The Allegheny County Health Department has confirmed rising case counts of cyclosporiasis, the parasitic infection causing what doctors describe as “explosive diarrhea,” and at least one hospitalization. Experts say it is too early to determine if the local cases are connected to the confirmed outbreaks in neighboring Ohio and West Virginia, as well as Michigan and Kentucky.
Dr. Jillian Irwin, Allegheny County medical director, said the parasite is spread through food contaminated with feces. The county has not yet been able to determine if there is a common source, making it difficult to track the origin.
Although the county is reporting lower case counts than some other affected areas, Irwin said the number has risen.
“I think it’s important to note that it is an increase in cases over what we would expect, and given the national context and the other outbreaks that have been defined, we have a high index of suspicion, but we don’t have any clear expectation at this time,” Irwin said.
Here’s what’s known locally about the outbreak, and expert advice on reducing the risk.
What is cyclospora?
Cyclospora is a (usually foodborne) environmental parasite caused by microscopic eggs that infiltrate the small intestine, causing extreme diarrhea, according to Dr. Graham Snyder, the medical director of infection prevention at UPMC.
Unlike diarrhea associated with other illnesses, diarrhea caused by cyclosporiasis can last for weeks and is characteristically watery, Snyder said. It is not often accompanied with other symptoms, he said.
“It can look like it’s getting better and then get worse again,” Snyder said.
Although it is treatable for low-risk groups, side effects such as dehydration and nutrient deficiencies are dangerous when left untreated, especially for people with weakened immune systems.
“For most individuals, maintaining adequate hydration and time will generally rid themselves of the infection,” Rau said.
According to the CDC, transmission from direct person-to-person contact is unlikely.
Should we eat vegetables?
Avenues for control include washing your hands regularly and rinsing produce well, although the only method that kills the parasite is heating the produce to at least 158 degrees, according to doctors interviewed by Public Source.
Dr. Brent Rau, vice chair of emergency medicine for Allegheny Health Network, advised eating produce from trusted sources like local farms and your own back yard.
“This is not the time to be buying bags of lettuce from unknown sources from areas with high cases,” Rau said.
Although Rau said rinsing produce can reduce any infectious process, it should not be the only line of defense.
“I just don’t want people to believe that if I take a head of lettuce that’s potentially contaminated with this, and I just rinse it underwater for a little bit, that my risk goes to zero. It does not,” Rau said.
When should you seek care?
Under typical circumstances, experts suggest that people seek medical care for diarrhea if their symptoms are persistent or if they are in a high risk group. In light of the recent outbreaks, though, Irwin advises anyone with that symptom for more than a “day or two” should see a doctor.
Irwin said the county is advising medical practitioners in the region to lower their threshold for testing in order to test and diagnose more cases.
“[Lab testing] can give us more information and also expedite the proper treatment of cyclosporiasis for positive cases,” Irwin said.
Why don’t we have better data?
After federal Centers for Disease Control and Prevention reassessments, cyclosporiasis is no longer one of the illnesses that doctors in Pennsylvania are mandated to report. Ronnie Das, Allegheny County Public Health Information Officer, said the county urges medical practitioners to willingly provide case information.
Unlike some other infectious diseases, data on cyclosporiasis is not shared publicly on the county’s website.
Cyclosporiasis shares symptoms and treatment methods with similar gastrointestinal parasites so many clinicians opt for treatment over diagnosis, said Snyder.
“If you don’t diagnose it with a lab test, it may not be reported,” Snyder said.
Irwin said it takes a week after the point of infection for someone to show symptoms, leaving the case numbers constantly catching up to the parasite’s spread.
“It’s a delayed process so we’re not through it yet,” said Irwin. “We aren’t certain what is to come in terms of more information, more cases.”
How worried should we be?
Although the source of the Allegheny County cases is still unknown, Snyder said it’s too early to panic, adding that more cases are likely to be detected and reported.
“I would say the concern should be low, or at least typical to what it might be,” Snyder said.
Cilia Catello is an editorial intern at Pittsburgh’s Public Source. She can be reached at cilia@publicsource.org.
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