For more than a decade working in infection prevention, Nicole Pirlot, RN, has seen her share of outbreaks. But nothing compares to the cyclosporiasis outbreak now sweeping across the Midwest.

In Michigan alone, thousands of people have become sick from the parasite this summer. According to the Michigan Department of Health and Human Services, the state has reported 8,176 cyclosporiasis cases and 160 hospitalizations, as of July 24, with just over 600 cases reported in one day. About 2% of those cases have led to hospitalization.

“Normally, we see in Michigan about 50 cases a year of cyclosporiasis,” says Pirlot, an infection preventionist at OSF HealthCare St. Francis Hospital & Medical Group in Escanaba, Michigan. “Most of those come from individuals who have traveled internationally in developing countries. We do see occasional cases locally in Michigan, but not at the extent we're seeing right now.”

Nine states now have related cases of diarrheal illness caused by iceberg lettuce contaminated with the microscopic cyclospora parasite, according to the U.S. Centers for Disease Control and Prevention (CDC). On July 24, the CDC added Illinois, Indiana, Kansas, Oklahoma and Pennsylvania to the cyclosporiasis outbreak investigation. A total of 41 states has reported at least one case since May 1.

Pirlot says people become infected by ingesting the cyclospora parasite, usually through contaminated food or water. Fresh produce, including fruits and vegetables, have been linked to outbreaks when it becomes contaminated. Scientists are still studying how long the parasite remains infectious under different temperatures, humidity, and agricultural conditions. This knowledge could improve prevention strategies.

Pirlot says symptoms include watery diarrhea, loss of appetite, weight loss, low-grade fever, cramping, bloating and increased gas, nausea and fatigue. “Studies show that you can start with symptoms two days to two weeks after eating,” Pirlot says.

Most healthy people will recover without long-term problems. However, it can last longer in people who are elderly, young children or people who are immuno-compromised. Seek medical attention if your symptoms become worse or you become dehydrated.

Cyclosporiasis is treatable with prescription antibiotics, so it's important to contact a health care provider if symptoms are severe or don't improve.

“(Especially) anyone who is feeling dehydrated, if they cannot keep their fluids up, starting to feel weak, multiple loose stools, or you're just not getting any better,” says Pirlot. “Come in, see your provider. They can help you out.” Consult with your medical provider to see if a virtual visit is an option.

Pirlot reminds people to always wash fruits and vegetables, which can reduce the risk of illness but won’t reduce the threat completely. Cooking food to at least 158 degrees Fahrenheit will help since heat destroys the parasite. For lettuce the recommendation is buying whole heads over chopped prepackaged kits and discarding those first outer layers before preparation.

“Good hand hygiene, washing those fruits and vegetables,” she adds. “Even if you're going to peel them, make sure you wash those skins and cook everything thoroughly. Use clean utensils. That way, you'll prevent all those other foodborne illnesses from undercooking and contaminated surfaces.”

Pirlot says the current outbreak serves as an important reminder that people can't control every source of contamination. The best defense is identifying symptoms early and seeking care when needed.

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Cyclosporiasis, caused by the parasite cyclospora, has made headlines this summer, as investigators work to identify its source. 

"It is a microscopic parasite. So, you can't see it with the naked eye," says Sharjeel Ahmad, MD, an infectious disease doctor with OSF HealthCare. "It causes an infection of the small intestine and produces a diarrheal illness."

As of July 14, nearly 7,000 cases of cyclosporiasis across 34 states are under investigation, with 141 people hospitalized, according to the U.S. Centers for Disease Control and Prevention (CDC). “This is substantially higher than the 249 cases reported nationally by this same time last year,” the CDC points out. Many of these cases are not connected to the Taylor Farms outbreak, which the CDC lists as having more than 1,644 cases as of Monday, July 20.

Michigan has reported the most cases so far, with health officials there recently identifying lettuce as a possible source.

How does cyclospora spread?

Unlike other gastrointestinal illnesses like norovirus, cyclosporiasis does not spread from person to person. Instead, the parasite must mature in the environment before it becomes infectious, a process that can take up to a week, Dr. Ahmad says.

"It's beginning at the farm," Dr. Ahmad says, adding that it spreads through fecal matter contaminating the soil and water, which then passes on to the food being grown.

Common foods affected are leafy greens like lettuce, as well as herbs, melons and berries.

"When the running water for irrigation gets contaminated, then the soil gets contaminated while you're growing raw produce," Dr. Ahmad adds. "It's meant to be consumed raw, but things like berries and lettuce have a big surface area with crinkles, cracks and crevices."

Contamination can also occur during harvesting if workers do not properly wash their hands after using the restroom.

How to reduce your risk

Wash each piece of produce individually.

