A parasitic infection that causes “explosive,” watery diarrhea is spiking across the United States, with health authorities scrambling to identify the source of the widespread surge. As of July 14, approximately 5,000 cases of cyclosporiasis have been reported across at least 31 states, according to data tracked by NBC News from state health departments. The U.S. Centers for Disease Control and Prevention (CDC) confirms that at least 86 people have been hospitalized due to the illness. While the infection is typically not life-threatening, it is described by medical professionals as extremely unpleasant, with symptoms often lasting for weeks.
The Scope of the Outbreak
The current surge has been characterized by health officials as “highly unusual” and “striking.” While cyclosporiasis is a seasonal illness that typically sees increased rates in the U.S. during warmer months—specifically between May and August—the current case counts in several regions far exceed annual norms. Michigan has emerged as one of the hardest-hit areas. The CDC noted on July 10 that it was aware of more than 1,500 additional cases requiring further analysis to confirm if they were domestically acquired. Officials caution that the true number of infections is likely higher, as many individuals may recover without seeking medical care or undergoing testing.
For more on this story, see Cyclosporiasis Outbreak Hits 32 States With Nearly 3,000 Reported Cases.
Understanding Cyclosporiasis
The infection is caused by the microscopic parasite *Cyclospora cayetanensis*. It infects the small intestine after a person consumes food or water contaminated with trace amounts of feces from an infected person, a process known as the fecal-oral route. According to the CDC, person-to-person transmission is considered highly unlikely because the parasite requires one to two weeks outside the body to become infectious. Symptoms typically appear two to 14 days after ingestion and include: * Severe, watery, “explosive” diarrhea * Stomach cramps * Appetite loss * Nausea and vomiting * Low-grade fever
This follows our earlier report, Cyclosporiasis Outbreak Hits 32 States With Thousands of Confirmed Cases.
Challenges in Identifying the Source
Investigating the source of a cyclosporiasis outbreak is inherently complex. Because the parasite is commonly linked to fresh produce—such as cilantro, basil, raspberries, snow peas, and salad greens—and because symptoms can take up to two weeks to appear, patients often struggle to recall their specific food history. “Foodborne disease investigations are complicated in general because you have to rely on interviews with the case patients to get their food history,” said Dr. Carl Williams, State Public Health Veterinarian for the North Carolina Department of Health and Human Services. “If you wait too long, you tend to get food preferences as opposed to the specific history.” Furthermore, the short shelf life of fresh produce means that by the time a common ingredient is identified, the contaminated product has often already been discarded from the food supply. While Michigan officials have investigated potential links to lettuce and salad greens, no definitive grower, supplier, or specific food item has been confirmed as the universal source for the current multi-state surge.
Read also: Michigan Cyclosporiasis Outbreak Linked to Lettuce and Salad Greens.
Ongoing Investigations and Prevention
The CDC, in coordination with the U.S. Food and Drug Administration (FDA) and local health departments, is conducting ongoing investigations to determine if the various state clusters are connected. As of early July, the CDC stated there was “no evidence of a single, multi-state cyclospora outbreak linking all cases.” Health officials emphasize that the best defense against the parasite is adhering to safe food handling practices. This includes washing fresh produce thoroughly.
Find more reporting in our Health section.
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