A general overview of the 2014 Outbreak of Cilantro Cyclosporiasis in Texas, United States. The poster below summarizes the investigation and secondary data analysis of the disease outbreak. It further highlights the important data and epidemiological information of the disease outbreak. This poster was printed and presented in a Public Health Pandemics Seminar at the University of South Florida, College of Public Health, on January 29, 2015. (c) Badru, M.A., & Perez, J. (2015)

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2014 OUTBREAK OF CILANTRO CYCLOSPORIASIS IN TEXAS
Mariam A. Badru & Jennifer Perez
College of Public Health, University of South Florida
INTRODUCTION
Cyclosporiasis is an intestinal illness caused by a microscopic parasite called
Cyclospora Cayetanensis. People can become infected with Cyclospora by consuming
food or water that has been contaminated by the parasite. People living or traveling in
countries where cyclosporiasis is endemic may be at increased risk for the infection. It is
also very common in tropical or subtropical regions.3
Cyclosporiasis outbreak was spotted in the United States towards mid-2014. The number
of confirmed cases began to rise after May 1, 2014. However, as of August 26, 2014,
when the number of cases reduced to almost 0, the Center for Disease Control(CDC)
confirmed that:
 There was a total of 133 cases of Cyclospora infection specifically among Texas
residents who did not travel outside the country within the two weeks prior to
becoming ill.
 A total of four hospitalizations were reported in Texas during the outbreak
 Texas state health officials reported that most cases of the illness occurred in June and
July 2014.
 Many of these cases are linked back to humans consuming cilantro.2
Symptoms of Cyclosporiasis
METHODOLOGY
Epidemiological and trace back investigations were conducted at 4 different restaurants
in Texas, where multiple unrelated ill persons had reportedly eaten. All the ill persons
in these four clusters were also reported having eaten at least a food item containing
fresh cilantro about 2-14 days prior to becoming ill. Preliminary trace back
investigations carried out by the Food and Drugs Administration and the State of Texas
indicated that cilantro suppliers in Puebla, Mexico were a source of the cilantro that
was served at the four restaurants.3
Stool specimens were collected from each ill person infected with cyclosporiasis who
eat a cilantro-containing food at any of the four restaurants about 2-14 weeks prior to
the onset of their illnesses. Regular stool examinations are not efficient enough to
determine the cyclospora oocysts and as a result of this, scientists had to carry out
special lab testing specifically to detect the oocysts. 2
SYMPTOMS
Headaches Bloating
Fatigue Loss of Appetite Watery Diarrhea Nausea Vomiting
* Average Incubation Period: 2-14 Days.
* Disease can also remain asymptomatic for months.
* The most common symptom is watery diarrhea.1
RESULTS
Most of the confirmed cases of cilantro cyclosporiasis were significantly
associated with the consumption of cilantro-containing foods at restaurant
Figure 1: Confirmed Cases of Cyclosporiasis in Texas since May1, 2014.
The epi-curve shows the total laboratory confirmed cases of Cilantro
Cyclosporiasis (from May 1 – Aug 7) with no known history of international
travel outside the US 14 days before the onset of illness. The sample size, N
is 126. According to the graph, the two peaks occurred in mid-June and
early- July respectively. Overall, the epidemic was most prevalent between
June and July and then returned to the baseline level in August. 2
Figure 2: Populations affected by the cyclosporiasis infection.
Based on the information from the case control study:
• A total of 4 restaurants were identified as sources of the illness
• Each restaurant had 2-12 ill people with 100% of them reporting to have
consumed a cilantro-containing food at all 4 restaurants
CONCLUSIONS
Fresh cilantro from Puebla, Mexico was likely the source of cyclosporiasis illness among Texans in 2014. As a result of this, the Food and Drugs Administration(FDA) has
begun increased surveillance and sampling of food items at the US/Mexico Boarder to prevent future import of contaminated foods. The FDA is also continually working
with the Mexican authorities to investigate the farm practices being carried out in the production of cilantro. Preventive measures such as proper hygiene practices and safe
handling recommendations and inspection of restaurants are being promoted as well. There is also a treatment for it called Trimethoprim-sulfamethoxazole . However,
although the outbreak is likely to have ended, further investigations are still being carried out to make sure that there are no longer any confirmed cases that result from
asymptomatic or susceptible hosts. 2
REFERENCES
Cyclospora. (n.d.). Retrieved January 24, 2015, from http://www.dshs.state.tx.us/idcu/disease/cyclospora/
Cyclosporiasis Outbreak Investigations — United States, 2014. (2014, August 28). Retrieved January 24, 2015, from
http://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2014/
U.S. Food and Drug Administration. (n.d.). Retrieved January 24, 2015, from http://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm411990.htm
Cyclosporiasis Cases Population Affected % of Population
Total Confirmed Cases
(2014)
133 64% of Texas
Population
Confirmed Cases (After
May 1)
126 95% of Total Confirmed
Cases
Total Confirmed Deaths
(2014)
0 0%
Number reported eating
fresh cilantro 2-14 days
before illness
76 57%
Source: Center for Disease Control & Prevention 2014
Source of Data: Center for Disease Control & Prevention