Cyclospora Lawyer & Attorney : Marler Clark : Cyclospora Blog

The independent Institute of Food Science & Technology has issued a new Information Statement on Cyclospora dated May 2008, replacing that of March 2003.

The updated version makes the following new conclusions:

• Care must be exercised in implicating any source of food or water as the source of any pathogen before the pathogen has both been identified and shown to occur in the incriminated vehicle.
• Both national and international reporting and communicating cases/outbreaks of food or water borne disease need to be improved.
• Every importer of fresh products (i.e. not pasteurised by heat/irradiation or other means), especially if these come from tropical countries, should be alert to the possibility that hazards, little known in the developed world, may be present and ensure that best practice is followed throughout the chain from farm to table.
• Chlorination may be an inadequate safeguard against some such contaminants.
• Routine laboratory analysis may be inadequate to identify all pathogens, some of which call for unusually sophisticated analytical techniques.

The Institute of Food Science & Technology (IFST) is the independent professional qualifying body for food scientists and technologists. It is totally independent of government, of industry, and of any lobbying groups or special interest groups.  Its entire new Cyclospora paper can be found here.

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The FoodNet system gives a close up count on food-borne illnesses in states that contain about 45 million people or about 15 percent of the U.S. population.  The data on laboratory-confirmed cases of food-borne illnesses provides a way of comparing the incidents of one type of illness to another.

FoodNet shows Cyclospora is clearing bring up the rear when it comes to food-borne illnesses in the covered states of  Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, and Tennessee, plus parts of California, Colorado, and New York. 

Here's how it stacks up according to the Center for Infectious Disease Research & Policy (CIDRAP) at the University of Minnesota:

A total of 17,883 foodborne infections were reported in 2007, up slightly from the 17,252 reported in 2006, according to the full FoodNet report published today in Morbidity and Mortality Weekly Report.

Salmonella led the list, with 6,790 confirmed cases (38% of the total), or 14.92 cases per 100,000 population. Case totals and rates per 100,000 population for the other pathogens were: Campylobacter, 5,818, 12.79; Shigella, 2,848, 6.26; Cryptosporidium, 1,216, 2.67; E coli O157:H7, 545, 1.20; Shiga toxin–producing E coli (STEC) non-O157:H7, 260, 0.57; Yersinia, 163, 0.36; Listeria, 122, 0.27; Vibrio, 108, 0.24; and Cyclospora, 13, 0.03.

Yes, that's 13 cases of Cyclospora for a rate of 0.03 per 100,000.  People returning from third world countries are usually said to be most at risk of Cyclospora.   And, as we learned a decade ago, all it takes for an large Cyclospora outbreak in the U.S. is to import the wrong berries from the wrong place.

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Maybe its because we are thinking about a spring trip to some destination in South or Central America that an especially good write up on Travelers' Diarrhea caught our attention.  Its on a blog called Pharma-YNG and it includes just about all causes of TD with suggested treatements.

It includes this about treatment of TD caused by protozoa like cyclospora:

"The most common parasitic cause of TD is Giardia intestinalis, and treatment options include metronidazole, tinidazole, and nitazoxanide (10). Although cryptosporidiosis is usually a self-limited illness in immunocompetent persons, nitazox-anide can be considered as a treatment option. Cyclosporiasis is treated with TMP-SMX. Treatment of amebiasis is with metronidazole or tinidazole, followed by treatment with a luminal agent such as iodoquinol or paromomycin."

All in all, the Pharma-YNG summary of TD is very well done.

Its the sort of helpful advice that you might want to slip into your permanent travel file.   It can be found here.

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In Sub Saharan Africa, cyclosporiasis has been reported in at least 3 countries, including Tanzania, in East Africa, occurring in both immunocompromised and immunocompetent patients. Zoonotic species of Cyclospora have also been identified in East African primates, indicating likely endemicity of this little reported disease in the region. This can be attributed to lack of awareness in the public and medical profession concerning the disease, and therefore not routinely checked at the health centres. Cyclosporiasis is characterized by intermittent diarrhoea, and secondary conditions or sequelae such as reactive arthritis syndrome (Reiter's syndrome), have been associated with progression of the disease. Its management is based on antibiotics, an unusual scenario for a protozoa.

 

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If your international travel plans for 2008 include any of these counties---Bangladesh, Brazil, Chile, China, Cuba, Dominican Republic, Egypt, Guatemala, Haiti, India, Indonesia, Jordan, Mexico, Morocco, Nepal, Nigeria, Pakistan, Peru, Puerto Rico, Romania, Saudi Arabia, Tanzania, Thailand, Turkey, Venezuela, Viet Nam, Zimbabwe ---then you should plan on combating Cyclospora.

Cyclospora is endemic in those 27 countries, according to Dr. William H. Shoff, Director of PENN Travel Medicine and the author of a 2007 article on Cyclospora found on Emedicine from WebMD.

Countries with many international travelers are the next category of concern for Dr. Shoff.  Those include: Australia, Belgium, Czech Republic, Germany, Greece, Ireland, Italy, Japan, The Netherlands, Spain, Switzerland, United Kingdom, and the United States.  About 4 percent of those returning from an endemic country return with diarrhea.

Food-borne Cyclospora is also common in the U.S., Mexico, Canada, and Germany. Water-borne cases have been recorded in Chicago and Nepal. 

