About Cyclospora

From the nation’s leading law firm representing victims of Cyclospora and other foodborne illness outbreaks.

About Cyclospora Blog

Marler Clark retained by victim of 2020 Cyclospora Outbreak

The CDC, public health, and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) investigated a multistate outbreak of Cyclospora infections linked to bagged salad mix purchased at ALDI, Giant Eagle, Hy-Vee, Jewel-Osco, ShopRite, and Walmart stores in 14 states, and produced at Fresh Express’s Streamwood, Illinois production facility.

According to the FDA and the CDC, as of September 23, 2020, a total of 701 people with laboratory-confirmed Cyclospora infections associated with this outbreak were reported from 14 states: Georgia (1), Illinois (211), Iowa (206), Kansas (5), Massachusetts (1), Michigan (4), Minnesota (86), Missouri (57), Nebraska (55), North Dakota (6), Ohio (7), Pennsylvania  (2), South Dakota (13), and Wisconsin (47). Exposures were reported in 13 states (IL, IA, KS, MA, MI, MN, MO, NE, ND, OH, PA, SD, WI).[1]

Illnesses started on dates ranging from May 11, 2020 to July 24, 2020. Ill people ranged in age from 11 to 92 years with a median age of 57; 51% were female. 38 (5%) people were hospitalized. No deaths were reported in this outbreak.

In Canada, as of November 4, 2020, 370 confirmed cases of Cyclospora illness were reported in the following provinces and territories: British Columbia (1), Ontario (255), Quebec (105), New Brunswick (1), Newfoundland and Labrador (6), and Nunavut (2). Individuals became sick between mid-May and late August 2020. Ten individuals were hospitalized. No deaths were reported. Individuals who became ill are between 0 and 83 years of age. The illnesses are distributed equally among men (50%) and women (50%).[2]

Epidemiologic evidence and product traceback indicated that bagged salad mix containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express was a likely source of this outbreak. Fresh Express recalled Fresh Express brand and private label brand salad products produced at its Streamwood, IL facility that contained iceberg lettuce, red cabbage, and/or carrots on June 27, 2020. The Fresh Express recall included only products containing the ingredients iceberg lettuce, red cabbage, and/or carrots, and displaying the Product Code Z178, or a lower number.

On June 20, 2020, Jewel Osco, in cooperation with Fresh Express, voluntarily recalled its 12-ounce bagged Signature Farms Garden Salad sold in its stores in Illinois, Indiana, and Iowa.

On June 22, 2020, ALDI, in association with Fresh Express, recalled ALDI’s 12-ounce Little Salad Bar Brand Garden Salad from stores in Arkansas, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, North Dakota, South Dakota and Wisconsin.

On the same day, June 22, 2020, Hy-Vee recalled its 12-ounce Hy-Vee Bagged Garden Salad product across its eight-state region due to the potential that they may be contaminated with Cyclospora. On June 29, 2020, Hy-Vee recalled an additional 12 salads across its eight-state region. The potential for contamination was brought to Hy-Vee’s attention when Fresh Express—which manufactures the product—announced that the FDA and the CDC expanded its investigation of an outbreak of Cyclospora in the upper Midwest section of the United States.

On June 25, 2020, Fresh Express recalled 12- and 24-ounce bagged Walmart Marketside Classic Iceberg Salad, sold in Walmart stores in Iowa, Minnesota, Michigan, Nebraska, North Dakota, South Dakota, and Wisconsin.

Cyclospora:   Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Cyclospora outbreaks. The Cyclospora Attorneys and Lawyers have represented victims of Cyclospora and other foodborne illness outbreaks and have recovered over $8000 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.

If you or a family member became ill with a Cyclospora infection after consuming food and you are interested in pursuing a legal claim, contact the Marler Clark Cyclospora attorneys for a free case evaluation.

