Cyclospora Hits Raleigh

Here’s what to know—and do—about the microscopic, diarrhea-causing parasite.

As one Raleighite warned online: “It’s official: watery, explosive diarrhea has hit the Raleigh area.”

That resident is referring to cyclosporiasis—the illness that’s on everyone’s tongue right now. Like bird flu and measles, it’s not new on the contractable-disease roster. But what is new is the multistate outbreak that’s causing some consumers to shun summer produce.

According to the CDC, 1,645 domestically-acquired cases have been confirmed across the country.* And while North Carolinians are faring better than our Midwest neighbors in Michigan—who are experiencing the brunt of the outbreak—things are pretty, well, crappy around these parts.

As of July 20, Wake County was bearing the brunt of North Carolina’s outbreak, accounting for 295 of the state’s 307 confirmed cases and five of its 14 hospitalizations—helping propel NC to No. 3 in the nation for reported cases.

WakeMed Urgent Care Medical Director Dr. Christopher Chao, who has been practicing medicine in the Triangle for 20-plus years, doesn’t recall seeing cyclosporiasis in his clinics before this summer—even during the past two years, when the case numbers saw a similar spike.

But by July 13, that had changed. “I had eight patients come in asking for diarrhea Cyclospora testing,” he shares. “I tested about a third of them, and I know one of them was negative and one of them was positive. But prior to this week, I was four for four.”

Dr. Chao says that Cyclospora, the microscopic parasite that gives the illness its name, causes one hallmark symptom: “persistent, multiple bouts of watery diarrhea, lasting 10 to 12 days or longer.” Others include stomach cramps, bloating, nausea and more.

In the U.S., Cyclospora typically gets around via infected food or water. Historic culprits include fresh herbs, berries and leafy veggies—all key players in most people’s diet. Bagged, precut greens can also carry it—which has turned out to be the source of a recently identified five-state cluster, per the CDC. However, in NC, the exact source is still unknown.*

So, does that mean it’s time to avoid the produce aisle like the plague—literally?

Dr. Chao, along with Dr. Ryan Lamb, medical director of UNC Health REX’s emergency department, share the same answer: No. At least, not for most.

Why? Dr. Lamb points to the non-lethal nature of cyclosporiasis. “It doesn’t tend to be invasive or cause severe infections,” he explains. “It’s just going to chronically deplete you of the nutrients and the volume you need, and so when that keeps happening, you get sicker. But when you see people being admitted, it’s usually going to be as a result of them having some other condition.”

For those immunocompromised people, Dr. Chao gets skipping on the salad mixes or other high-risk produce. But to others, he simply suggests the “common, basic precautions”—like keeping your food refrigerated, aggressively washing produce and cooking meals to the appropriate internal temperature.

“It’s a very low incidence of people that have this illness,” Dr. Lamb points out—read: 295 confirmed cases in Wake County compared to the 1.26 million people living here.* Though now might be a good time, he says, to check out a local farmers market, where he believes cases are less likely to be coming from. And if you do start to experience that watery, explosive diarrhea: “we can take care of you if you get sick, and you’ll be fine.”

*As of press time