"Washing may not make the risk go down to zero, but that's your best bet. Wash your hands first before you wash the products and then wash them individually," Dr. Ahmad says. "That will give you the most effective protection. Take the berries individually and washing them will help more than anything."

Refrigerating or freezing the products does not kill the parasite. Only cooking produce to 158 degrees Fahrenheit or hotter can kill it. Chemical washes and vinegar are not guaranteed to eliminate the parasite. Don’t use bleaches or other cleaners with your food, as they can cause health problems.

People who are pregnant or immunocompromised should be especially cautious, Dr. Ahmad says. During this time, Dr. Ahmad recommends that such people only eat leafy greens after they have been thoroughly cooked.

Cyclosporiasis symptoms to look out for

While explosive diarrhea has received the most attention, it is not the only symptom of cyclosporiasis. Other symptoms include:

• Bloating
• Cramping
• Fatigue
• Loss of appetite
• Low-grade fever
• Headaches
• Weight loss

Symptoms may come and go, meaning you may feel better for a period before they return, and they can last anywhere from a few days to a month.

Treatment options currently available

Treatment includes staying hydrated by drinking plenty of fluids and replacing lost electrolytes. An antibiotic called Bactrim, the brand name for trimethoprim-sulfamethoxazole, can be prescribed to kill the parasite and relieve symptoms.

Healthy adults may eventually clear the infection on their own as the immune system fights off the parasite. However, if your symptoms are severe, Dr. Ahmad recommends contacting your primary care provider to discuss testing. Routine stool tests do not screen for cyclospora, so a specialized test must be ordered.

Dr. Ahmad expects cases to continue increasing over the next few weeks before gradually declining. Historically, most cyclospora infections are reported between May and August, but this year is a much bigger outbreak than usual.

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Story update, BrucePac recalls: 

Nearly 10 million pounds of ready-to-eat meat and poultry products made by BrucePac have been recalled, according to the U.S. Department of Agriculture. 

The recall, with impacts nationwide, are due to concern the meat and poultry products are contaminated with listeria. 

"The ready-to-eat meat and poultry items were produced from June 19, 2024, to October 8, 2024. These products were shipped to other establishments and distributors nationwide then distributed to restaurants and institutions. Information regarding product labels and the list of products will be provided when available," the USDA wrote in a release. "The products subject to recall bear establishment numbers "51205 or P-51205" inside or under the USDA mark of inspection." 

Original story, Boar's Head recall:

Approximately 7 million pounds of deli meat sold by Boar’s Head Provisions Co., one of the most well-known deli meat brands in America, have been recalled due to a listeria outbreak.

The outbreak has reached 13 states, including Illinois, and has resulted in the hospitalization of over 30 people. Two people have died after being infected.

The recall of ready-to-eat liverwurst includes 71 products under the Boar’s Head and Old Country brand names, distributed across the United States and to Mexico, Panama, the Dominican Republican and the Cayman Islands, according to the United States Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS). 

Stay informed

Doug Kasper, MD, is an infectious disease specialist with OSF HealthCare. He says listeria outbreaks are nothing new, and recalls aren’t meant to scare people. He says you don’t have to completely change your diet or stop eating certain foods because of a recall, rather just stay informed with recalls from the Centers for Disease Control and Prevention (CDC) or USDA.

“These recalls help you audit what you’ve purchased, where you’ve eaten recently, and potentially adjust, for a short amount of time, before the quality has improved,” Dr. Kasper says.

Dr. Kasper says during a recall, the CDC and USDA perform tests on the food while notifying manufacturers and consumers.

What is listeria?

Listeria monocytogenes (L. monocytogenes) is a series of disease-causing bacteria. When eaten, people can develop a disease called listeriosis.

“It’s a bacterium that can normally be found in the environment. It can be found as part of agriculture where food is produced and then as it’s handled, it can become contaminated,” Dr. Kasper says. “Bacteria is present throughout our world, and we have measures in place to wash food, and ensure food is handled safely. The rates of listeria are consistently monitored, audited and then retroactively checked in fields where there were higher rates detected in the past.”

Who is most at risk?

The CDC says listeriosis can be dangerous for pregnant women and their unborn babies, alongside those 65 and older or people with a weakened immune system.

“Pregnant women are frequently advised to stay away from products that could potentially be infected with listeria. These could be deli meats, unpasteurized dairy and raw milk,” Dr. Kasper says. “The risk is relatively higher. Some other patients on chemotherapy or those with other significant conditions may choose to stay away from those products.”

What do symptoms look like?

The USDA says listeriosis symptoms are very similar to flu-like symptoms. It can cause fever, muscle aches, stiff neck, confusion, loss of balance or convulsions. It can also give a person gastrointestinal (GI) symptoms like upset stomach or diarrhea.