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[1]           CDC. (2020, September 24). CDC – Outbreak of Cyclospora Infections Linked to Bagged Salad Mix. https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2020/index.html

[2]           Public Health Agency of Canada (2020, November 4). Public Health Notice: Outbreak of Cyclospora infections linked to salad products and fresh herbs – Final Update. https://www.canada.ca/en/public-health/services/public-health-notices/2020/outbreak-cyclospora-infections-salad-products.html

Cyclospora found in Ocean Mist Farms brand Romaine Hearts

The Minnesota Department of Agriculture (MDA) is alerting consumers to avoid eating Ocean Mist Farms brand Romaine Hearts (Coeurs de laitue Romaine) with coding “22RHDM2L” and a harvest date of “MAR 10,” grown in Coachella, CA. The MDA Laboratory found Cyclospora in the product during routine surveillance sampling. Customers who purchased the product should discard the product and not eat it. No illnesses associated with this product have been reported at this time in Minnesota.

The Ocean Mist Farms brand Romaine Hearts lettuce (22 oz. package) was sourced from Ocean Mist Farms of Castroville, CA. The product was sold at the following grocery locations in Minnesota:

  • Bob’s Produce Ranch – Fridley, MN
  • Brink’s Market – Chisago City, MN
  • Coborn’s Grocery – Hastings, MN
  • Daggett’s Fresh Foods – Hinckley, MN
  • Driskill’s Downtown Market – Hopkins, MN
  • Festival Foods – Andover, MN
  • Festival Foods – Bloomington, MN
  • Festival Foods – Hugo, MN
  • Festival Foods – Lexington, MN
  • Festival Foods – White Bear Lake, MN
  • Festival Foods – Brooklyn Park, MN
  • Jerry’s Market – North Branch, MN
  • Jubilee Foods – Mound, MN
  • King’s County Market – Andover, MN
  • King’s County Market – St. Francis, MN
  • Knowlan’s Fresh Foods – Maplewood, MN
  • Knowlan’s Fresh Foods – South St. Paul, MN
  • Kowalski’s Market – Eagan, MN
  • Kowalski’s Market – Excelsior, MN
  • Kowalski’s Market – Eden Prairie, MN
  • Kowalski’s Market on Grand – St. Paul, MN
  • Kowalski’s Market on Chicago – Minneapolis, MN
  • Kowalski’s Market on Lyndale – Minneapolis, MN
  • Kowalski’s Market – Oak Park Heights, MN
  • Kowalski’s Market – Shoreview, MN
  • Kowalski’s Market – White Bear Lake, MN
  • Kowalski’s Market – Woodbury, MN
  • Longfellow Market – Minneapolis, MN
  • Mackenthun’s Foods – Waconia
  • North Market – Minneapolis, MN
  • Oxendale’s Market Randolph – St. Paul, MN
  • Speedy Market – St. Paul, MN
  • Super One Plaza – Duluth, MN
  • Super One West – Duluth, MN
  • Super One – Two Harbors, MN

Symptoms of illness caused by Cyclospora typically include watery diarrhea, stomach cramps, nausea, loss of appetite, and weight loss. People typically become ill about a week after eating contaminated food, but this period can range from 2-14 days. Diarrhea can last several weeks or longer if not treated. Contact your health care provider if you have become ill.

Box sticker for Ocean Mist brand romaine hearts
                                      Box sticker for Ocean Mist brand romaine hearts.
Front package view of Ocean Mist romaine hearts
                               Front package view of Ocean Mist brand romaine hearts.
Back sticker for Ocean Mist brand romaine hearts
                                     Back sticker for Ocean Mist brand romaine hearts.

Blueberries recalled due to Cyclospora

In June 2021 a limited number of cases of Dole Fresh blueberries were recalled last week due to a possible parasite contamination, but so far no illnesses have been reported in connection with the products.

On Friday, the US Food and Drug Administration (FDA) announced that Dole Diversified North America, Inc. had voluntarily recalled a limited number of its blueberry products in a variety of sizes.

The agency said that Dole was “coordinating closely with regulatory officials,” as part of the effort and confirmed that “no illnesses have been reported to date in association with the recall.”

US Cyclospora cases surge to 1,020

In 2021, multiple outbreaks of cyclosporiasis cases associated with different restaurants or events were investigated by state public health authorities, CDC, and FDA.CDC investigated two large multistate outbreaks of cyclosporiasis, one including 40 illnesses and one with 130 illnesses, in which ill people reported eating various types of leafy greens. State officials and FDA conducted traceback investigations for these two outbreaks, but a specific type or grower of leafy greens was not identified as the source of either outbreak.

