A parasite known for triggering sudden, severe bouts of diarrhea is spreading rapidly in one state as part of a wider outbreak across the US.
Michigan has reported 10,700 cases of cyclosporiasis, an intestinal illness that can cause diarrhea and abdominal pain, according to an update issued Friday by state health officials.
The figure is more than twice the total in Ohio, the state with the next highest count at 4,000 infections, and marks an increase of 387 cases from just one day earlier.
So far, 193 people in Michigan have been hospitalized after becoming ill.
Nationwide, the Centers for Disease Control and Prevention (CDC) says 18,000 cases of cyclosporiasis have been identified. The illness is most often linked to food or drinks contaminated with human feces, though federal totals can trail behind figures released by local health departments.
Investigators have tied a major cluster of infections to shredded iceberg lettuce from Taylor Farms that was sold at Taco Bell and other retailers.
In North Carolina, officials are also examining parsley and cilantro as possible sources of the outbreak there.
Taylor Farms has recalled the affected lettuce and closed the Mexico facility that has been connected to the reported cases.
The above shows the skyline in Detroit, Michigan. The state is at the heart of the major cyclosporiasis outbreak
In Michigan, health officials have not pinpointed a source of the outbreak, but have urged people to thoroughly wash and trim certain produce before consuming them.
These were lettuce and leafy greens, cilantro, basil, green onions, raspberries and snow peas.
Michigan has been recording its surge in cases since late June, with infections mostly diagnosed in people in their 20s, 30s and 40s.
Within the state, the majority of cases are being diagnosed in and around Detroit. Oakland County, one of the three counties that make up metropolitan Detroit, has recorded more than 1,000 cases, the most out of any county in the state.
Typically, Michigan records around 50 cases of the parasite every year.
Nationwide, the CDC reports that Illinois, Indiana, North Carolina and New York are all also recording high case numbers, at up to 500 infections detected in each state.
Overall, 45 states in the US have recorded at least one case of a resident being infected by the parasite this year.
The FDA is currently tracking six outbreaks of cyclospora, the parasite that causes the sickness cyclosporiasis. The outbreaks are not necessarily unconnected, but may have been separated as the agency believes they were caused by a different food source.
In the major outbreak linked to Taylor Farms lettuce, cases are being recorded in nine states. These are Illinois, Indiana, Kansas, Kentucky, Michigan, Ohio, Oklahoma, Pennsylvania and West Virginia.
The FDA initially named lettuce supplied by produce grower Taylor Farms as the culprit, leading the company to temporarily shut down the Central Mexico processing facility linked to the parasite.
But on July 19, the FDA said lettuce from Taylor Farms returned a false-positive result for the cyclospora parasite.
The named Taylor Farms facility produces five-pound bags of shredded iceberg lettuce sold to Taco Bell, Sysco and other large food distributors. It has since been shut down temporarily and its lettuce has been recalled.
Cyclospora, the parasite that causes the illness, takes about a week or two to mature after it is excreted on to produce, meaning most people are infected by consuming contaminated food or water.
Experts say though that it is also theoretically possible for the parasite to remain and mature on a surface such as a button on a bus and then infect another individual.
Cyclosporiasis typically causes explosive diarrhea, abdominal cramping, nausea, vomiting and fatigue.
The cyclospora parasite causes cyclosporiasis, an infection that leads to diarrhea, severe cramping, nausea and vomiting and fatigue
Unlike norovirus or routine food poisoning, however, symptoms often come and go rather than resolving after a few days.
Without treatment, experts say the illness can persist for weeks or repeatedly return.
Anyone with diarrhea lasting more than a few days should seek medical care and specifically ask for a cyclospora test, as it is not routinely ordered, Dr Swapnil Patel, vice chair of medicine at Hackensack Meridian Jersey Shore University Medical Center, told the Daily Mail.
The test detects cyclospora DNA in stool samples and typically requires one to three samples.
Treatment for the infection consists of the antibiotic trimethoprim-sulfamethoxazole, sold under the brand names Bactrim, Septra and Cotrim.