Unlike viruses, listeria cannot be passed from person to person. It can only infect a person when they consume a decent portion of the infected product.

“These are not transmissible by touch or sharing common dining utensils,” Dr. Kasper says. “It’s based off of the product you were exposed to.”

What to do if you’re feeling sick

If you’re feeling sick and it may have been from a food product you’ve eaten recently, Dr. Kasper recommends seeking medical attention immediately, whether it’s your primary care provider or an OSF OnCall Urgent Care or OSF PromptCare.

“If a person develops a fever or sustained illness that lasts more than a day, then it becomes in their best interest to notify their medical provider,” Dr. Kasper says. “For most people that are exposed, the risk is very minimal. It’s unlikely to have a severe outcome, unless the food is repetitively eaten or if the person has an underlying issue.”

In addition to avoiding recalled deli meats entirely and contacting your medical provider, the CDC says to clean your refrigerator and containers and surfaces that may have touched any recalled sliced deli meats. Businesses affected by the recall are advised to thoroughly clean and sanitize all non-food surfaces and throw away any open meats and cheeses in the deli. Taking this a step further, the USDA-FSIS recommends delis to not use any opened deli products because recalled products can cross-contaminate other deli products.

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She was about to become a statistic in a polio epidemic and battle a disease that still impacts her in 2024.

Though polio is nearly eradicated today thanks to childhood vaccinations, both the disease and the shots have garnered headlines lately. This month, Paul Alexander, who spent much of his life in an iron lung, passed away at age 78. And the state of Illinois is combating a measles outbreak, reminding us of the importance of vaccines.

Kemnetz’s story

Kemnetz says the week she got her headache that led to a polio diagnosis was a painful blur.

“All my senses were on high alert,” she says. “The littlest sound was like somebody stomping next to my ear. We had a little night light. I couldn’t even stand to have it on.”

On Sunday, the family doctor made a house call and immediately called for an ambulance. Kemnetz wound up at Mercy Hospital in Urbana, Illinois (now OSF HealthCare Heart of Mary Medical Center). That next month, she says, was also a blur. Among other things, doctors upon her arrival performed a spinal tap to examine Kemnetz’s spinal fluid. She also recalls waking up one day with doctors preparing to put her in an iron lung to help her breathe.

“I screamed at my parents not to put me in that. I was terrified,” Kemnetz says.

After leaving the hospital, Kemnetz got more treatment near her home before spending over a year at a hospital in New York. There, she reprogrammed her leg muscles to work through repetitious exercises. It’s what we know today as physical therapy. Eventually, she returned to a mostly normal life and a career in real estate.

Polio then vs. now

Albert England, MD, an infectious disease physician at OSF HealthCare, says polio has been around “for a long time.” There’s even evidence of ancient Egyptians having it, he says. The disease is caused by a virus that “invades the nervous system and can cause total paralysis in a matter of hours,” according to the World Health Organization (WHO). Other symptoms are flu-like, including fever, difficulty breathing, fatigue, headache, vomiting, a stiff neck and pain in the arms or legs.

Dr. England says today, doctors use ventilators to help sick people who can’t breathe. But back in 1952, the iron lung – which Kemnetz got acquainted with – was the help available for people with polio.

“It produced negative pressure around the patient, allowing the lungs to expand and contract regularly,” Dr. England explains.

“It was like having CPR 24/7,” Kemnetz says of lying in the tube. “So uncomfortable.”

Kemnetz also gave blood to help develop a polio vaccine, the number one way we have come to fight that disease and many others. It’s a topic she’s passionate about today.

“We have to save the children,” she says.

The United States Centers for Disease Control and Prevention (CDC) says children should get four doses of the polio vaccine as a part of routine childhood vaccinations. The CDC says while it’s rare, adults who know or suspect they did not get the shots as kids should get them as adults. Adults who are at an increased risk of getting the disease, such as working in a laboratory where the virus may be present, can get a booster shot.

“The vaccine prevents illness by developing antibodies,” Dr. England explains.

Kemnetz today

In 1985, Kemnetz developed post-polio syndrome, a disorder that weakens the nerves and muscles. She says her hands “look nice,” but everyday tasks like writing, eating or shuffling cards are tough.

“There are just not as many neurons providing the strength the people need,” Dr. England says of post-polio syndrome.

But, after being told in 1952 that walking, having children and living a long life was unlikely, Kemnetz is counting her blessings. Among them are the chances to recount her life story with her children and grandchildren.

“I think I thumbed my nose at them pretty good,” she quips about her prognosis back then. “The word ‘can’t’ isn’t in my vocabulary.”

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