July 26, 2019

Summer is the season of fresh produce.  Who doesn’t love getting tomatoes and zucchini from a generous neighbor with a garden?  Farmers markets and farm stands offer the most beautiful variety of fruits and vegetables. 

It’s very tempting to grab a fresh nectarine or plum and immediately bite into it, enjoying the burst of sweetness and the warm juice dribbling down your chin.  But, it’s important to wash all of the fruit you purchase before taking that bite.

Since May 1st of this year, Massachusetts has had more than 100 reports of Cyclospora infection.  Cyclospora is a foodborne illness that causes gastrointestinal symptoms.  Massachusetts has seen 18-33 cases per year over the past three years–100 cases in three months is a significant increase.  While most of the cases have been reported in the Boston area, there have been cases reported from across the state.  Other states have also reported increases in Cyclospora infection.

Cyclospora is a single cell parasite that enters the body via tainted food or water.  The time between becoming infected and becoming sick is about one week. It usually causes watery diarrhea, with frequent bowel movements. Other common symptoms include loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, and fatigue. Vomiting, body aches, headache, fever, and other flu-like symptoms may be noted. Some people infected with Cyclospora do not have any symptoms.  Antibiotics are often prescribed to treat Cyclospora.  As a parasitic infection, a person can be re-infected and develop this illness multiple times.

Until the 1990s, Cyclospora was usually experienced by people who had traveled to developing countries.  However, in recent years, outbreaks in the United States have been linked to imported fruits and vegetables. Less than 25% of the cases in May-June 2019 reported recent international travel.

The Center for Disease Control (CDC) recommends that consumers and retailers should always follow safe fruit and vegetable handling recommendations:

Wash: Wash hands with soap and warm water before and after handling or preparing fruits and vegetables. Wash cutting boards, dishes, utensils, and counter tops with soap and hot water between the preparation of raw meat, poultry, and seafood products and the preparation of fruits and vegetables that will not be cooked.

Prepare: Wash all fruits and vegetables thoroughly under running water before eating, cutting, or cooking. Fruits and vegetables that are labeled “prewashed” do not need to be washed again at home. Scrub firm fruits and vegetables, such as melons and cucumbers, with a clean produce brush. Cut away any damaged or bruised areas on fruits and vegetables before preparing and eating.

Store: Refrigerate cut, peeled, or cooked fruits and vegetables as soon as possible, or within 2 hours. Store fruits and vegetables away from raw meat, poultry, and seafood.

In small children, elders, and people with compromised immune systems, Cyclospora can be dangerous because of the possibility of severe dehydration.  Warning signs of dehydration include sunken eyes, dry mouth and tongue, reduced production of tears, and decreased urine output.  If a person with diarrhea experiences becomes dehydrated, they should be seen by a doctor as quickly as possible.

Many conditions can cause diarrhea and other gastrointestinal signs and symptoms. Anyone with persistent diarrhea that lasts several days or recurs should contact their doctor to identify the cause and obtain treatment.

Massachusetts health officials are working with local boards of health, other states, the U.S. Centers for Disease Control and the U.S. Food and Drug Administration to discover the cause of the outbreak.  For more information about Cyclospora, contact your doctor or the local Board of Health.