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By Marni Rose McFall

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Health officials are investigating an increase in cases of cyclospora infection (cyclosporiasis), a foodborne illness that can cause "explosive" diarrhea that is spreading across the United States.

Several states have reported an outbreak, with Michigan reporting an unusually large number and states also seeing elevated case numbers.

Cyclosporiasis is caused by the microscopic parasite Cyclospora cayetanensis. According to the Centers for Disease Control and Prevention (CDC), the illness commonly causes watery diarrhea that can include frequent, and sometimes explosive, bowel movements.

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Previous U.S. outbreaks have often been linked to contaminated fresh produce, and infections tend to worsen in the summer months.

Newsweek has contacted the CDC via email for comment.

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States Reporting Cases

Recent CDC surveillance data and state health department reports indicate confirmed cases have been identified in at least the following states:

• Alaska
• Colorado
• Connecticut
• Florida
• Georgia
• Illinois
• Louisiana
• Massachusetts
• Michigan
• New Jersey
• New York
• North Carolina
• Ohio
• Pennsylvania
• Tennessee
• Texas
• Virginia
• Wisconsin

Michigan has reported the largest number of confirmed cases. Ohio has also reported a significant increase, while several other states continue to investigate smaller clusters.

Michigan Reports Unusually Large Outbreak

Michigan has reported more than 700 confirmed cases. State officials have described the outbreak as highly unusual and are reviewing food histories and grocery purchases to help identify a possible source.

As of early July, Ohio had 177 cases and Texas had 48, while New York (120), North Carolina (141) and Illinois (110) have also reported increased numbers of cases or are investigating suspected clusters.

What the CDC Says

Case of cyclosporiasis tend to increase during the summer, usually between May 1 and August 31, per the CDC.

The CDC's latest national surveillance update reported 145 domestically acquired cases across 17 states between May 1 and June 16, including 20 hospitalizations and no deaths.

Because national surveillance data are published with a delay, the figures do not reflect more recent state reports. Based on publicly reported state case counts, the total number of reported infections is likely substantially higher, although the CDC has not released an updated nationwide total.

The CDC says there is currently no evidence that all reported illnesses are part of a single nationwide outbreak. Instead, federal and state investigators are examining multiple clusters to determine whether any share a common food source.

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Why Official Numbers May Underestimate the Total

Public health officials note that many people with cyclospora infection never receive laboratory testing or medical care. As a result, reported case counts likely underestimate the true number of infections.

Additionally, delays between exposure, symptom onset, testing and reporting mean surveillance data often trails real-world outbreaks by several weeks.

Foods Previously Linked to Cyclospora

Investigators have not identified a specific food responsible for the current outbreaks.

However, previous U.S. outbreaks have been associated with:

• Basil
• Cilantro
• Mesclun lettuce
• Bagged salad mixes
• Raspberries
• Snow peas
• Green onions (scallions)

Fresh produce is commonly implicated because contamination can occur before foods reach consumers through contaminated irrigation water or other environmental sources. The parasite generally is not spread directly from person to person because it must mature in the environment before becoming infectious.

Symptoms

Symptoms typically begin about one week after consuming contaminated food or water, although they can appear anywhere from two days to two weeks after exposure.

Common symptoms include:

• Watery diarrhea
• Frequent diarrhea, which may be severe
• Stomach cramps
• Bloating
• Nausea
• Loss of appetite
• Fatigue
• Weight loss

Without treatment, symptoms can last for several weeks and may improve before returning.

What Happens Next

The Food and Drug Administration, CDC and state health departments continue investigating potential sources of contamination. As of reporting, no specific grower, supplier or food product has been identified.

Because cyclospora infections are seasonal and reporting delays are common, additional cases are expected to be identified in the coming weeks. Investigators are working to determine whether the current illnesses stem from one or more unrelated contamination events rather than a single nationwide outbreak.

Contact Newsweek editors on this story: John Fitzpatrick and Dave Siminoff.

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