CASES CONTINUE TO CLIMB
Health officials say NC cyclosporiasis numbers have more than doubled as investigators work to identify source
CDC's Cyclospora outbreak map shows confirmed cases reported across 34 states. Investigators are still trying to determine what food may be linked to the growing outbreak.
Cyclosporiasis is caused by a microscopic parasite called Cyclospora, which is not transmitted person-to-person. Fresh produce — berries, herbs and vegetables — is almost always the source.
STATE TRACKS DIARRHEA OUTBREAK
The number of confirmed cases of cyclosporiasis, better known as "explosive diarrhea," in North Carolina has more than doubled.
The number of confirmed cases rose from 148 to 307, the N.C. Department of Health and Human Services said on Tuesday.
The state timeframe for the cases began May 1 and was updated through Tuesday. The department said it will provide weekly updates on Tuesday as necessary.
There have been 13 hospitalizations related to cyclosporiasis, according to the state.
"If you are experiencing severe or persistent diarrhea, you should reach out to your healthcare provider," state Epidemiologist Dr. Zack Moore said.
Dr. John Sanders, an infectious disease expert at Atrium Health, said about 95% of cases are mild to moderate and don't require hospitalization to recover. Of those who require hospitalization, Sanders said stays tend to be a few days "since it does respond well to standard antibiotics."
The state has not provided a breakdown of confirmed cases by county or region.
The Guilford County Department of Public Health said on Tuesday there were two confirmed cases as of June 30. Elizabeth O'Brien, the department's communications director, said the next county cyclosporiasis case update won't be until after July 31. According to Raleigh TV station WRAL, Wake County's Department of Public Health listed 186 cases and at least four related hospitalizations as of Tuesday. The Mecklenburg County Department of Public Health has confirmed 18 cases as of Tuesday.
According to a USA Today report, there have been more than 4,700 suspected cases in at least 34 states, led by Michigan with more than 3,300 cases, followed by Kentucky, Ohio and West Virginia.
What is cyclosporiasis?
The diarrhea related to cyclosporiasis, in most instances, is watery, not bloody, but occurs at "a pretty high volume," Sanders said.
Other symptoms include stomach cramps, nausea, loss of appetite, weight loss, bloating, increased gas, fatigue and other flu-like symptoms.
Symptoms can take 1 to 2 weeks to develop after exposure, making it difficult to identify the source of their illness.
Cyclosporiasis is caused by a microscopic parasite called Cyclospora, which is not transmitted person-to-person.
Rather, fresh produce — berries, herbs and vegetables — is almost always the source. It is found in food that is served uncooked, according to Sanders and DHHS.
"If present, cyclospora can survive the trip from the field to the plate," the state said.
"This most often happens if there is nothing to stop it, like cooking or cleaning. For this reason, it is imperative to clean fresh produce."
Sanders said there are cyclosporiasis outbreaks pretty regularly.
"This is not a new pathogen, not a new parasite. It's not behaving any differently than it's behaved in many other outbreaks of this that we've had over the last 20-25 years," he said.
Sanders added, "I think it's a safe bet to assume that a national outbreak like this, there's a contaminated food product that was distributed nationwide."
No common source in NC
"Although a single product has not been identified as the source of the cases in North Carolina, NCDHHS is working with local partners to keep North Carolinians informed," the department said. Dr. Carl Williams, the state's Public Health veterinarian, said that "many individuals may not even realize they have consumed the ingredient that is making them sick, which makes tracing the source of contamination more difficult."
"For example, someone may recall that they had pico de gallo with their dinner, but not that it included cilantro."
On Tuesday, the Taco Bell restaurant chain issued a statement saying it had "voluntarily and temporarily removed limited ingredients at select restaurants as a precautionary measure. We will continue to closely monitor the situation and follow the guidance of public health authorities."
Several media outlets reported Tuesday that the FDA said it "is continuing its traceback investigation on multiple produce items, also including locations that are reported by the case patients before they became sick."
USA Today has reported that several public health experts and watchdogs have tied the scale of the outbreak to budget and staff cuts led by U.S. Health Secretary Robert F. Kennedy Jr. as part of the Department of Government Efficiency (DOGE) efforts.
In 2025, the Trump administration significantly scaled back the Centers for Disease Control and Prevention's Foodborne Diseases Active Surveillance Network (FoodNet), which previously mandated tracking eight pathogens.
Monitoring for six of those — including cyclospora — was reduced or made optional. Additionally, the FDA temporarily suspended its Food Emergency Response Network, which tests for foodborne contaminants.
Lingering illness
"We just recommend maintaining hydration, drink a lot of fluid, continue to eat, and most people just get over it and don't even know they have it," Sanders said.
"It is also important for everyone to follow routine safety practices like washing your hands with soap and water before and after handling or preparing food and washing all fresh produce under clean running water."
Sanders said cases of cyclosporiasis are attracting more attention than most viral or bacterial infections because they can linger for weeks, particularly among immunocompromised individuals.
"You can end up with a persistent or chronic infection that you just don't seem to get over," Sanders said.
"Many patients will experience: 'Oh, I think I'm getting better. Now, I'm getting worse again. I think I'm getting better.' So, it's not so much that it goes away and then comes back, but it causes a persistent infection in some people, and their symptoms will wax and wane during that time."
When asked what to do if symptoms surface, Sanders said, "Water is the most critical element of staying hydrated."
He added, "But certainly, if you've got a baby, Pedialyte is a good way to maintain hydration and electrolytes for older children and adults. Sports drinks are not perfectly balanced as oral rehydration salts, but they're pretty good."
"Over-the-counter remedies, Pepto-Bismol and Imodium, that are safe to use for this sort of infection and are going to provide some benefit."
rcraver@wsjournal.com 336-727-7376 @rcraverWSJ
FDA recommendations
The Food and drug administration has the following tips about handling and cleaning fresh produce:
Wash hands for 20 seconds with warm water and soap before and after preparing fresh produce.
if damage or bruising occurs before eating or handling, cut away the damaged or bruised areas before preparing or eating.
Rinse produce before you peel it so that dirt and bacteria aren't transferred from the knife onto the fruit or vegetable.
Gently rub produce while holding under plain running water. There's no need to use soap or a produce wash.
Use a clean vegetable brush to scrub firm produce, such as melons and cucumbers.
Dry produce with a clean cloth or paper towel to further reduce bacteria that may be present.
Remove the outermost leaves of a head of lettuce or cabbage. The Fda also recommends avoiding bagged lettuce and pre-mixed salad kits for now.
