It’s summer! Time for sun, fun and — yeech — diarrhea

July 4, 2018 GMT

It’s become a seasonal rite of passage: Health clinics and doctor’s offices reporting a spike in cyclosporiasis, an intestinal infection linked to the consumption of tainted fruits and vegetables — summer’s bounty.

In the annual Cyclospora sweepstakes, Bexar County is already a front-runner, with 11 cases reported since May, out of 56 statewide, second only to 16 cases in Travis County.

Harris, the largest county in the state, has reported six cases.

Dr. Anita Kurian, director of the communicable disease division at the San Antonio Metropolitan Health District, said Bexar County is on par with what is the norm for this seasonal illness. Still, state health officials have opened an investigation to determine the source of the outbreak — cilantro has proved the culprit in Texas in past years.

“We had 41 cases (of cyclosporiasis) all total last year, so what we’re seeing now is not that unusual,” she said. “We tend to see anywhere from 10 to 45 cases.”

Signs of cyclosporiasis include watery diarrhea, vomiting, nausea and low fever. Symptoms can come and go over a period of weeks or months. The illness, often linked to fresh produce, is brought on by consuming food or water tainted with the Cyclospora parasite.

The reason for the spike in diarrheal illnesses in general in the summer is because people tend to eat more fruit and vegetables, Kurian said.

Another reason reported numbers of cyclosporiasis might be increasing is linked to health care providers testing for it more often.

“When people go to their health-care provider with diarrheal illnesses, they’re not routinely tested for this parasite,” Kurian said. “Now, because we are proactively educating providers == ‘Hey, it’s summertime, be on the look-out’ — doctors are testing more frequently. They’re looking for it, so they’re finding it.”

Like tuberculosis, HIV and tetanus, cyclosporiasis is one of 80 diseases that health providers are required by law to report to their local health departments, which, in turn, must report to the Texas Department of State Health Services.

Kurian said there are some “commonsensical” prevention methods that will prevent infection, which — while nasty — typically isn’t life-threatening for healthy adults:

Wash your hands when working with fresh produce

Refrigerate fresh produce and fruit within two hours of cutting it

Keep meats and produce separate

The DSHS recommends thoroughly washing all fresh produce; cooking will kill the parasite.

State health officials have asked all health providers to test patients who have diarrhea lasting for a few days, along with other symptoms of the illness. The infection is “completely treatable with an antibiotic,” Kurian said.

In addition to cilantro, past cyclosporiasis outbreaks have been associated with pre-packaged salad mix, raspberries, basil, snow peas and mesclun lettuce, the department said.

In mid-June, the Centers for Disease Control and Prevention announced a multistate outbreak of Cyclospora-related illness tied to vegetable trays sold by Del Monte Fresh Produce. Texas was not among the six affected states, which included Iowa, Michigan and Wisconsin.

The company recalled some trays — containing carrots, broccoli, cauliflower and celery sticks — about two weeks ago, according to the U.S. Food and Drug Administration.

More than 300 cases of Cyclospora infections were reported in Texas last year. This is the sixth summer in a row the state has experienced an outbreak, the agency said..

Melissa Fletcher Stoeltje is a San Antonio Express-News staff writer. Read more of her stories here. | mstoeltje@express-news.net | Twitter: @mstoeltje