‘Lettuce or salad greens' could be potential source of cyclosporiasis outbreak, health officials say

Health officials in Michigan investigating thousands of cases cyclosporiasis, a parasitic infection that causes “explosive diarrhea,” said Monday that current results point to “lettuce or salad greens” as a potential source of the outbreak.

Still, “other food items cannot be completely ruled out,” a release from the Michigan Department of Health and Human Services said, and “no specific type of produce, grower or supplier has been identified as the source.”

The update comes as Michigan reported 2,640 cases of the infection so far. That’s compared to the 40 or 50 cases Michigan typically records annually.

In Illinois, cases are nearing 200, a report from WTTW said, with 47 probably cases in Chicago. According to the Centers for Disease Control and Prevention, 31 states have reported cases of cyclosporiasis so far, and 86 people have been hospitalized.

The CDC added that people who became sick with the parasite did so after eating food in the U.S., and did not report any travel during the 14 days before symptoms started.

“Although we do not have a definite product identified as the source of the outbreak, we want to let Michiganders know what we have learned so far so they can take steps to protect their families,” MDHHS chief medical executive Dr. Natasha Bagdasarian, said in a release. “Early information has shown lettuce as a common product that regularly comes up during the investigation. We will continue to provide updates as we learn more.”

How does Cyclosporiasis spread?

Cyclospora is a parasite that infects the intestines, the MDHHS said, and is known for causing watery diarrhea, nausea and stomach cramps. It is often contracted by eating or drinking something contaminated with the parasite.

While the infections can be contracted from swimming in contaminated waters, such transmission is uncommon and Michigan health officials said it is “not a recognized risk factor” and “there is currently no evidence linking recreational water activities to this outbreak.”

“While people should always avoid swallowing recreational water, foodborne exposure – particularly exposure to contaminated produce – remains the primary focus of this outbreak investigation,” the MDHHS said.

What other foods that could be linked to the illness?

In Monday’s update, Michigan health officials said “current results point to lettuce or salad greens as a potential source” of the latest outbreak. However, other food items were not ruled out, and “no specific type of produce, grower or supplier has been identified as the source.”

As part of the investigation, anyone who eats, buys or prepares lettuce or salad greens, including restaurants and commercial kitchens, are advised to the following precautions:

• Purchase whole heads: Buy whole heads of lettuce rather than pre-washed, bagged lettuce or pre-mixed salad kits.

• Discard outer layers: Before preparation, throw away the outer two to three layers of leaves.

• Wash inner leaves: Thoroughly wash the remaining inner leaves under clean running water.

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What is cyclosporiasis, the ‘explosive diarrhea' parasite infection tied to produce?

• Prioritize cooking: For any greens that can be cooked, cooking to a temperature of at least 158 F (70 C) is the safest option, as the parasite is resistant to routine chemical disinfection and washing alone cannot guarantee its removal.

• Wash all fresh produce. Wash under clean running water, even if you plan to peel it. “Pre-washed” does not guarantee safety and rewashing bagged lettuce is unlikely to remove cyclospora. While washing alone may not fully eliminate cyclospora, it enhances protection when combined with cooking or peeling.

“Not everything is meant to be cooked, which is why washing your produce is still one of the best food safety habits—whether you’re planning to eat it raw or cook it,” the Illinois Department of Health said in a recent social media post. “Simply rinse fruits and vegetables under clean running water and scrub firm produce (like melons) with a produce brush. No soap needed.”

Other recommendations include:

• Cook produce when possible. Heating food to 158 F (70 C) or higher kills cyclospora.

• Peel produce. Peeling is highly effective for food items with removable skin as the parasite sits on the outer surface.

Food items that have been linked to previous cyclospora outbreaks in the U.S. and Canada include:

• Bagged salad mixes and kits

• Fresh cilantro (coriander leaves)

• Fresh basil

• Raspberries

• Snow peas

• Green onions (scallions)

How long do symptoms last?

While the most common and notable symptom of the infection is known as “explosive diarrhea,” there are other signs of the infection.

“The first thing is explosive diarrhea, bloating, cramping, loss of appetite,” Dr. Sharon Welbel, chair of infectious diseases for Cook County Health, said. “Some people have a low-grade fever but that’s pretty uncommon.”

One of the larger indications of cyclosporiasis is likely the timing of infection and symptoms. While many other foodborne illnesses will show symptoms within hours, cyclosporiasis can up to two weeks to develop.

The infections can also last much longer than other foodborne illnesses.

“Most people recover within 1-2 weeks with rest and fluids, though symptoms can sometimes last longer or return,” the IDPH said. “Some people may need antibiotics prescribed by a healthcare provider.”

People experiencing frequent, watery diarrhea are being urged to contact their healthcare provider and “specifically request testing for cyclospora as routine stool tests may miss the parasite,” MDHSS stated.

Treatment for confirmed infections will include antibiotics, but those who contract it should also be prepared to rest and drink fluids to maintain hydration.

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