As of September 28, 2021, 1,020 laboratory-confirmed cases of cyclosporiasis in people who had no history of international travel during the 14-day period before illness onset have been reported to CDC by 37 jurisdictions, including 36 states and New York City, since May 1, 2021.The median illness onset date is June 25, 2021 (range: May 1–August 31, 2021).

At least 70 people have been hospitalized; no deaths have been reported.

US Cyclospora cases surge to 864 in 34 States

The number of reported cases of domestically acquired cyclosporiasis illnesses has increased by 402 cases since the last update on July 29, 2021. Cases continue to be reported to CDC.

As of August 25, 2021, 864 laboratory-confirmed cases of cyclosporiasis in people who had no history of international travel during the 14-day period before illness onset have been reported to CDC by 35 jurisdictions, including 34 states and New York City.The median illness onset date is June 24, 2021 (range: May 1, 2021–August 7, 2021).

At least 59 people have been hospitalized; no deaths have been reported.

Cyclospora illnesses spike in the US

As of July 13, 2021, 208 laboratory-confirmed cases of cyclosporiasis in people who had no history of international travel during the 14-day period before illness onset have been reported to CDC by 23 jurisdictions, including 22 states and New York City.

The median illness onset date is June 17, 2021 (range: May 1, 2021–July 3, 2021).

At least 21 people have been hospitalized; no deaths have been reported.

What to know about Cyclospora

Cyclospora cayetanensis is a unicellular, microscopic parasite that can cause food- or water-related gastrointestinal illness. Cyclospora cannot be transmitted directly from one person to another through infected fecal matter; the parasite must complete part of its lifecycle outside of a host. Most cases of cyclosporiasis occur in underdeveloped tropical and subtropical regions of the world where the parasite is endemic.

In the United States, Cyclospora causes about 11,000 illnesses and 11 hospitalizations, but infestations of this parasite do not typically result in death. Due to the self-limiting nature of the pathogen (which causes some people to not seek medical care), difficulty in diagnosing it specifically, and other factors, the Centers for Disease Control and Prevention (CDC) estimates that there could be very broad ranges of infection, from 140 to 38,000 annual cases. In North America, outbreaks of cyclosporiasis in humans have been reported mostly from contaminated fresh food products, such as soft fruits (raspberries, blackberries, and strawberries), leafy vegetables (lettuce and mixed salad), and herbs (basil and cilantro). Soil is another possible infection source, particularly in areas with poor environmental sanitation.

Since Cyclospora infections tend to respond to the appropriate treatment, complications are more likely to occur in individuals who are not treated or not treated promptly. These can include disorders of malabsorption, reactive arthritis, cholecystitis (inflammation of the gallbladder), and, possibly, Guillain-Barré Syndrome. 

2020 Cyclospora Outbreak

 

Cyclospora – Salads

As of September 23, 2020, a total of 701 people with laboratory confirmed Cyclospora infections associated with this outbreak were reported from 14 states: GA, IL, IA, KS, MA, MI, MN, MO, NE, ND, OH, PA, SD, WI. Exposures were reported in 13 states (IL, IA, KS, MA, MI, MN, MO, NE, ND, OH, PA, SD, WI).

Illnesses started on dates ranging from May 11, 2020 to July 24, 2020. Ill people ranged in age from 11 to 92 years with a median age of 57; 51% were female. 38 (5%) people were hospitalized. No deaths were reported in this outbreak.

Epidemiologic evidence and product traceback indicated that bagged salad mix containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express was a likely source of this outbreak.

Fresh Express recalled Fresh Express brand and private label brand salad products produced at its Streamwood, IL facility that contained iceberg lettuce, red cabbage, and/or carrots on June 27, 2020.

In interviews, ill people answered questions about the foods they ate and other exposures in the 2 weeks before they became ill. An illness 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 common event, or shopping at the same location of a grocery store in the week before becoming ill. Investigating illness clusters provides critical clues about the source of an outbreak. If several unrelated ill people ate or shopped at the same location of a restaurant or store within several days of each other, it suggests that the contaminated food item was served or sold there. In this bagged salad-associated cluster, there were several situations in which people reported purchasing the product from the same stores.