Dr. Shoff gives a straight description of this nasty little bug: "Cyclospora is a small bowel pathogen. After ingestion, Cyclospora oocysts excyst in the GI tract and invade small bowel epithelia, where they undergo asexual division followed by sexual division and produce mature oocysts that are shed in the stool."

We will continue to look for the medical news on Cyclospora, and we trust you will be careful during all your international travels!

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The CDC today released its preliminary 2006 food-borne illness data from 10 states: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee. A total of 17,252 confirmed cases (actual cases may be anywhere between 20 and 30 times the confirmed cases) of food-borne illness were reported in those states in 2006, according to the CDC. The most commonly reported illnesses were:

Salmonella: 6,655 cases

Campylobacter: 5,712 cases

Shigella: 2,736 cases

Cryptosporidium: 859 cases

E. coli O157: 590 cases

E. coli non-O157: 209 cases

Yersinia: 158 cases

Vibrio: 154 cases

Listeria: 138 cases

Cyclospora: 41 cases

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The Centers For Disease Control and Prevention have stated that the rate of some foodborne illnesses such as E. coli and salmonella in the United States are on the rise

A new report released by the United States government finds that the amounts of food born illnesses such as e. coli and salmonella are on the rise.

The report states that although it appears that e. coli and salmonella cases are on the rise, that other food born illnesses have leveled off when it comes to their infection prevalence rate.

Listeria, Shigella, Campylobacter, and Yersinia are all food born bacterial infections that according to data gathered from 10 states have fallen in prevalence since the 90's.

Keep reading here

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The blog, Messaged from the Outhouse, posted two pictures of Cyclospora in June of 2006. In addition to the photos, the blog's author included a short description of Cyclospora cayatenensis, which includes the following:

UV-light photography of Cyclospora cayatenensis, a human parasite only discovered in 1994 in Peru. This protozoon is transmitted via the faecal-oral route has been popping up all over the world, but seems to be most prevalent in tropical and subtropical regions. It causes a prolonged course of up to 12 weeks of watery diarrhoea, abdominal pain, fevers, muscle aches and flatulence, and, when untreated, can lapse regularly.

Visit the blog post to see the pictures of Cyclospora, which are said to look like a new galaxy.

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The Be Healthy blog write a recent article on food safety. The lessons to be learned were mostly related to food safety in summer, but the message can be applied year-round. See Be Healthy for the entire post. Here is an excerpt:

Many of the pathogens of greatest concern today (e.g., Campylobacter jejuni, Escherichia coli O157:H7, Listeria monocytogenes, Cyclospora cayetanensis) were not recognized as causes of foodborne illness just 20 years ago.

Do you know how long that potato salad has sat out? Do you know what may have stopped by to ‘visit’ your container of mayo salad dressing topping that’s on the table, next to the hot dogs? Never take food safety lightly. Just to emphasize the point, spend some time on this site from a mother who lost her daughter to food poisoning: http://www.geocities.com/tysca66/kelly.html.

Here are some tips how you can practice food safety at your summer barbeques and picnics:

Wash hands. Frequently wash your hands – before and after eating. If you anticipate no running water available where you are, be sure to pack a waterless hand sanitizer in your bag. Remind family members to do the same.

Check that cold foods are cold. Be certain that foods you are eating are as cold as they should be. Be sure bowls of cold food are nesting in bowls filled with ice.

Check how the meats are cooked. Before biting into a burger – break it open to be sure it looks thoroughly cooked – brown in the middle. Be sure you do not eat chicken that has pink inside.

Pay attention to how food is served. Check that each salad or plate of food has its own serving utensils.

Eat once food is served. Eating once food is brought out lessens the chance of bacteria growing as it sits out.

Ask your host. Finally – if you have any questions about how the food was prepared or how long something has been out – ASK. Chances are your host or hostess will want to assure you that she has taken appropriate food-safety precautions as she prepared for the barbecue."

Tags: Cyclospora Watch, food safety

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A recent study titled, "Cyclosporiasis: a point source outbreak acquired in Guatemala," appears in the No vember-December 2006 Journal of Travel Medicine. The following is an abstract:

"Cyclosporiasis is a disease due to Cyclospora cayetanensis, an emerging coccidian parasite first described in 1979. It is an orally transmitted disease that is more frequent in tropical and subtropical areas. Cyclospora cayetanensis has been mainly described as a cause of travelers' diarrhea. This pathogen has given rise to a number of epidemic outbreaks attributable to ingestion of imported foods, particularly from tropical areas. Methods. Descriptive study of clinical and epidemiological data of a small epidemic outbreak of C cayetanensis-induced gastroenteritis. Results. Seven confirmed cases of C cayetanensis among Spanish nationals who had traveled to Antigua Guatemala are described. The incubation period was 6 days. Diarrhea, asthenia, anorexia, borborygmi, flatulence, and abdominal distension were present in all cases. Fever and heart burn in 85.7%. Weight loss in 71.4%. Abdominal pain, rectal tenesmus, and nausea in 42.8%. Vomiting and eructation in 14.2%. Heart burn was a frequent symptom, a finding not often previously described. The infection was probably acquired from raspberry juice. All cases improved with trimethoprim/sulphametoxazol. Conclusions. Cyclosporiasis is a cause of travelers' diarrhea. Parasitology laboratories must be advised of clinical suspicion of cyclosporiasis so that they can conduct a suitable targeted study; otherwise, false negative results may arise."

