Food-borne disease infects state
7/01/2005
High number of cases cited of parasite that causes persistent diarrhea
EDWARD J. CROWDER, ecrowder@ctpost.com
Connecticut Post
Health officials are on the lookout for a nasty food-borne bug that causes persistent diarrhea after eight cases turned up over the last week in New Haven County.
The state Department of Public Health is asking doctors to be on the lookout for symptoms of the parasitic infection, known as cyclosporiasis.
All of the cases were identified since June 22, state officials said. Normally, the whole state gets just four cases in a year.
"We assume there are others and we're looking for them," said Dr. Matthew L. Cartter, coordinator of the department's Epidemiology and Emerging Infectious Diseases Program.
Cartter said the cases were found in half a dozen communities, but declined to say which ones. The department Wednesday alerted local health departments and doctors of the outbreak. As additional cases are diagnosed, Cartter said, it will help health officials trace the source of the outbreak.
Cyclosporiasis is caused by the cyclospora bacterium, a parasite that infects the small intestine and is spread by contaminated produce.
Victims typically suffer persistent or on-and-off watery diarrhea ó sometimes explosive ó that can last weeks if it's not treated with antibiotics. Other symptoms include bloating, stomach cramps, aches and low-grade fever.
In severe cases, the diarrhea can lead to dehydration or malnutrition, health officials said.
The state health department asked doctors to keep cyclosporiasis in mind as they diagnose patients with typical symptoms.
Cyclosporiasis can be identified in the laboratory by testing stool samples, but most labs look for it only if they're specifically asked.
"This might not be something that a doctor thinks of, but if they think of it then they can test for this," Cartter said.
The first known cases of cyclosporiasis were reported in 1979 and there have been sporadic outbreaks since.
An outbreak in Florida earlier this year sickened nearly 300; public health officials suspected a batch of fresh basil.
According to the U.S. Centers for Disease Control and Prevention, cyclosporiasis is spread through food or water infected with contaminated stool.
However, according to the CDC it's probably not passed directly from person to person ó for example, from someone who didn't wash after using the bathroom ó because it takes the germs several days to become infectious after being passed in a bowel movement.
"It's not something that's passed person to person; this is something that's going to be passed by something you eat," agreed Dr. Joanne Passalacqua of St. Vincent's Medical Center's Division of Infectious Diseases in Bridgeport.
"You make sure that the foods that you eat, particularly fresh produce ó fruits and vegetables ó is thoroughly washed before consuming it."
Several hospital and local health department officials did not return calls late Thursday afternoon.
A spokesman for Yale-New Haven Hospital, after consulting with an epidemiology expert there, said the hospital has not seen "many" cyclosporiasis infections recently, but could not immediately elaborate.
According to Cartter, the widespread importation of produce has introduced public health challenges not faced by generations past.
"Certainly, how food is distributed today is very different than 25 or 30 years ago, and that is probably a component not just for [the spread of] cyclospora but for other food-borne illnesses as well," he said.
Public health authorities offer the following advice (some of it painfully obvious) to avoid contracting cyclosporiasis:
l wash fruits and vegetables before eating them.
l avoid drinking untreated water from lakes, streams, springs or other untreated sources.
l avoid touching human or animal feces.
l wash hands after using the toilet, after changing diapers and before handling food or eating.
Edward J. Crowder, who covers regional issues, can be reached at 330-6326.
