Taco Bell lettuce linked to multistate explosive diarrhea parasite outbreak

Federal health officials have linked a major outbreak of cyclosporiasis to shredded iceberg lettuce from Mexico served at Taco Bell restaurants in Ohio and four other states.

The Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) say the affected lettuce was served at some Taco Bell locations in Ohio, Michigan, Indiana, Kentucky and West Virginia.

Investigators traced the lettuce to a single supplier in Mexico, Taylor Farms. Taco Bell says it’s indefinitely removing lettuce from the implicated supplier from its nationwide supply chain.

More than 1,644 people included in this outbreak reported eating at Taco Bell restaurants in the five states. Ninety-four were hospitalized and no deaths have been reported. Among 190 Michigan patients whose meals were examined, 90% reported eating iceberg lettuce.

The FDA is investigating whether potentially contaminated lettuce was distributed to additional restaurants, stores or businesses. Officials caution additional products or locations could be identified.

Ohio reports hundreds of cases

As of July 9, the Ohio Department of Health had reported 364 cases of cyclosporiasis statewide, including 46 hospitalizations and no deaths.

That represents approximately three reported cases for every 100,000 Ohioans (or about 0.003% of the state’s population). The Ohio total includes all reported cyclosporiasis cases and not only those associated with Taco Bell.

What is cyclosporiasis?

Cyclosporiasis is an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis. People can become infected by consuming food or water contaminated with the parasite.

The infection generally does not spread directly from one person to another because the parasite needs time outside the body to become infectious.

Symptoms typically begin about one week after exposure, but can appear anywhere from two days to two weeks (or longer)after the contaminated food is eaten.

Frequent, watery and sometimes explosive diarrhea is the primary symptom. Others can include:

* Stomach cramping and pain
* Bloating and increased gas
* Nausea or vomiting
* Loss of appetite and weight loss
* Headache, body aches or a low-grade fever
* Significant fatigue

Without treatment, symptoms may continue for a month or longer. They may also appear to improve before returning again.

How is someone tested for Cyclospora?

Anyone experiencing prolonged or severe watery diarrhea should contact a healthcare provider, particularly if they ate Taco Bell lettuce or other fresh produce during the two weeks before becoming sick.

Testing is performed on a stool sample. Patients should specifically ask whether the sample will be tested for Cyclospora, because routine stool tests do not always screen for the parasite automatically.

A healthcare provider may need to order a specialized stool examination or molecular PCR test. Because the parasite may not appear in every sample, a patient may be asked to provide multiple stool specimens collected on different days before the infection can be ruled out.

How is it treated?

The preferred treatment is the prescription antibiotic Bactrim. Staying hydrated is also important because prolonged diarrhea can cause serious dehydration. Anyone experiencing severe diarrhea, very little urination, dizziness, fainting, a racing heartbeat or an inability to keep fluids down should seek prompt medical care.

Washing produce thoroughly can reduce contamination but cannot guarantee that Cyclospora has been removed. The CDC says cooking produce to at least 158 degrees can kill the parasite. More information is available through the FDA’s outbreak investigation.