Fresh basil exported by Siga Logistics de RL de CV in Morelos, Mexico is under investigation for a multistate outbreak of Cyclospora infections, according to the Federal Centers for Disease Control and Prevention (CDC) in Atlanta. The US Food and Drug Administration (FDA) and public health and government agencies in several states are also involved in the investigation.
As of August 15, 2019, a total of 205 people were laboratory-confirmed Cyclospora Infections associated with this outbreak have been reported from 11 states: CT (1), FL (50), GA (2), IA (2 ), MA (1), MN (33), NY (107), OH (3), RI (1), SC (1) and WI (4). Exposures were reported in five states (Florida, Minnesota, New York, Ohio and Wisconsin).
Since the last report, a further 73 cases were added to the outbreak. Diseases started on dates from June 10, 2019 to July 18, 2019 . Sick people ranged in age from 15 to 98 with a median age of 51 and 70% were women. Five (2%) people are hospitalized. No deaths have been reported until Cyclospora .
Diseases may not have been reported yet due to the time taken between when a person becomes ill and when the disease is reported. This takes on average 4 to 6 weeks.
There are usually several clusters of Cyclospora infections that occur during a given season. It is unknown at this time whether other reported cases of Cyclospora infection in the United States this season are related to fresh basil. This investigation is ongoing.
Epidemiological evidence and early product distribution information indicate that fresh basil exported by Siga Logistics de RL de CV in Morelos, Mexico, is a likely source of this outbreak.
In interviews, sick people answered questions about the food they ate and other exposures in the week before they became ill. A disease cluster is defined as two or more people who do not live in the same household who report eating at the same restaurant location, attending a regular event or shopping at the same place in a grocery store the week before they became ill. Investigation of disease clusters provides critical clues as to the source of an outbreak. If several unrelated sick people ate or shopped at the same place at a restaurant or store for several days in succession, it would indicate that the contaminated food was served or sold there. In this healthy basil-associated cluster, there were several situations where people reported eating at the same restaurants.
The FDA and authorities in several states collect records to determine the source of the fresh basil that sick people ate in five affected states. Product distribution information available at this time indicates that the fresh basil that made people sick was exported by Siga Logistics de RL de CV in Morelos, Mexico. This traceback investigation is ongoing to determine the source of pollution. Additional disease clusters are currently under investigation to determine if they are linked to fresh basil exported by Siga Logistics de RL de CV in Morelos, Mexico.
Consumers should not eat fresh basil exported by Siga Logistics de RL de CV in Morelos, Mexico until we learn more about this outbreak. This investigation is ongoing, and the CDC will provide updates when more information is available.
What is Cyclospora?
Cyclospora is a cell consisting of a cell too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a major form of cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans. The first known human cases of disease caused by cyclospora infection (ie cyclosporiasis) were first discovered in 1977. An increase in the number of cases reported began in the mid 1980s, in part due to the availability of better diagnostic techniques. Over 15,000 cases are estimated to occur in the United States each year. The first recorded cyclospora outbreak in North America occurred in 1990 and was linked to contaminated water. Since then, several outbreaks of cyclosporiasis have been reported in the United States and Canada, many associated with eating fresh fruits or vegetables. In some developing countries, cyclosporiasis is common among the population, and travelers to these areas have also been infected.
Where does Cyclospora come from?
Cyclospora spreads when people eat water or food contaminated with infected feces. For example, exposure to contaminated water among farm workers may have been the original source of the parasite in raspberry-associated outbreaks in North America. Cyclospora need time (one to several weeks) after getting a bowel movement to become contagious. Therefore, cyclospora is unlikely to be transmitted directly from one person to another. It is unknown whether animals can be infected or transmitted to humans.
What are the typical symptoms of Cyclospora infection?
Cyclospora infects the small intestine (intestine) and usually causes aqueous diarrhea, bloating, increased gas, stomach cramps, loss of appetite, nausea, low-grade fever and fatigue. In some cases, vomiting, explosive diarrhea, muscle pain and significant weight loss may occur. Some people infected with cyclospora have no symptoms. Symptoms usually appear about a week after infection. If left untreated, the disease can last from a few days to six weeks. Symptoms may also recur one or more times. In addition, people who have previously been infected with cyclospora may become infected again.
What is the serious and long-term risk of Cyclospora infection?
Cyclospora has been associated with a number of chronic diseases. complications such as Guillain-Barre syndrome, reactive arthritis or Reiter's syndrome, gallbladder disease and acalcous cholecystitis. Since cyclospora infections tend to respond to the right treatment, there is a greater likelihood of complications in individuals who are not treated or not treated promptly. Extra-intestinal infection also appears to occur more often in people with a compromised immune system.
How is Cyclospora infection detected?
Your healthcare professional may ask you to submit a stool sample for analysis. Because it can be difficult to test for cyclospora infection, you may be asked to submit several stool samples over several days. Identification of this parasite in feces requires special laboratory tests that are not routinely performed. Therefore, if suspected, your health care provider should specifically request testing for cyclospora. Your health care provider may have your stools checked for other organisms that may cause similar symptoms.
How is Cyclospora infection treated?
The recommended treatment for infection with cyclospora is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim, Septra or Cotrim. People who have diarrhea should rest and drink plenty of fluids. No alternative medication has been identified yet for people with cyclospora infection who are unable to take sulfa medication. However, some experimental studies have suggested that ciprofloxacin or nitazoxanide may be effective, although less so than trimethoprim-sulfamethoxazole. Contact your health care provider to discuss alternative treatment options.
How can Cyclospora infection be prevented?
Avoiding water or food that may be contaminated is advisable when traveling. Drinking bottled or boiled water and avoiding fresh, ready-to-eat raw materials should help reduce the risk of infection in regions with high infection rates. Improving sanitary conditions in developing regions with poor environmental and economic conditions is likely to help reduce exposure. Washing fresh fruits and vegetables at home can help remove some of the organisms, but cyclospora can remain on production even after washing.
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