More information about the Journal of Travel Medicine can be found on the Blackwell Publishing Web site.

Tags: Cyclospora Watch, research

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Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a large form of Cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans. The first known human cases of illness caused by Cyclospora infection (that is, cyclosporiasis) were first discovered in 1977. An increase in the number of cases being reported began in the mid-1980s, in part due to the availability of better diagnostic techniques. Over 15,000 cases are estimated to occur each year in the United States. The first outbreak in North America occurred in 1990 from contaminated water. Since then, several outbreaks of cyclosporiasis have been reported in the U.S. and Canada, many associated with eating fresh fruits or vegetables. In some developing countries, cyclosporiasis is common among the population and travelers to those areas have become infected as well.

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Cyclospora Infection or Cyclosporiasis (sigh-clo-spore-EYE-uh-sis)

Cyclospora cayetanensis (SIGH-clo-SPORE-uh KYE-uh-tuh-NEN-sis) is a parasite composed of one cell, too small to be seen without a microscope. The first known human cases of illness caused by Cyclospora infection (that is, cyclosporiasis) were reported in 1979. Cases began being reported more often in the mid-1980s. In the last several years, outbreaks of cyclosporiasis have been reported in the United States and Canada.

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Cyclospora

• Cyclospora [SIGH-clo-SPOR-uh] infection is a newly emerging parasitic illness that can cause severe diarrhea.
• People most likely get cyclospora infection by eating food or drinking water that was contaminated with stool from an infected person.
• Cyclospora infection is treatable with antibiotics.
• Cyclospora infection can probably be prevented by avoiding food or water that might be contaminated with stool.

Cyclospora infection is a rare infection of the intestines that can cause severe diarrhea.

What is the infectious agent that causes cyclospora infection?

Cyclospora infection is caused by Cyclospora cayetanensis, a microscopic one-celled parasite.

How do people get cyclospora infection?

Cyclospora is different from many other organisms because it is not infectious when it is passed in the stool of an infected person. Cyclospora needs days or weeks after being passed in a bowel movement to become infectious. Therefore, it is unlikely that the parasite is passed directly from one person to another. People most likely get Cyclospora infection by ingesting food or water that was contaminated with stool from an infected person. It is unknown if animals can be infected and pass infection to people.

In 1996, a large outbreak of cyclospora infection in the United States and Canada was caused by imported raspberries. It is not clear how the fruit became contaminated, but it might have happened when fruit touched the ground or when contaminated water was sprayed over fruit fields by sprinkling systems.

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In a July 21, 2006 article in the New Haven Advocate, reporter Carole Bass wrote about a trip to the Centers for Disease Control and Prevention in Atlanta.

You might think a public health "boot camp" for reporters at the CDC would furnish a week-long break from politics. And indeed, the 23 journalists who convened there during the last week of June did spend most of our time in a windowless auditorium, watching PowerPoint presentations on "The Ecology of Disease" and "The U.S. Public Health Infrastructure." There were no sessions on the Lieberman-Lamont race, no gubernatorial gabbery, no aldermanic antics. Just doctors and scientists teaching about E. coli and cyclospora parasites, tobacco and TB and the H and N proteins that characterize flu viruses. I didn't read a newspaper all week.

Ms. Bass included commentary on a "boot camp" session about Cyclospora:

The morning's session is a case study in cyclosporiasis--yet another gastrointestinal illness caused by a microscopic parasite known as cyclospora. The disease was unknown in North America until 1996, when three Canadian businessmen came down with it.

Trainer Jeanette Stehr-Green walks us through the steps that epidemiologists took to track down the source of the outbreak. The Canadians, it turned out, had recently returned from a conference in Houston; many other attendees also developed diarrhea after the conference. By piecing together accounts of what food was served and what was eaten both the sick and non-sick people, Texas public health officials determined that California-grown strawberries were to blame. After they tracked a second cyclosporiasis outbreak, also in Houston, to California strawberries (from a different farm), the Texas public health department issued a warning about the berries.

The article is an interesting lesson on how the CDC engages reporters who cover health issues, and on what a reporter learned hands-on in a week in Atlanta.

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ATLANTA--Outbreaks of illness in the United States causing infectious watery diarrhea, nausea, and vomiting have been found to be related to a parasite called Cyclospora.

The Cyclospora parasite is transmitted to persons who contact objects contaminated with infected stool. In 1997, reports of outbreaks of Cyclospora infection were preliminarily associated with the consumption of fresh fruits, such as strawberries and raspberries.

The Center for Disease Control and Prevention (CDC) worked with the federal, state, and local health departments to determine the extent and causes of the recent outbreaks of Cyclospora. They pointed out that although it is prudent to thoroughly wash produce that will be eaten raw, this practice may not eliminate the risk of transmission of Cyclospora. Further, they recommend that health care providers consider Cyclospora infection in persons with prolonged diarrheal illness and specifically request laboratory testing for this parasite.

SOURCE: MedicineNet.com

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JAMA. 2006;295:2241-2243.

