A parasite that causes extreme diarrhea, seen in recent outbreaks across the country, has been documented in over 20 counties in Florida. But experts say there could be more cases than what has been reported.
According to the Florida Department of Health’s Reportable Diseases Frequency Report, 50 cases of cyclosporiasis have been reported in the state since May 1.
“This infectious disease may be hard to monitor due to the nature of the signs and symptoms,” said Dr. Norman Beatty, an associate professor of medicine and hospital epidemiologist at UF Health Shands. “It’s common to get a diarrheal illness at times, and other infectious diseases can resolve on their own, but cyclosporiasis is important to identify right now because there are multiple outbreaks across the country.”
Cyclosporiasis is a gastrointestinal disease caused by the parasite cyclospora, which causes diarrhea, abdominal pain, nausea, fatigue and loss of appetite, according to the U.S. Centers for Disease Control.
Once a case is confirmed through testing, a report is sent to the state department of health. But if someone doesn’t seek medical attention, the case could go unreported, Beatty said.
There could be a six-week reporting lag between illness onset and reporting, according to the CDC.
Since May 1, the federal agency has received reports of 1,645 confirmed domestic cases of cyclosporiasis but is aware of more than 5,100 cases that require further analysis, the CDC stated Tuesday.
In Florida since May 1, DOH data shows Lee County has seen the most cyclosporiasis cases with nine, followed by Miami-Dade with six and Broward with five.
Other counties with cases include: Alachua, Brevard, Collier, Columbia, Duval, Escambia, Flagler, Gadsden, Highlands, Hillsborough, Lake, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Seminole, St. Johns, Sumter and Volusia.
In Alachua County, Beatty said he has seen several cases at UF Health Shands, which doctors believe stemmed from eating produce.
Previous outbreaks in the U.S. have been linked to raw produce, like lettuce and raspberries.
According to DOH data, Alachua County has seen one case of cyclosporiasis in June. But the department’s data is 10 days out of date, according to DOH’s website. The last day cases were uploaded to the report was July 4. And the U.S. Centers for Disease Control’s data on Florida undercounts DOH’s data, with only 11-30 reported sick people in the state.
In most scenarios, people who get cyclosporiasis will recover on their own. But in some cases, people can have persistent symptoms and relapsing infections over time, so any suspected cases should be tested, Beatty said.
Direct human to human transmission is rare, he said, but if infected, people could shed the parasite into the environment, where it could become infectious again within a week or two, contributing to another outbreak.
“It’s a very hardy parasite,” he said.
The outbreak was first reported in Michigan on July 1, with other outbreaks later reported in Ohio, West Virginia and Kentucky, according to the CDC.
While 34 states, including Florida, have reported cases, the source of the outbreak is still unknown.