People across the country are experiencing bouts of explosive diarrhea due to a parasitic outbreak, and public health experts are asking people to take a few steps to minimize their risk of exposure.
Major outbreaks caused by the protozoan parasite Cyclospora cayetanensis are occurring in Michigan and Ohio, with confirmed cases in 18 states as of Wednesday, including Pennsylvania, New York and New Jersey. Dr. Jeffrey Jahre, chief emeritus of infectious disease for St. Luke’s University Health Network, said the health network is paying close attention to this parasite and its spread.
Jahre said St. Luke’s has treated patients with the condition in the past, though there are currently no confirmed or suspected cases in the Lehigh Valley.
Cyclospora is transmitted by coming into contact with infected fecal matter or infected water. It is most common in tropical areas of the world, but the U.S. frequently experiences cases thanks to it being brought over on certain fresh produce. It is not believed that the parasite can be transmitted from person to person.
“When you excrete the parasite in your stool, it has to go through a maturation process over several weeks and has to have certain very strict environmental conditions. That’s very different than what goes on with a bacterium and a virus. So it is not a person-to-person-spread disease,” Jahre said.
The greatest risk posed by a Cyclospora infection is dehydration as a result of diarrhea, which can be fatal if not managed. But the lethality of the illness is not what has public health experts concerned as much as how much more severe this outbreak is than anything involving the parasite before in the U.S.
There are more than 1,000 cases between Michigan and Ohio, Jahre said. The number of recorded cases in Pennsylvania is on par with what one would expect for a normal year, but cases are quite a bit higher in New York.
Though it is not a viral illness, Jahre said that cyclosporiasis, the condition caused by the parasites in the Cyclospora genus, has similarities to some other diseases such as norovirus, also known as the stomach bug or stomach flu. Cyclosporiasis symptoms include loss of appetite, bloating, burping, farting, fatigue, low-grade fever, stomach cramps, nausea and vomiting. Jahre said the biggest differentiating indicator is highly explosive diarrhea, but that is not always present. He said for this reason, and its similarity in presentation to norovirus, he is recommending everyone who is experiencing persistent diarrhea see their doctor and get tested.
Getting tested will help public health officials better track the spread of the parasite and get you access to effective treatments. Though the condition can get better on its own, it’s not always advisable, as bouts of diarrhea can persist for weeks or months if left untreated. And as with most illnesses, it more likely to be worse in the very old, the very young, and people with other health conditions. Fortunately, hospitalization is rarely necessary. Jahre describes it as an outpatient illness that is treated with antibiotics, though this isn’t always necessary.
Jahre said to protect against the parasite, people should make sure the produce they buy is properly cleaned. He said this starts with washing your hands thoroughly with soap and water before and after handling produce, and using a vegetable brush. With lettuce, removing the first two to three layers is advised. There is also research that vinegar and vinaigrettes can help neutralize the parasite, though this is not a surefire approach. The only foolproof way of eliminating the parasite from food is to thoroughly cook it.
“I’m not telling people to avoid all fruits and vegetables that are raw at this time of the year, but to try and take some of these standard precautions to reduce the risk. And obviously, we’re all waiting to try and find out what may be a single source,” Jahre said.