities are pursuing all leads. Previous outbreak investigations have implicated various types of fresh produce.
- It is not yet clear whether the cases from all of the states are part of the same outbreak.
- No common events (e.g., social gatherings) have been identified among the case patients.
- Additional cases are currently under investigation and will be included on this page as states confirm them.
Laboratory Investigation
- To date, CDC has confirmed 5 cases of Cyclospora infection in CDC laboratories. One of those cases was confirmed via telediagnosis.
- CDC encourages laboratories to obtain confirmation of cases using telediagnosis. Telediagnosis allows for rapid laboratory confirmation. State health laboratories may submit images showing suspected Cyclospora oocysts to CDC. Images may be captured from modified acid-fast stained smears or from wet mounts examined by UV fluorescence microscopy. Both techniques require concentrated stool specimens. Instructions for submitting images for telediagnosis are found on the DPDx site.
Prevention and control is problematic, as the CDC explains below:
Prevention & Control
On the basis of the currently available information, avoiding food or water that may have been contaminated with feces is the best way to prevent cyclosporiasis. Treatment with chlorine or iodine is unlikely to kill Cyclospora oocysts. No vaccine for cyclosporiasis is available.
The U.S. Food and Drug Administration's (FDA) Center for Food Safety and Applied Nutrition (CFSAN) publishes detailed food safety recommendations for growers and suppliers. In its Guide to Minimize Microbial Food Safety Hazards for Fresh Fruits and Vegetables, CFSAN describes good agricultural practices (GAPs) and good manufacturing practices (GMPs) for fresh fruits and vegetables. The guidelines address the growing, harvesting, sorting, packaging, and storage processes; following the guidelines can help reduce the overall risk for microbial contamination during these processes. The precise ways that food and water become contaminated with Cyclospora oocysts are not fully understood.