MMWR. 2006;55:392-395

Foodborne illnesses are a substantial health burden in the United States.1 The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program collects data from 10 U.S. states* regarding diseases caused by enteric pathogens transmitted commonly through food. FoodNet quantifies and monitors the incidence of these infections by conducting active, population-based surveillance for laboratory-confirmed illness.2 This report describes preliminary surveillance data for 2005 and compares them with baseline data from the period 1996-1998. Incidence of infections caused by Campylobacter, Listeria, Salmonella, Shiga toxin--producing Escherichia coli O157 (STEC O157), Shigella, and Yersinia has declined, and Campylobacter and Listeria incidence are approaching levels targeted by national health objectives3. However, most of those declines occurred before 2005, and Vibrio infections have increased, indicating that further measures are needed to prevent foodborne illness.

In 1996, FoodNet began active, population-based surveillance for laboratory-confirmed cases of infection from Campylobacter, Listeria, Salmonella, STEC O157, Shigella, Vibrio, and Yersinia. In 1997, FoodNet added surveillance for cases of Cryptosporidium and Cyclospora infection. In 2000, FoodNet began collecting data on STEC non-O157 and comprehensive information on hemolytic uremic syndrome (HUS). FoodNet personnel ascertain cases through contact with all clinical laboratories in their surveillance areas. HUS surveillance is conducted through a network of pediatric nephrologists and infection-control practitioners. In addition, eight states review hospital discharge data to ascertain HUS cases. Because of the time required for review of hospital records, this report contains preliminary 2004 HUS data.

During 1996-2005, the FoodNet surveillance population increased from 14.2 million persons (5% of the U.S. population) in five states to 44.5 million persons (15% of the U.S. population) in 10 states. Preliminary incidence for 2005 was calculated using the number of laboratory-confirmed infections and dividing by 2004 population estimates. Final incidence for 2005 will be reported when 2005 population estimates are available from the U.S. Census Bureau.

2005 Surveillance

In 2005, a total of 16,614 laboratory-confirmed cases of infections in FoodNet surveillance areas were identified, as follows: Salmonella (6,471 cases), Campylobacter (5,655), Shigella (2,078), Cryptosporidium (1,313), STEC O157 (473), Yersinia (159), STEC non-O157 (146), Listeria (135), Vibrio (119), and Cyclospora (65). Overall incidence per 100,000 population was 14.55 for Salmonella, 12.72 for Campylobacter, 4.67 for Shigella, 2.95 for Cryptosporidium, 1.06 for STEC O157, 0.36 for Yersinia, 0.33 for STEC non-O157, 0.30 for Listeria, 0.27 for Vibrio, and 0.15 for Cyclospora. Substantial variation occurred across surveillance sites. In 2004, FoodNet identified 44 cases of HUS in children aged <15 years (rate: 0.49 per 100,000 children); 30 (68%) of these cases occurred in children aged <5 years (rate: 0.94).

Of the 5,869 (91%) Salmonella isolates serotyped, six serotypes accounted for 61% of infections, as follows: Typhimurium, 1,139 (19%); Enteritidis, 1,080 (18%); Newport, 560 (10%); Heidelberg, 367 (6%); Javiana, 304 (5%); and a monophasic serotype identified as Salmonella I 4,[5],12:i:-, 154 (3%). Among 109 (92%) Vibrio isolates identified to species level, 59 (54%) were V. parahaemolyticus, and 15 (14%) were V. vulnificus. FoodNet also collected data on 145 STEC non-O157 isolates that were tested for O-antigen determination; 117 (81%) had an identifiable O antigen, including O26 (37 [32%]), O103 (36 [31%]), and O111 (23 [20%]); 28 isolates did not react with the typing antisera used.

In 2005, FoodNet sites reported 205 foodborne disease outbreaks to the national Electronic Foodborne Outbreak Reporting System; 121 (59%) were associated with restaurants. Etiology was reported for 159 (78%) outbreaks; the most common etiologies were norovirus (49%) and Salmonella (18%).

Comparison of 2005 Data With 1996-1998

A main-effects, log-linear Poisson regression model (negative binomial) was used to estimate statistically significant changes in the incidence of pathogens. This model accounts for the increase in the number of FoodNet sites and its surveillance population since 1996 and for variation in the incidence of infections among sites.2 The average annual incidence for 1996-1998 (1997-1998 for Cryptosporidium), the first 3 years of FoodNet surveillance, was used as the baseline period. For HUS surveillance, 2000-2001 was used as the baseline. The estimated change in incidence (relative rate) between the baseline period and 2005 was calculated, along with a 95% confidence interval (CI).

The estimated annual incidence of several infections declined significantly from 1996-1998 to 2005. The estimated incidence of infection with Yersinia decreased 49% (CI = 36%-59%), Shigella decreased 43% (CI = 18%-60%), Listeria decreased 32% (CI = 16%-45%), Campylobacter decreased 30% (CI =25%-35%), STEC O157 decreased 29% (CI = 12%-42%), and Salmonella decreased 9% (CI = 2%-15%). Although Salmonella incidence decreased overall, of the five most common Salmonella serotypes, only the incidence of S. Typhimurium decreased significantly (42% [CI = 34%-48%]). The estimated incidence of S. Enteritidis increased 25% (CI = 1%-55%), S. Heidelberg increased 25% (CI = 1%-54%) and S. Javiana increased 82% (CI = 14%-191%). The estimated incidence of S. Newport increased compared with the baseline, but the increase was not statistically significant. The estimated incidence of postdiarrheal HUS in children aged <5 years decreased 45% in 2004 compared with 2000-2001; whether this trend is significant could not be determined, partly because the limited time span does not provide enough data to evaluate a Poisson regression model. The estimated incidence of Vibrio increased 41% (CI = 3%-92%) compared with the baseline, whereas the estimated incidence of Cryptosporidium infections did not change significantly.

