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Cilantro linked to Cyclospora outbreak at Alabama restaurant proves to be much larger than initially perceived. However, it was the uptick of this fairly rare illness domestically that revealed a much larger foodborne problem.
Cyclospora outbreaks are not very common. Particularly in Alabama, where the outbreak was first identified. According to historical data, fewer than 20 cyclosporiasis cases are reported each year in the state of Alabama.
Between May and July 2023, 89 cases were reported. From a single county.
This is significant and an indication of a foodborne outbreak.
In response to this uptick in Cyclospora cases, the Alabama Department of Public Health issued a press release on June 14, 2023, to warn residents and to raise awareness about the illness.
“The Alabama Department of Public Health (ADPH) is investigating multiple reports of Cyclospora infection statewide. ADPH has seen more infections with this parasite since April, and there are more than twice as many cases as were reported in Alabama last year.”
The press release described the symptoms and explained how it is transmitted.
At the time, no source had been identified.
When patient interviews revealed that nearly three-quarters of these Cyclospora infection cases developed within two weeks of eating at a certain Mexican style restaurant, an outbreak investigation was initiated.
The majority of illnesses were associated with consuming food from the establishment between May 20 and June 6, 2023.
Based on in-depth patient interviews, salsa roja was a commonly consumed food item. This, along with other indicated foods, provided four individual ingredients to go on.
Cilantro, jalapenos, onions, and tomatoes became subjects for further investigation.
Based on statistical analysis, cilantro was the most likely candidate.
State agricultural partners from Florida, Georgia, and Texas were invited into the investigation. Cilantro obtained by the Alabama restaurant was traced back through an unlicensed firm in Texas to a distributor in Mexico.
This expanded the outbreak outside of the state of Alabama.
Cyclospora, unlike most foodborne illnesses is a microscopic parasite, and not a bacterium. It is also fairly rare in the states, as it is more commonly found in tropical countries.
In the United States, Cyclospora infections are associated with travel to areas where the parasite is endemic or by consuming a contaminated food imported from an area where it is found.
Foodborne outbreaks of cyclosporiasis have been linked to a variety of fresh imported produce.
Previous outbreaks have been associated with:
According to the Centers for Disease Control and Prevention (CDC), no commercially frozen or canned produce has been implicated in a Cyclospora foodborne outbreak to date.
Cyclosporiasis symptoms often begin about a week after ingesting sporulated oocysts (the infective form of the parasite). It can, however, present as early as 2 days or even greater than 2 weeks after exposure in some cases.
The most common symptom of cyclosporiasis is watery diarrhea.
Other symptoms may include:
Some people may also experience vomiting and low-grade fever.
While not life-threatening, without treatment symptoms may persist for several weeks to a month or more with symptoms returning in cycles. Some symptoms, such as fatigue, may remain long after gastrointestinal symptoms have resolved.
In areas where Cyclospora is endemic, those infected with the parasite may not show any symptoms at all.
When a health care provider suspects cyclosporiasis, specialized diagnostic tests must be performed for accurate diagnosis. However, even in symptomatic patients, diagnosis can be tricky.
A patient’s stool specimen is examined for Cyclospora oocysts. In many cases the patient may not shed enough oocysts to be detectable by laboratory examinations. Multiple tests over a period of time are usually performed to ensure diagnosis cannot be ruled out.
Without specialized treatment, people with a healthy immune system will likely recover on their own. Appropriate treatment can help speed up that process. People with other health conditions or a weakened immune system may be at higher risk for more severe or prolonged illness associated with Cyclospora infection.
Anti-diarrheal medicine may help reduce diarrheal symptoms. However, certain medications are better suited to combat the parasite, which in turn will resolve the symptoms.
Trimethopirm/sulfamethoxazole (TMP/SMX), otherwise known as Bactrim, Cotrim, or Septra brand products, are the usual therapy for Cyclospora infection. Unfortunately for those with a sulfa drug allergy, no other antibiotic regimine has been found as an effective alternative.
Fortunately, cyclosporiasis isn’t directly contagious. This is due to the parasite’s life cycle and the periods in which it is infectious.
An infected person only sheds unsporulated Cyclospora oocysts in their stool. It takes about a week or two for these oocysts to sporulate and become infective under optimal conditions. An infected person cannot transmit cyclosporiasis directly to another person, but they can, however, infect a water source or runoff used to water produce.
If you have been impacted by the Cyclospora outbreak linked to cilantro in Alabama or another affected state, you might have questions. The Lange Law Firm has experienced E. coli lawyers that understand your situation and may be able to help. Reach out for your free consultation by calling (833) 330-3663 or click here for email.
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By: Heather Van Tassell (contributing writer, non-lawyer)
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