Parasite outbreak spreads in Texas and Arkansas; Miller County reports cases

Miller County is among the Arkansas counties reporting confirmed cases of cyclosporiasis, a parasitic intestinal illness that has sickened more than 10,000 people nationwide this summer and prompted a recall of iceberg lettuce sold at Walmart stores in both Texas and Arkansas.

The Arkansas Department of Health map released Wednesday shades Miller County in the category for fewer than 10 confirmed cases. The state suppresses exact counts in counties with between one and nine patients to protect privacy, so the precise local number is not public.

Statewide, Arkansas has confirmed 205 cases as of Aug. 5. Texas has confirmed 198 as of the same date, with 37 hospitalizations and no deaths, according to the Texas Department of State Health Services. DSHS does not publish a county breakdown.

Both numbers are climbing fast. Arkansas had 10 confirmed cases on July 14. Texas added roughly 100 cases in the last two weeks of July.

The recall reached both sides of the line

On July 17, Taylor Farms de Mexico recalled all iceberg lettuce it sourced from central Mexico. The recall included Marketside-brand iceberg salad in 12-ounce and 24-ounce packages and shredded lettuce in 8-ounce and 16-ounce packages, sold at Walmart, with best-if-used-by dates from July 18 through Aug. 3.

The Food and Drug Administration says recalled Marketside product was sold at select Walmart stores in both Texas and Arkansas. Recalled foodservice product, the kind that goes to restaurants and institutional kitchens, was distributed in both states between June 29 and July 16.

Anyone who still has recalled product should throw it out. Refunds are available at the point of purchase. FDA also advises cleaning and sanitizing any surfaces or containers the lettuce touched.

The use-by dates on the recalled retail packages have all passed, so the immediate risk from that specific product has largely worked its way through. But because it can take two weeks for symptoms to appear and up to six weeks for a case to be confirmed and reported, the case counts will keep rising for a while regardless.

What cyclosporiasis is

Cyclosporiasis is caused by Cyclospora cayetanensis, a microscopic parasite that infects the small intestine. People get it by eating food or drinking water contaminated with feces.

The good news for families is that it does not spread from person to person. The parasite needs days or weeks in the environment before it can infect anyone, so a sick child is not going to give it to a sibling. Contamination happens on the farm or in processing, usually through irrigation or wash water.

Symptoms start two to 14 days after exposure. The main one is watery diarrhea, frequent and sometimes explosive. People also report cramping, bloating, nausea, fatigue, loss of appetite and weight loss. Some people have no symptoms at all.

One feature makes this illness distinct from ordinary food poisoning. Symptoms can seem to clear up, then come roaring back days later. Untreated, the infection can last more than a month. It is rarely life-threatening, though two deaths have been reported in Michigan as part of the national outbreak.

Treatment is the antibiotic trimethoprim-sulfamethoxazole.

Where investigators think it started

CDC and FDA have traced the largest cluster of illnesses to iceberg lettuce processed by Taylor Farms de Mexico from growers in central Mexico. That outbreak covers 6,358 illnesses in 15 states, including Arkansas.

Texas is not among the states tied to the lettuce. DSHS says it has not identified a source for the Texas cases.

That gap matters locally. Texarkana straddles a state line where one side has been linked to a known contaminated product and the other has not, and there is no evidence yet that they are the same event. Nationally, CDC counted 10,468 lab-confirmed cases since May 1 in its Aug. 4 weekly update, and says it is investigating other cyclosporiasis outbreaks unrelated to the lettuce.

The lettuce evidence itself has a wrinkle. FDA reported a positive lettuce sample from the border on July 18, then withdrew it a day later as a false positive. As of July 19 no product sample had tested positive. The case rests on interviews with sick people and on tracing shipments back to a common supplier. FDA says that evidence is strong enough to stand on its own.

What to do

Wash all fruits and vegetables thoroughly under running water before eating, cutting or cooking. Wash your hands before and after handling raw produce. Cut away bruised or damaged spots. Refrigerate cut or cooked produce within two hours.

Washing reduces risk but does not eliminate it. Cyclospora clings to some produce surfaces and can be hard to rinse off completely.

If you have had diarrhea for more than a few days, call your doctor and ask specifically about Cyclospora testing. Standard stool tests generally will not catch it. Providers have to request the test directly, and a single negative result does not rule it out because the parasite sheds intermittently.

Arkansas residents diagnosed with the illness may get an email from ADH asking them to complete a state survey on recent food and travel history. The department says it comes from [email protected].

Cyclospora season runs May 1 through Aug. 31.