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Foodproductiondaily.com

April 18, 2006- Incidents of many foodborne illness have declined since statistical collection began in 1996, with rates for some of the most common pathogens falling by up to 32 per cent.

However Listeria infection rates have started to climb again, according to preliminary data published by the federally-funded Foodborne Diseases Active Surveillance Network (FoodNet).

The declines could indicate that efforts by regulatory agencies and by manufacturers are working to combat common foodborne pathogens. Concerns about the safety of the food supply have led to increased regulatory action to cut down the number of illnesses and death caused by pathogens.

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Bill Marler is the managing partner in the law firm Marler Clark L.L.P., P.S. Since 1993, Bill has represented thousands of victims of E. coli, Salmonella, Hepatitis A, Listeria, Shigella, Campylobacter and Norovirus illnesses in over thirty states. As a trial lawyer, Bill has been involved in several cases of national importance. He represented Brianne Kiner in her $15.6 million E. coli settlement with Jack-in-the-Box. This settlement created a Washington State record for an individual personal injury action. Bill resolved several other Jack-in-the-Box E. coli cases for more than $2.5 million each.

In May of 1998, he settled the Odwalla Juice E. coli litigation for the families of children who were severely injured after consuming Odwalla apple juice for a reported $12 million. Bill represented several children in an E. coli outbreak stemming from E. coli-contaminated swimming pool water in Georgia in 1998. In 2001 he successfully tried to verdict an E. coli case involving a school lunch program in Washington State. The jury returned a verdict of $4.75 million. He also resolved dozens of E. coli cases in 2003 related to one of the largest meat recalls in United States. Bill recently settled an E. coli case for a young girl for $11 million. In addition, Bill has been lead counsel in:

Sheetz Salmonella Outbreak Litigation
Chi-Chi's Hepatitis A Outbreak Litigation
Pat & Osacarís E. coli Outbreak Litigation
Chili's Salmonella Outbreak Litigation
And in many more cases . . .
Bill speaks frequently on issues of safe food and has formed Outbreak, Inc., a non-profit business dedicated to training companies on how to avoid foodborne illness outbreaks.

Bill graduated from the Seattle University School of Law in 1987. In 1998 he became the Law School's "Lawyer in Residence." He received undergraduate degrees in Political Science, English and Economics from Washington State University in 1982. While attending WSU, Bill was elected to the Pullman City Council. At 19 years of age he was the youngest person, and first student ever elected. In 1997, Bill received the Distinguished Achievement Award from the WSU College of Liberal Arts. In 1998, Governor Gary Locke appointed Bill to the University Board of Regents. He recently served as President of the Board. He also served on the State Higher Education Coordinating Board.

He has an AV rating from Martindale-Hubbell, and is listed in the Bar Register of Preeminent Attorneys. He is married to Julie Marler and they have three daughters, Morgan, Olivia and Sydney. He is a past board member of the Washington State Trial Lawyers, a member of the board of directors of Bainbridge Youth Services, and a member of the Children's Hospital Circle of Care. He is involved in numerous other civic and political causes.

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Coming to a supermarket near you: fresh-squeezed oysters, raspberries and steaks.
By Tonia Moxley

BLACKSBURG -- There are few things more seductive than fresh raspberries glistening on the supermarket shelf, just waiting for a talented cook to turn them into sauce for chocolate ice cream or more often, for eating straight from the carton with a little whipped cream.

But in 1996, fresh raspberries from Guatemala contaminated with a parasite called cyclospora cayetanensis sickened 1,465 people in 20 states, the District of Columbia and two U.S. territories.

Cyclospora infection causes severe stomach cramps, explosive diarrhea and fever that can last from a few days to more than a month.

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On April 28, 2005, the Florida Department of Health announced the ongoing investigation of an upsurge of Florida residents ill with Cyclospora. Over the course of several weeks, Florida residents had complained of intermittent or persistent diarrhea, loss of appetite, substantial weight loss, bloating, increased gas, stomach cramps, nausea, vomiting, muscle aches, low-grade fever, and fatigue.

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Frequently Asked Questions

Q. What is infectious diarrhea?

A. Infectious diarrhea is an alteration of normal bowel habits, usually characterized by increased stool frequency and liquid consistency, which is caused by infectious bacteria, viruses or protozoa that infect the intestinal tracts of humans and animals. The infectious organisms are normally contracted by ingestion of contaminated water or food. Some of the more well-known organisms causing infectious diarrhea include Campylobacter, enterotoxigenic or Shiga toxin-producing E. coli, Salmonella, Shigella, Clostridium, Cryptosporidium, Giardia, Cyclospora and rotavirus.

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Monday, December 19, 2005
Davao Sun Star

IT TOOK about ten years for the United States to allow the importation of Guimaras fresh mangoes. The time required for the importation of mangoes produced elsewhere in the Philippines will be much shorter now, said Hernani Golez, National Mango Research and Development Center (NMRDC) chair.

"We have very high chances of exporting to the US and Australia soon," Golez declared.

Golez, who spoke at the recent 7th National Mango Congress in Zamboanga City, said these countries have commissioned projects to determine the food safety for RP mangoes at the production and post-harvest stages.

