RALEIGH — North Carolina is among dozens of states across the United States experiencing an increase in cyclosporiasis cases.

From May 1 to July 14, 307 cases of cyclosporiasis and 13 hospitalizations have been reported in North Carolina. Although a single product has not been identified as the source of the cases in the state, the North Carolina Department of Health and Human Services is working with local partners to keep residents informed.

Cyclosporiasis is an intestinal illness caused by consuming food or water contaminated with a microscopic parasite. The time between infection and symptoms is typically about one week. The parasite usually causes watery diarrhea with frequent bowel movements. Other common symptoms include loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, fatigue and other flu-like symptoms may be noted. Some people who are infected do not have any symptoms. The disease can be treated with certain antibiotics.

"If you are experiencing severe or persistent diarrhea, you should reach out to your healthcare provider," state epidemiologist Dr. Zack Moore said. "It is also important for everyone to follow routine safety practices like washing your hands with soap and water before and after handling or preparing food, and washing all fresh produce under clean running water." 

Public health investigations are ongoing to identify possible sources of exposure. To date, the increase in cases in North Carolina has not been linked to outbreaks in other states. Most cases here do not yet have a common source associated with them.

North Carolina foodborne illness investigations involve local, state and federal partners until a source is verified and traceback completed. Cyclospora originates from a particular ingredient where it is grown, not from contamination at a restaurant or food establishment.        

"Many individuals may not even realize they have consumed the ingredient that is making them sick, which makes tracing the source of contamination more difficult," said Dr. Carl Williams, state public health veterinarian. "For example, someone may recall that they had pico de gallo with their dinner but not that it included cilantro."

Most foodborne illnesses can be prevented by pasteurization or by cooking foods to 165 degrees Fahrenheit. However, cyclospora is often associated with fresh herbs and produce that are served uncooked, like parsley or cilantro, making prevention much more challenging.

Cyclospora can survive the trip from the field where produce is grown to the plate, particularly if the produce is not cooked or cleaned. For this reason, it is imperative to clean fresh produce as indicated by the FDA:        

* Wash your hands for 20 seconds with warm water and soap before and after preparing fresh produce.   

* If damage or bruising occurs before eating or handling, cut away the damaged or bruised areas before preparing or eating.     

* Rinse produce BEFORE you peel it, so dirt and bacteria aren’t transferred from the knife onto the fruit or vegetable.     

* Gently rub produce while holding under plain running water. There’s no need to use soap or a produce wash. 

* Use a clean vegetable brush to scrub firm produce like melons and cucumbers.     

* Dry produce with a clean cloth or paper towel to further reduce bacteria that may be present.     

* Remove the outermost leaves of a head of lettuce or cabbage.

For more information on cyclosporiasis, visit https://epi.dph.ncdhhs.gov/cd/diseases/.

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