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It's a good idea to wash the fresh fruits and vegetables you buy before you eat them, even though officials don't yet know whether the food is the source of a nasty bug.
Public health officials in Nebraska and Iowa are reporting a dozen cases of cyclospora infection over the past several days.
They're still investigating what's causing the infections, but they're telling physicians to be aware of the illness and to test specifically for the Cyclospora cayetanensis parasite.
The illness that develops, called cyclosporiasis, is not spread person to person, health officials said.
People can become infected by consuming food or water contaminated with the parasite. In the U.S., outbreaks have been linked to various types of fresh produce, including raspberries, basil, snow peas and mesclun lettuce, health officials said. No commercially frozen or canned produce has been implicated, they said.
It's important to wash all produce, said Dr. Patricia Quinlisk, medical director of the Iowa Department of Public Health. Berries can be especially difficult to wash thoroughly, she said.
Iowa health officials note that the symptoms of cyclospora infection last an average of 57 days in otherwise healthy people, who may have five to 15 bouts of watery diarrhea per day.
Fatigue and a lack of appetite are common, officials said, adding that other symptoms include nausea, flatulence, abdominal cramping, low-grade fever and weight loss.
People with compromised immune symptoms will have more severe and longer-lasting symptoms, officials said.
“This is not a fun disease,” Quinlisk said. “This is not your typical 'I've got a couple days of diarrhea and I'm back to normal' disease.”
Quinlisk said she used to work in Nepal, where cyclospora infections are much more common than in the U.S.
“People are absolutely miserable,” she said. “I've talked to patients who are in bed for a month. Some people said the fatigue was the worst.”
The seven cases reported in Iowa have been in the central and eastern parts of the state, Quinlisk said. Nebraska's five cases have been in the state's eastern half, said Kathie Osterman, a spokeswoman for the Nebraska Department of Health and Human Services.
Nebraska and Iowa each reported one case in 2011, according to the U.S. Centers for Disease Control and Prevention. Ten cases have been identified in Iowa over the past 20 years, Quinlisk said.
Cyclosporiasis cases usually are reported by people who have traveled outside the U.S., Quinlisk said.
“The difference is these people are not people who have been traveling,” she said. “They most likely had to be exposed here in Iowa.”
Physicians generally don't test for cyclospora, Quinlisk said, so more cases may be out there.
State health officials in Iowa and Nebraska have notified the CDC of the recent cases, a CDC spokeswoman said. Nebraska health officials are just starting to talk to the infected people about where they have been and what they have eaten, Osterman said.
The recommended treatment for cyclosporiasis is the antibiotic
sulfamethoxazole/trimethoprim, most commonly known as Bactrim, Quinlisk said. But it doesn't work in all cases, she said.
In addition, she said, some people are allergic to sulfa drugs such as Bactrim.
Physicians still might prescribe it in cyclosporiasis cases, she said, because there is no other treatment.
Physicians then try to handle the side effects of the allergy, she said.