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Friday June 03, 2005 8:53pm

TALLAHASSEE, Fla. (AP) - Contaminated fresh basil is suspected as the most likely cause of an outbreak of the parasitic illness cyclospora that has sickened 300 Floridians, state health officials said Friday. Officials don't know where the basil came from, or where it is being sold, said state Health Secretary John O. Agwunobi.

A spokesman for the Health Department said the federal Food and Drug Administration has agreed to try to trace the product and find out where it came from.

The disease isn't fatal, but can cause severe diarrhea and other painful symptoms.

Cases have been reported in 32 Florida counties in all regions of the state going back to April.

Health officials say people should wash fresh produce to prevent food-borne illnesses, but say that washing may not prevent cyclospora infection.

Cyclospora are microscopic, one-celled organisms that can contaminate fresh produce and burrow in the small intestine.

The illness can be treated with antibiotics or could pass naturally within a period of a few days up to a month.

On the Net:

Florida Department of Health: http://www.doh.state.fl.us/

Federal CDC (website - news) cyclospora page: http://www.cdc.gov/ncidod/dpd/parasites/cyclospora/default.htm

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OTTAWA, August 3, 2005 - The Canadian Food Inspection Agency (CFIA) and Aliments Fontaine SantÈ Inc. are advising public not to consume the Fontaine SantÈ pesto products described below as they may contain the microorganism Cyclospora cayetanensis which presents a health risk.

The following Fontaine SantÈ products are affected by this alert:

Fontaine SantÈ, Pesto, Fresh Basil, sold in a 180 g package bearing UPC 7 70333 08100 6 and the Best Before dates from 30 AU 05 (August 30, 2005) up to and including 27 SE 05 (September 27, 2005);
Fontaine SantÈ, Pesto Cilantro, sold in a 180 g package bearing UPC 7 70333 08110 5 and the Best Before dates from 11 SE 05 (September 11, 2005) up to and including 25 SE 05 (September 25, 2005);
Fontaine SantÈ, Pesto Fusilli Salad, sold in a 350 g package bearing UPC 7 70333 00135 6 and the Best Before dates from 3 AU 05 (August 3, 2005) up to and including 17 AU 05 (August 17, 2005);
Fontaine SantÈ, Feta Penne Salad, sold in a 350 g package bearing UPC 7 70333 00125 7 and the Best Before dates from 4 AU 05 (August 4, 2005) up to and including 19 AU 05 (August 19, 2005);
There have been no reported illnesses associated with the consumption of these products.

Aliments Fontaine SantÈ Inc., St-Laurent, Quebec, is voluntarily recalling the affected products from the marketplace. The affected products were distributed in Quebec and Ontario.

For general information, food contaminated with Cyclospora cayetanensis may not look or smell spoiled. Cyclospora cayetanensis is a parasite that causes gastrointestinal infection. Usually the symptoms of infection begin about 1 week after exposure and may include watery diarrhea, loss of appetite, weight loss, stomach cramps, nausea, vomiting, prolonged fatigue, muscle aches, and low-grade fever. If untreated, the illness can last for weeks to months and symptoms can come and go.

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The chicken samples came from supermarkets, high street shops and wholesalers

Significant numbers of chickens on sale in UK shops are contaminated with superbugs, a scientific survey commissioned by BBC One's Real Story suggests.

Of the British-grown chickens analysed, over half were contaminated with multi-drug resistant E.coli which is immune to the effects of three or more antibiotics.

More than a third of the 147 samples, which included overseas and UK produced chicken, had E.coli germs resistant to the important antibiotic Trimethaprim which is used to treat bladder infections.

The Health Protection Agency scientists testing the meat also found 12 chickens had antibiotic resistant Campylobacter.

And VRE, or Vancomycin Resistant Enteroccci, were in 1 in 25 of the samples, although more tests would be needed to confirm the exact type of the bug found.

No organic chickens were used - 64 were from the UK and 83 from abroad.

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Last updated Aug 5 2005 04:00 PM EDT
CBC News

Quebec's Fontaine SantÈ food producer is pulling a number of pesto and pasta products off shelves in about 1,000 stores across Quebec and Ontario.

Fontaine SantÈ product alert
Fontaine SantÈ, Pesto, Fresh Basil, sold in a 180 g package bearing UPC 7 70333 08100 6 and the best-before dates from 30 AU 05 (August 30, 2005) up to and including 27 SE 05 (September 27, 2005)
Fontaine SantÈ, Pesto Cilantro, sold in a 180 g package bearing UPC 7 70333 08110 5 and the best-before dates from 11 SE 05 (September 11, 2005) up to and including 25 SE 05 (September 25, 2005)
Fontaine SantÈ, Pesto Fusilli Salad, sold in a 350 g package bearing UPC 7 70333 00135 6 and the best-before dates from 3 AU 05 (August 3, 2005) up to and including 17 AU 05 (August 17, 2005)
Fontaine SantÈ, Feta Penne Salad, sold in a 350 g package bearing UPC 7 70333 00125 7 and the best-before dates from 4 AU 05 (August 4, 2005) up to and including 19 AU 05 (August 19, 2005)

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Canadian Press
Thursday, August 04, 2005

OTTAWA (CP) - The Canadian Food Inspection Agency and Aliments Fontaine Sante Inc. are advising consumers not to eat the Fontaine Sante pesto products described below as they may contain the micro-organism Cyclospora cayetanensis which presents a health risk.