The FDA and regulatory officials in several states collected records to determine the source of the bagged salad that ill people ate in the affected areas. Product distribution information indicated that the Streamwood, Illinois Fresh Express production facility is the likely producer of the bagged salad mixes eaten by ill people.

Basil recalled over Cyclospora risk

Southeastern Grocers announced Friday that they are voluntarily recalling SE Grocers Naturally Better Organic Fresh Cut Basil.

The recall is due to Cyclospora. Cyclospora infections, known as cyclosporiasis, can cause diarrhea, abdominal cramps, nausea and vomiting, among other symptoms.

SE Grocers says if customers still have this product, regardless of the expiration date, they should throw it out or return it to the store purchased for a full refund.

BI-LO, Fresco y Más, Harveys Supermarkets and Winn-Dixie are all SEG stores.

Customers with questions about the recalled products may contact the Southeastern Grocers Customer Call Center at (844) 745-0463, Monday through Friday from 8 a.m. to 7 p.m., and Saturday from 8 a.m. to 4 p.m.

The UPC code for SE Grocers Naturally Better Organic Fresh Cut Basil is as follow:

  • SE Grocers Naturally Better Organic Fresh Cut Basil – 0.5 oz container: 6-07880-20230-4

What is Cyclospora cayetanensis?

Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a large form of Cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans.

Cyclosporiasis is an intestinal illness caused by the parasite Cyclospora cayetanensis, which is transmissible by ingestion of fecally contaminated food or water.[1] Cyclosporiasis is most common in tropical and subtropical regions of the world. In the United States, foodborne outbreaks of cyclosporiasis have been linked to various types of imported fresh produce (e.g., basil, raspberries, and snow peas). Validated molecular typing tools, which could facilitate detection and investigation of outbreaks, are not yet available for C. cayetanensis.

Outbreaks of cyclosporiasis in humans have been reported mostly from North America, from the infection sources of contaminated fresh food products, such as soft fruits (raspberries), leafy vegetables (coriander, basil, and mixed salad), and herbs. Soil is another possible infection source, particularly in areas with poor environmental sanitation.[2]

The Centers for Disease Control and Prevention (CDC) has been conducting national surveillance for cyclosporiasis since it became a nationally notifiable disease in January 1999. As of 2015, cyclosporiasis was a reportable condition in 42 states, the District of Columbia, and New York City (NYC). Health departments voluntarily notify CDC of cases of cyclosporiasis through the National Notifiable Diseases Surveillance System and submit additional case information using the CDC cyclosporiasis case report form or the Cyclosporiasis National Hypothesis Generating Questionnaire (CNHGQ).[3]

While cyclosporiasis cases are reported year-round in the United States, cyclosporiasis acquired in the United States (i.e., “domestically acquired,” or cases of cyclosporiasis that are not associated with travel to a country that is considered endemic for Cyclospora) is most common during the spring and summer months. The exact timing and duration of U.S. cyclosporiasis seasons can vary, but reports tend to increase starting in May. In 2020, multiple outbreaks of cyclosporiasis were identified and found to be linked to different produce items. As of September 23, 2020, the CDC documented 1,241 laboratory-confirmed cases of cyclosporiasis in people who had no history of international travel during the 14-day period before illness onset.[4]

What are the typical symptoms of Cyclospora infection?

Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, bloating, increased gas, stomach cramps, and loss of appetite, nausea, low-grade fever, and fatigue. In some cases, vomiting, explosive diarrhea, muscle aches, and substantial weight loss can occur. Some people who are infected with Cyclospora do not have any symptoms. The time between becoming infected and becoming ill is usually about one week. If not treated, the illness may last from a few days up to six weeks. Symptoms also may recur one or more times (relapse). In addition, people who have previously been infected with Cyclospora can become infected again.[5]

Where does Cyclospora come from?

