Cases of parasitic infection causing weeks of diarrhea climb past 300

North Carolina is among dozens of states experiencing an increase in cyclosporiasis cases, an intestinal illness that can cause severe diarrhea lasting for weeks.

The North Carolina Department of Health and Human Services (NCDHHS) reported 307 cases of cyclosporiasis and 13 hospitalizations between May 1 and July 14. The number of reported cases has risen sharply in recent weeks, with only 110 cases reported as of July 2.

Despite the rapid rise in cases, state health officials have not yet been able to identify a single food product as the source of the illnesses. Most North Carolina cases have not been connected to a common source, and the increase has not been linked to outbreaks in other states.

Wake County has accounted for most of North Carolina’s reported cases. As of July 16, the county had recorded 216 cases of cyclosporiasis, including five hospitalizations, according to the Wake County Department of Public Health.

Cyclosporiasis is an intestinal illness caused by consuming food or water contaminated with a microscopic parasite. Symptoms typically begin about one week after infection.

The illness generally causes watery diarrhea and frequent bowel movements that can last for weeks. Other common symptoms include loss of appetite, weight loss, stomach cramps, bloating, increased gas, nausea, and fatigue. Some people may experience flu-like symptoms, while others may not develop any symptoms.

The disease can be treated with certain antibiotics.

“If you are experiencing severe or persistent diarrhea, you should reach out to your health care provider,” state epidemiologist Dr. Zack Moore said in a NC DHHS press release. “It is also important for everyone to follow routine safety practices like washing your hands with soap and water before and after handling or preparing food and washing all fresh produce under clean running water.”

Local, state, and federal public health officials are continuing to investigate possible sources of exposure. Foodborne illness investigations remain open until officials verify the source and complete a traceback through the supply chain.

Health officials said Cyclospora contamination generally originates from an area where an ingredient is grown, rather than at the restaurant, grocery store, or other establishment where it was served.

“Many individuals may not even realize they have consumed the ingredient that is making them sick, which makes tracing the source of contamination more difficult,” said Dr. Carl Williams, state public health veterinarian, in a NC DHHS press release. “For example, someone may recall that they had pico de gallo with their dinner, but not that it included cilantro.”

Most foodborne illnesses can be prevented by pasteurizing food or cooking it to 165 degrees. Cyclospora, however, is often associated with fresh herbs and produce served uncooked, such as parsley and cilantro.

Past cyclosporiasis outbreaks in the United States have been linked to fresh produce, including raspberries, cabbage, basil, cilantro, parsley, broccoli, snow peas, sugar snap peas, and leafy greens, according to the FDA.

The parasite can survive as produce travels from the field where it was grown to the consumer’s plate, particularly when the produce is not cooked or properly cleaned.

The FDA recommends the following steps when handling and cleaning fresh produce to lessen the chance of infection:

• Wash your hands with warm water and soap for 20 seconds before and after preparing fresh produce.
• Cut away damaged or bruised areas before preparing or eating produce.
• Rinse produce before peeling it to prevent dirt and bacteria from transferring from the knife to the fruit or vegetable.
• Gently rub produce under plain running water. Soap and commercial produce washes are not necessary.
• Scrub firm produce, including melons and cucumbers, with a clean vegetable brush.
• Remove the outermost leaves of lettuce or cabbage.

The increase extends beyond North Carolina. Since May 1, the Centers for Disease Control and Prevention (CDC) has received reports of 1,645 confirmed domestically acquired cases nationwide, up sharply from 249 at the same point last year.

The CDC is also reviewing more than 5,100 additional cases to determine whether they were acquired domestically. Of the confirmed patients, 141 (9%) were hospitalized. No deaths have been reported.

“Cases of parasitic infection causing weeks of diarrhea climb past 300” was originally published on www.carolinajournal.com.