Twenty-eight counties in the state have reported cases of cyclospora parasite illnesses this year so far, according to the state Department of Health and Human Services. But it still remains unclear the cause behind the more than 200 cases seen in the state.
Wake County leads the way with 125 cases, followed by 17 in New Hanover, 14 in Brunswick and Mecklenburg and 13 in Guilford since January 1.
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"The local health department staff try and interview every one of those cases to determine what is their food history, what might be their likely source of exposure," said Dr. Carl Williams, Public Health Veterinarian with NCDHHS.
In his role with the state, Williams works with the communicable disease branch and in medical consultation. Food borne disease is one of his areas of focus.
With at least 206 cases across multiple counties, Williams said the cause "could be coming from more than one source or one source that's widely distributed."
Further analyzing stool samples from patients could also reveal details, he said.
"If it’s a single point source that’s distributed widely you’re more likely to see highly related specimens from the patients. If it’s multiple introductions of cyclospora from multiple sources, you’re going to see different genetic sequences," Williams said.
Williams said the downside is that kind of diagnostic testing isn’t currently required in North Carolina, and most specimens simply aren’t kept long enough by labs for it to be considered.
The state is also using tools like grocery store membership cards and credit card receipts to try to track down the source.
The Wake County Health Department explained cyclosporiasis cases in North Carolina must be reported by physicians within 24 hours of a positive test. The department added the state requires all reportable disease investigations be completed within 30 days from the date of the initial report.
NC State Food Safety Specialist Ben Chapman said the challenging part with cyclospora is how long it can take for someone to get sick after consuming the infected produce.
“Investigating an outbreak of something like cyclospora is very similar to investigating something like other food-borne pathogens where you’re really looking for: What are the common elements that these individuals have? Did they eat the same foods? Did they eat the same dishes? Did they eat at the same restaurants?” Chapman said.
He further explained, “Where it differs from pathogens like salmonella or listeria is that cyclospora, it can impact anybody. It’s not one of the pathogens that we look at and say ‘Hey, it’s most likely young or the elderly or pregnant individual or someone that’s immune compromised,' which is really what we focus on when it comes to listeria.”
Cyclosporiasis infections are usually characterized by diarrhea, nausea, body aches, fever and other flu-like symptoms. Cyclospora can take anywhere from a few days to weeks to make someone sick. Symptoms of something like salmonella usually occur within 72 hours.
People who believe they are suffering from a cyclosporiasis infection should seek medical care through their primary doctor and request the parasite be specifically tested through a stool sample.
Previous cases in the U.S. have been linked to raspberries, basil, cilantro, snow peas and mesclun lettuce, commonly found in salad mixes.
Consumers are advised to thoroughly wash hands and produce and cut away bruised or damaged areas, though the FDA notes washing produce may not always be enough to kill the parasite.
Cooking produce rather than consuming it raw does kill cyclospora.