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Washington, D.C.: A Cyclospora outbreak in the United States has prompted health authorities to expand their investigation after thousands of people reportedly fell ill following the consumption of recalled iceberg lettuce. The outbreak, which was initially linked to nine states, has now spread to 15 states, according to updates from the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC).

Health officials have linked the outbreak to 6,358 confirmed illnesses, 278 hospitalisations, and two deaths reported in Michigan. Investigators say many of those affected had either eaten at Taco Bell restaurants or consumed recalled iceberg lettuce supplied by Taylor Farms de Mexico.

Investigation expands across multiple states

The FDA said the recalled iceberg lettuce was sourced from central Mexico and distributed to restaurants, food-service providers and retailers across the United States.

Taylor Farms de Mexico voluntarily recalled the affected products on July 17 after investigators linked them to the outbreak. The recall also includes certain Marketside-branded salad products sold through Walmart.

Officials believe the actual number of infections could be significantly higher because many people with mild symptoms do not seek medical care or undergo laboratory testing.

The investigation remains ongoing, and additional cases may be identified in the coming weeks because Cyclospora infections can take time to confirm.

What is Cyclospora?

Cyclospora is a microscopic parasite known as Cyclospora cayetanensis, which causes an intestinal infection called cyclosporiasis.

People become infected by consuming food or drinking water contaminated with the parasite.

Unlike many foodborne pathogens, Cyclospora requires time outside the human body before it becomes infectious. As a result, it is generally not spread directly from one person to another.

Fresh fruits and vegetables are among the most common sources of infection because they are often eaten raw and may become contaminated during cultivation, harvesting or washing.

How investigators traced the source

According to the FDA, investigators traced the outbreak to shredded iceberg lettuce supplied by Taylor Farms de Mexico.

The agency used patient interviews, food histories and supply chain records to identify a common source of exposure.

Many patients reported consuming shredded iceberg lettuce at Taco Bell outlets or eating recalled packaged salad products before becoming ill.

Although one laboratory test on lettuce later proved to be a false positive, the FDA said the overall epidemiological evidence continues to strongly indicate the recalled lettuce as the likely source of the outbreak.

Symptoms of Cyclospora infection

Symptoms of cyclosporiasis generally appear about one week after a person ingests the parasite.

Common symptoms include:

• Frequent watery diarrhoea
• Stomach cramps
• Loss of appetite
• Weight loss
• Bloating
• Excessive gas
• Nausea
• Fatigue
• Headache
• Low-grade fever in some cases

Without treatment, symptoms can persist for several weeks or may recur.

Who faces a higher risk?

While anyone can contract Cyclospora infection, certain groups are at greater risk of developing severe illness or complications.

These include:

• Older adults
• Young children
• Pregnant women
• People with weakened immune systems
• Individuals with serious underlying medical conditions

Severe diarrhoea can lead to dehydration, particularly among vulnerable groups, making prompt medical attention important.

Safety precautions

Although the current outbreak is linked to specific recalled products, health experts recommend following standard food safety practices to reduce the risk of foodborne illnesses.

These include:

• Avoid consuming any recalled iceberg lettuce or affected salad products.
• Wash hands thoroughly with soap and water before preparing food and after handling fresh produce.
• Clean cutting boards, knives, containers and kitchen surfaces that may have come into contact with recalled products.
• Purchase fruits and vegetables from reliable retailers that follow recognised food safety standards.

When to seek medical care

People who develop severe diarrhoea, dehydration or persistent stomach pain after consuming fresh produce—particularly recalled iceberg lettuce—should consult a healthcare provider.

Cyclosporiasis is typically treated with prescription antibiotics, and early diagnosis can shorten the duration of illness and reduce the risk of complications.

Medical attention should be sought immediately if symptoms include prolonged diarrhoea, dizziness, signs of dehydration, inability to retain fluids or illness lasting several days.