Cyclospora Found in North Texas Counties Likely Food Borne

Health officials say more than a dozen cases of cyclosporiasis have been confirmed in North Texas' four major counties and that the source is likely contaminated food.

The Texas Department of State Health Services said Wednesday the parasite was found in Dallas, Tarrant, Collin and Denton counties and that the origin may be linked to a fresh produce item.

County officials told NBC 5 there have been four cases recorded in Dallas County, three in Collin County, four in Denton County and seven in Tarrant County. The Denton County cases and at least four of the Tarrant County cases had recently traveled out of the country -- calling into question the point of origin.

It is not known if any of the patients in Dallas County or Collin County had recently traveled abroad.

Across the state, there are currently 66 confirmed cases of cyclosporiasis -- though the sources of infection haven't been confirmed. For most people, the symptoms are serious. "But for those who are very young and those who are older, or those who have a suppressed immune system, this illness can cause major problems," said Dr. Khang Tran, chief medical officer at The Medical Center of Plano. 

In recent years, 2012-2015, cyclospora outbreaks were associated with fresh cilantro imported from Puebla, Mexico. Since the summer of 2015, the Food and Drug Administration has instituted ban on imports from that region between from April through August.

"Buy local," said Cameron Satterthwaite, of Georgia's Farmers Market in Plano. "That way you can have more of an assurance you're not getting some massive widespread disease or illness that's on the ground." 

The only imports allowed to enter the U.S. from that region are those that are on the FDA's green list.

What to Know About Cyclospora/Cyclosporiasis: CDC

How is the parasite spread?
Cyclospora is spread by people ingesting something contaminated with feces. Since the parasite needs time to become infectious after being passed in a bowel movement, it's unlikely that it can be passed directly from person to person.

Who is at risk of infection?
People living or traveling in areas where the parasite is endemic are at risk. In the U.S., foodborne outbreaks have been linked to imported produce in 2014 and 2015.

What are the symptoms?
Some infected persons are asymptomatic, particularly in settings where cyclosporiasis is endemic. Among symptomatic persons, the incubation period averages ~1 week (ranges from ~2-14 or more days). cyclospora infects the small intestine and typically causes watery diarrhea, with frequent, sometimes explosive, stools. Other common symptoms include loss of appetite, weight loss, abdominal cramping/bloating, increased flatus, nausea, and prolonged fatigue. Vomiting, body aches, low-grade fever, and other flu-like symptoms may be noted. If untreated, the illness may last for a few days to a month or longer, and may follow a remitting-relapsing course. Although cyclosporiasis usually is not life threatening, reported complications have included malabsorption, cholecystitis, and Reiter's Syndrome (reactive arthritis).

How do you prevent infection?
On the basis of currently available information, avoiding food or water that might have been contaminated with stool is the best way to prevent infection. Travelers to cyclosporiasis-endemic areas should be told that food and water precautions for cyclospora are similar to those for other intestinal pathogens, except that cyclospora is unlikely to be killed by routine chemical disinfection or sanitizing methods. Symptomatic reinfection can occur. Cooking produce with the parasite will kill the parasite.

What should I do if I believe I'm infected?
See your doctor immediately.

How is the infection treated?
Cyclosporiasis infections are generally treated with a combination of two antibiotics. Those with diarrhea should also get rest and drink plenty of fluids.

More Information: Centers for Disease Control and Prevention

In 2015, the DSHS said there were 316 cases of cyclosporiasis in Texas.

Cyclosporiasis Case Counts and Incidence Rates in Texas, 2001-2014

Year | Case Count | Incidence Rates

2014* | 200 | 0.7
2013* | 351 | 1.3
2012* | 44 | 0.2
2011* | 14 | 0.1
2010 | 9 | 0.0
2009 | 10 | 0.0
2008 | 6 | 0.0
2007 | 2 | 0.0
2006 | 1 | 0.0
2005 | 1 | 0.0
2004 | 4 | 0.0
2003 | 1 | 0.0
2002 | 1 | 0.0
2001 | 0 | 0.0

IR=incidence rate per 100,000 *incidence rates are bases on projected census data obtained from the DSHS Center for Health Statistics.

More: CDC information on past multi-state outbreaks

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