The following Fontaine Sante products are affected by this alert:

-Fontaine Sante, Pesto, Fresh Basil, sold in a 180-gram package bearing UPC 7 70333 08100 6 and the best before dates from 30 AU 05 (Aug. 30, 2005) up to and including 27 SE 05 (Sept. 27, 2005).

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FONTAINE SANT... PESTO PRODUCTS MAY CONTAIN DANGEROUS MICROORGANISM

OTTAWA, August 3, 2005 - The Canadian Food Inspection Agency (CFIA) and Aliments Fontaine SantÈ Inc. are advising public not to consume the Fontaine SantÈ pesto products described below as they may contain the microorganism Cyclospora cayetanensis which presents a health risk.

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2005-07-27

Details are emerging in the case of the contaminated basil that sickened more than 200 diners earlier this month at Manoir Rouville-Campbell in Mont Saint-Hilliare.

Canadian food inspection agents say the basil came from Mexico and not from the Dominican Republic, as was originally reported by several media outlets.

The agency followed the trail of the basil from the diners' plates, to the importer, to the grower, confirming Mexico was the origin.

On July 9th, some 250 customers at Manoir Rouville-Campbel ate basil contaimated with the Cyclospora parasite, which causes symptoms that resemble an extreme case of gastroenteritis.

It was the third case this year in Canada of basil contaminated with Cyclospora.

The two earlier cases were in Ontario in April.

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July 9, 2005
Jjkeller.com

The Food and Drug Administration (FDA) is, according to this story, initiating an investigation to determine the source of several clusters of a gastrointestinal illness known as cyclosporiasis that is associated with fresh basil that was served in Florida during mid-March through mid-April.

The Florida Department of Health was cited as asking FDA on June 2, 2005, to begin a traceback after results of an epidemiological investigation implicated fresh basil as the source of illness in Florida. The Florida Department of Health has 293 laboratory-confirmed cases in 32 Florida counties during March and April of this year. The outbreak includes several clusters and a large number of sporadic cases.

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When diners become ill and blame something they ate, state experts start sleuthing. They interview the victims, conduct food lineups and try to narrow down the suspects.

By Scott Joseph
Sentinel Restaurant Critic
July 20, 2005

Sometimes people think it's just a touch of the flu, a 24-hour bug. Upset stomach, cramps and diarrhea might be some of the discomforts they experience. But on occasion, these are actually indicators of a food-borne illness, and, for epidemiologists such as Dean Bodager, they aren't symptoms, they're clues.

Whenever there is an outbreak of food-borne illnesses, it falls to Bodager and other members of the Florida Department of Health to track down the source. Sometimes it's simple. Most outbreaks occur at the point of preparation -- a restaurant employee who didn't wash his or her hands properly, food that wasn't kept at the correct temperature to prevent bacteria growth, or some sort of cross-contamination.

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By Thomas Caywood
Tuesday, July 19, 2005

Boston public health officials are probing an intestinal parasite outbreak at a swanky Back Bay private club.

A handful of people attending a dinner lecture at the exclusive Chilton Club on Commonwealth Avenue in April were infected with cyclospora, a nasty bug that causes severe diarrhea, cramping and vomiting. Cyclospora is spread when people eat food or drink water that has come in contact with infected feces.

The Boston Public Health Commission found out about the outbreak in May and has been tracking down all the club members and guests who attended the dinner lecture to determine exactly how many got sick, spokesman Tom Lyons said.

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MEDIA ADVISORY

SEATTLE (July 15, 2005) -- Connecticut health officials issued a warning early this month after several cases of Cyclospora infection surfaced in New Haven County. At least eight people tested positive for Cyclospora, a parasite. Cyclosporiasis, the illness caused by ingestion of Cyclospora, causes severe diarrhea, bloating, stomach cramps, aches, and low-grade fever. The parasite often is found in contaminated produce.

Marler Clark, the Seattle law firm nationally recognized for its successful representation of victims of foodborne illness, sponsors a blog about Cyclospora and Cyclosporiasis (http://www.CyclosporaBlog.com). The site provides news about outbreaks and information on Cyclospora, as well as a list of resources for victims of Cyclospora infection.

"This site should prove to be very useful for people suffering from Cyclospora infections," said William Marler, managing partner of Marler Clark. "There is much to learn about this parasite, which is relatively unknown by the public."

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(Bridgeport-AP, July 15, 2005 6:15 AM) _ State health officials are trying to locate the source of a food-borne illness that has afflicted more than a dozen people with dangerous diarrhea.

The focus is on cyclosporiasis.

The state Department of Public Health says the outbreak started in June and there were 13 recorded cases as of this week, all in New Haven County.

State health officials are still looking for the source of the outbreak. A previous outbreak of cyclosporiasis that sickened hundreds in Florida this spring was traced to a batch of imported basil.

Outbreaks are commonly traced to produce, such as tomatoes and basil, that has been imported from third-world countries.

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From the CDC

What is cyclosporiasis?

Cyclospora cayetanensis (SIGH-clo-SPORE-uh KYE-uh-tuh-NEN-sis) is a parasite composed of one cell, too small to be seen without a microscope. The first known human cases of illness caused by Cyclospora infection (that is, cyclosporiasis) were reported in 1979. Cases began being reported more often in the mid-1980s. In the last several years, outbreaks of cyclosporiasis have been reported in the United States and Canada.

