Cyclospora outbreak linked to cilantro
According to a release on the Texas Department of State Health Services (DSHS) website, an ongoing investigation into an outbreak of Cyclospora illness appears to have ended. The investigation included personnel with DSHS and local Texas health departments in conjunction with agents with the federal Centers for Disease Control and Prevention and Food and Drug Administration.
According to the report, the number of new illnesses being reported has returned to background levels. The investigation has linked the cases in four restaurant clusters to cilantro imported from Puebla, Mexico.
Cyclosporiasis is an intestinal illness caused by consuming food or water contaminated with the Cyclospora parasite. The single-celled parasite can be found in food or water exposed to infected feces and often in tropical areas.
Watery diarrhea, the major symptom, usually appears about one week after ingestion and can last a few days to a few months. Additional symptoms may include loss of appetite, fatigue, weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting and a low fever. Symptoms may come and go multiple times over a period of weeks.
The Cyclospora pathogen is not transmitted by person-to-person or through hand-to-hand contact and it cannot killed by chlorine or other safe sanitizers. The pathogen comes from soil or water that has become contaminated by fecal mater from less developed countries located in the tropics or subtropics - not the United States. Often groceries offer vegetables and fruits, such as cilantro and others, imported from countries where Cyclospora and other diseases are endemic because the products are less expensive for consumers.
According to DHSH, 126 reported cases were considered part of the outbreak with an onset of illness after May 1 and no history of international travel within the two weeks before onset. Most cases occurred in June and July. However, it is unknown whether all illnesses are linked to cilantro. A total of 166 cyclosporiasis cases have been reported in Texas in 2014, with most cases occurring in North Texas.
Closer to home, 12 cases were reported in Bexar County, three in Comal County and a single case in Kendall County.
The investigation eventually centered around four restaurant clusters in North Texas that included a total of 21 people who got ill. All 21 reported eating a food item from the restaurant containing cilantro within two weeks before becoming ill. A preliminary traceback investigation, conducted by FDA and DSHS, has identified Puebla, Mexico as the source of the cilantro that was served in all four restaurants.
While the investigation has not found samples of cilantro contaminated with Cyclospora, sufficient evidence established a strong epidemiological link between the illnesses and the cilantro. Additionally, the State of Puebla was also identified as the source of fresh cilantro linked to a cyclosporiasis outbreak in 2013.
DSHS and local health departments continue to monitor for new cyclosporiasis cases.