For the past few weeks, we have been reading about a rapidly spreading protozoan infecting a commercial lettuce supply operation in central Mexico.  Initially, five U.S. states reported a diarrheal disorder from eating fast-food items that used this commercial lettuce.  

Since May 1, CDC has received reports of 6,707 laboratory-confirmed domestic cases of cyclosporiasis, the disease caused by the parasite Cyclospora cayetanensis.  CDC is aware of more than 11,500 additional cases that are not laboratory confirmed or that require further investigation and analysis, such as ruling out international travel. Many of the additional cases have been reported by Michigan and Ohio.

CDC is working closely with states to update numbers as additional cases are confirmed.

The main signs of cyclosporiasis include watery diarrhea, which is frequent and sometimes explosive; stomach cramps and bloating; loss of appetite and nausea; and general exhaustion, weight loss and fatigue.  

Less common signs are a mildly elevated temperature and possible dehydration.

Signs and symptoms start about one week after consuming food or water contaminated with the Cyclospora parasite, according to the Cleveland Clinic.

Cyclosporiasis is treated primarily with a combination of hydration and the antibiotic trimethoprim-sulfamethoxazole (TMP-SMX), commonly known by brand names like Bactrim, Septra or Cotrim.

Antibiotic treatment

• Standard dosage: One double-strength tablet (160 milligrams TMP/800 milligrams SMX) taken orally twice a day.
• Duration: Usually prescribed for seven to 10 days.
• Full course: Finish all prescribed pills even if you feel better; this stops the infection from coming back.
• Sulfa allergies: Alternative options like ciprofloxacin or nitazoxanide may be considered by your doctor if you cannot take sulfa drugs, though they are less studied.

Home care and recovery

• Hydration: Drink plenty of water, electrolyte sports drinks or broths to replace fluids lost from watery diarrhea.
• Rest: Get adequate rest to help your body recover its strength.
• Anti-diarrheal medications: Do not take over-the-counter anti-diarrheal drugs unless explicitly approved by your health care provider, as they can sometimes prolong the infection.

Waterborne infections such as cyclosporiasis, E.coli, dysentery, giardia and others are encountered more frequently in areas that have poor hygiene and a contaminated water supply.  Widespread infections in our food distribution in the United States, such as this outbreak, are unusual.

Additionally, some Third World communities may have no facilities for bathing or hand washing, or could lack a source of clean drinking water. They could have problems with storage of meats and vegetables.

This infection is sometimes confused with cryptosporiadosis, which is contracted from contaminated lakes and streams.  Exposed individuals are sometimes more ill for longer periods of time.

On your travels

If you are visiting a country with poor sanitation and/or hygiene management, there are many waterborne infections that could make you ill.  Some examples include:

Salmonella,

Hepatitis A,

Escherichia coli (E.coli),

Giardia and

Cholera.

Before departure, you should always consult with an infectious disease specialist to prescribe vaccines and medication to keep you well during your travels.

Always wash your hands and wear protective clothing (if appropriate) if coming in direct contact with a person with an infectious condition.  

Fruits and vegetables should not be eaten raw, unless they can be peeled. 

Avoid drinking iced drinks unless you know the source of the water.

At this time there have been reported of cases of Cyclospora in the Northeast. Generally, people recover but there now have been reported two deaths in Michigan, but both had serious chronic health problems.  All of us need to be aware of local cases in this area. Our Board of Health is monitoring this area.