Three more states probe Cyclospora cases, links to outbreak

Three more Midwestern states — Illinois, Kansas, and Wisconsin — are reporting Cyclospora infections, but it's not clear if all are related to a multistate outbreak that may involve as many as 183 cases.

The cases in the three additional states were first reported yesterday by Marler Blog, published by foodborne illness attorney Bill Marler. And health officials in the three states told CIDRAP News that they have received reports of a few cases and are investigating if they are linked to an outbreak that appears to be focused in Iowa and Nebraska, two states that have reported numerous cases.

The Iowa Department of Public Health (IDPH) said today that it has received reports of 87 Cyclospora cases so far—6 more than reported yesterday. Iowa's cases are from 27 different counties, though many of them are from Linn County.

Yesterday the IDPH said illness numbers were starting to taper off and that onset dates suggest that the sick patients ate the contaminated food in the middle of June. It said there's a good chance the tainted food, probably a fresh vegetable, had already been consumed or discarded.

Nebraska, meanwhile, received a report of one more infection, raising the state's total to 54, according to Leah Bucco-White, a public information officer for the Nebraska Department of Health and Human Services.

Yesterday Texas health officials said the state had 37 cases so far this year, including 29 in northern Texas that were reported this week. Investigators are trying to determine if those cases are linked to the outbreak in the Midwestern states. An NBC TV affiliate in Dallas today reported that the 29 cases in north Texas are from four counties: Dallas (8), Denton (5), Tarrant (10), and Collin (6).

Meanwhile, Illinois has received two reports of Cyclospora infections with onset dates since Jun 13, according to Melaney Arnold, a spokeswoman for the Illinois Department of Public Health.

So far Illinois has no cases with suspected links to the outbreak who were exposed in Illinois. Arnold said one of the patients had a travel history outside of the United States and was likely exposed elsewhere. "The other traveled to Iowa on multiple occasions and purchased and ate food there, so the likely exposure is in Iowa," she told CIDRAP News.

Kansas health officials are aware of one case in a Kansas resident who was likely exposed in Nebraska, Miranda Steele, communications director for the Kansas Department of Health and Environment, told CIDRAP News. "This case is potentially associated, while the multistate investigation is ongoing," she said.

Wisconsin has received two reports of Cyclospora infections, both of which were diagnosed in June, Jennifer Miller, a communications specialist with the Wisconsin Department of Health Services, told CIDRAP News. She added that epidemiologists are investigating the cases, but so far it's not clear if they are linked to the multistate outbreak.

The gastrointestinal disease is caused by a rare parasite, and one of the main symptoms is prolonged watery diarrhea that can last as long as 57 days. Other symptoms include fatigue, muscle aches, and a low-grade fever. Most Cyclospora outbreaks in the past have been linked to imported produce items such as raspberries, basil, and snow peas.

See also:

Jul 16 Marler Blog post

Jul 17 IDPH press release

Jul 17 5NBCDRW.com story

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