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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.

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William D. Marler (www.williammarler.com), an attorney at Marler Clark LLP PS (http://www.marlerclark.com) has extensive experience representing victims of bacterial and viral food poisonings. Since 1993, Marler Clark has represented victims of most of the largest foodborne illness outbreaks in the United States, including the 1993 Jack in the Box E. coli, 1998 Odwalla E. coli, 1999 Sun Orchard Salmonella, 2002 ConAgra E. coli and Chili's Salmonella outbreaks, the 2003 Chi Chi's Hepatitis A outbreak, and the 2004 Sheetz Salmonella outbreak.
Bill feels that a lawyer should do more than just sue corporations. That is why he speaks frequently on issues of safe food and formed Outbreak, Inc. (http://www.outbreakinc.com), a not-for-profit business dedicated to explaining to companies why it is in their interest to avoid food illness litigation. Bill also has created (http://marlerblog.com) as a way of updating the Web on issues of interest to him.

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By Carole Sugarman

My daughter never met a chicken tender she didn't like. But during a recent family vacation in Florida, 9-year-old Anna was struck with a bad case of salmonellosis -- disease caused by salmonella. And while we'll never know for sure, we strongly suspect it was caused by contaminated, undercooked poultry at one of her daily restaurant chicken meals.

There is more than a little irony in this tale of excruciating stomach pains, bathroom vigils and hospital emergency rooms.

As a food writer for 25 years, I've interviewed numerous victims of food-borne diseases and parents of children who've died from them. I've attended scores of conferences and hearings where food safety issues are debated among government officials, industry and activist groups.

But this was the first time I got to see firsthand how devastating full-blown food-borne illness can be. Believe me, we're not talking about a bad tummy ache.

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Breaking News on Food Development in the US

08/06/2005 - Fresh basil, the most probable source of an outbreak of gastrointestinal illness in Florida earlier this year, is now the target of an FDA traceback operation, writes Anthony Fletcher.

The US Food and Drug Administration (FDA) is determined to identify the source of several clusters of gastrointestinal illness known as cyclosporiasis that occurred in the state during mid-March through mid-April.
The investigation began last week after the Florida Department of Health's epidemiological investigation implicated fresh basil as the source of the illness. Most cases were reported on the west coast and central areas.

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Mon 06 Jun 2005
FLORIDA (myDNA News)

The U.S. Food and Drug Administration (FDA) is initiating an investigation to determine the source of several clusters of a gastrointestinal illness known as cyclosporiasis that is associated with fresh basil served in Florida during mid-March through mid-April. Known as a traceback, the investigation will work to locate the source of the contaminated produce.

The Florida Department of Health asked FDA on June 2, 2005, to begin the traceback after results of an epidemiological investigation implicated fresh basil as the source of illness in Florida. The Florida Department of Health has 293 laboratory-confirmed cases in 32 Florida counties during March and April of this year. The outbreak includes several clusters and a large number of sporadic cases.

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June 4, 2005

TALLAHASSEE, Fla. - Contaminated fresh basil is suspected as the most likely cause of an outbreak of the parasitic illness cyclospora that has sickened 300 Floridians, state health officials said Friday.

Officials don't know where the basil came from, or where it is being sold, said state Health Secretary John O. Agwunobi.

A spokesman for the Health Department said the federal Food and Drug Administration has agreed to try to trace the product and find out where it came from.

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Sentinel Staff Writer
May 24, 2005

Health officials still don't know what is causing a widespread outbreak of a parasite called cyclospora that has been confirmed in 233 people from 31 counties statewide.

People typically catch the single-cell parasite from contaminated water or fresh fruits and vegetables. It causes bouts of diarrhea, weight loss, bloating, stomach cramps, muscle aches and low-grade fever.

A spokeswoman for the Florida Department of Health said Monday that investigators still are trying to nail down the source of the outbreak.

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The parasite has sickened dozens, including 10 in Pinellas County. Officials aren't sure what's causing it.
By LISA GREENE, Times Staff Writer
May 3, 2005

More than 60 infections with a parasite that causes diarrhea and intestinal problems have been diagnosed across Florida.

The cases so far include 10 in Pinellas County and one in Hillsborough, health officials said Monday. State health officials aren't sure what is causing the outbreak of the disease, called cyclospora.

People usually get the disease from consuming water or food contaminated with the cyclospora parasite. It is unlikely to be spread from one person to another.

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By FSNET
May 7, 2005, 19:48

Health officials were cited (by Orlando Sentinel) as confirming 94 cases of a parasitic infection called cyclospora among residents of at least 20 counties in Florida.

The parasite causes recurrent bouts of diarrhea, weight loss, bloating, stomach cramps, muscle aches and low-grade fever. The symptoms may lapse briefly before returning.

Lindsay Hodges, a spokeswoman for the Florida Department of Health, was cited as saying that investigators are trying to nail down the source of the infections, but the statewide nature of the problem is making it difficult, adding, "We're looking for commonalities among all the cases, and it's an intensive process."

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The outbreak has affected 20 counties in the state and sickened 77 people.

By Robin Williams Adams
The Ledger

BARTOW -- Three people in Polk County are among 77 statewide who are known to be infected by a parasite spread through contaminated food or water.

The three local cases appear to be unrelated, said Dr. Daniel Haight, director of the Polk County Health Department.

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