The modes of transmission of C. cayetanensis are still not completely documented, although fecal–oral transmission is the major route. Direct person-to-person transmission is unlikely. Indirect transmission can occur if an infected person contaminates the environment, the oocysts sporulate under the right conditions, and then contaminated food and water are ingested. The role of soil in transmission has also been proposed. The relative importance of these various modes of transmission and sources of infection is not known.[6]

The dissemination of infective Cyclospora oocysts via water, soil, and unprocessed foods (e.g., fruits and vegetables, including ready-to-eat salads) is enabled by their small size (8–10 μm), low specific gravity, and high infectivity. Such oocysts can survive for weeks to months in water and food, depending on the environmental temperature, and are resistant to the routine sanitization or chemical disinfection procedures used in irrigation systems, recreational waters, or drinking water treatment plants.[7]

How is Cyclospora diagnosed?

Cyclosporiasis is usually diagnosed symptomatically in clinical settings, including the presence of watery diarrhea, abdominal cramping, and bloating. In untreated, immunocompetent people, the diarrhea can last from days to weeks to a month or more, and can wax and wane, with variable oocyst shedding. Oocysts can continue to be shed (intermittently or continuously) by non-symptomatic people, and symptoms can also persist in the absence of oocysts in feces. In a clinical context, conventional diagnosis usually involves microscopic examination of intestinal tissue biopsy sections, stool samples for the presence of developmental stages of Cyclospora, or advanced molecular testing for DNA. Improved specificity and sensitivity have been possible largely through the use of PCR, which enables the specific amplification of genetic loci from tiny amounts of genomic DNA of Cyclospora. Because of the intermittent nature of oocyst shedding and the low numbers of this stage in feces, it is recommended that multiple stool samples be collected at 2–3 day intervals over a period of more than a week, to increase the likelihood of identifying the disease microscopically.[8]

What are the serious and long-term risks of Cyclospora infection?

Cyclospora has been associated with a variety of chronic complications such as malabsorption, reactive arthritis, and cholecystitis (inflammation of the gallbladder). Since Cyclospora infections tend to respond to the appropriate treatment, complications are more likely to occur in individuals who are not treated or not treated promptly. Extraintestinal infection also appears to occur more commonly in individuals with a compromised immune system.[9]

Although human cyclosporiasis is usually not fatal in developed countries such as the United States, protracted diarrhea often leads to dehydration, particularly in infants who are at greatest risk of severe dehydration and death, especially if cyclosporiasis is complicated by infections with other pathogens (viral, bacterial, or parasitic—e.g., Cryptosporidium and Giardia), malnutrition, or malabsorption, particularly in underprivileged communities.[10]

According to the CDC[11], the recommended treatment is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim, Septra, or Cotrim. It is advisable for people who have diarrhea to also rest and drink plenty of fluids.

[1]           Casillas, S. M., Hall, R. L., & Herwaldt, B. L. (2019). Cyclosporiasis Surveillance – United States, 2011-2015. Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002)68(3), 1–16. https://doi.org/10.15585/mmwr.ss6803a1

[2]           Giangaspero, A., & Gasser, R. B. (2019). Human cyclosporiasis. The Lancet Infectious Diseases, 19(7), e226–e236. https://doi.org/10.1016/S1473-3099(18)30789-8

[3]           Casillas, Ibid, Note 1 at Page 1.

[4]           CDC. (2020, September 24). Cyclosporiasis Outbreak Investigations – United States, 2020. Centers for Disease Control and Prevention. https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2020/seasonal/index.html

[5]           Cyclosporiasis – Disease. (2018, May 11). https://www.cdc.gov/parasites/cyclosporiasis/disease.html

[6]           Almeria S, Cinar HN, Dubey JP. Cyclospora cayetanensis and Cyclosporiasis: An Update. Microorganisms. 2019; 7(9):317.

[7]           Giangaspero, Ibid, Note 2 at Page 1.

[8]           Giangaspero, Ibid, Note 2 at Page 3-4.

[9]           CDC. (2020, October 21). CDC – Cyclosporiasis – Resources for Health Professionals. Centers for Disease Control and Prevention. https://www.cdc.gov/parasites/cyclosporiasis/health_professionals/index.html

[10]         Giangaspero, Ibid, Note 2 at Page 2.

[11]         CDC. (2020, September 17). CDC – Cyclosporiasis – General Information – Cyclosporiasis FAQs. https://www.cdc.gov/parasites/cyclosporiasis/gen_info/faqs.html

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