A major cyclosporiasis outbreak tied to shredded iceberg lettuce has expanded to six additional states, making it the largest known outbreak of its kind in the United States. The Centers for Disease Control and Prevention (CDC) has now identified cases in Arkansas, Iowa, Missouri, Nebraska, New Hampshire, and North Carolina, adding to the list of states affected since early May.
Cyclosporiasis is caused by the microscopic parasite Cyclospora cayetanensis, which infects the small intestine and leads to symptoms such as watery diarrhea, stomach cramps, bloating, and fatigue. The infection spreads when people eat food or drink water contaminated with feces containing the parasite. Nearly 18,000 cases have been reported nationwide this summer, with at least 423 hospitalizations and two deaths so far—both in Michigan.
The outbreak has been linked to shredded iceberg lettuce sourced from central Mexico and supplied by Taylor Farms. The affected lettuce was distributed to both restaurants and retail outlets, including Taco Bell and Walmart. After the outbreak was traced back to the lettuce, Taylor Farms issued a recall, and Taco Bell removed the product from its supply chain. The recalled lettuce was shipped to 27 states between June 29 and July 16, reaching thousands of consumers, as outlined in a detailed review by TransAct Technologies.
Health officials warn that the number of infections may be underreported because not everyone with symptoms seeks medical care or gets tested for cyclospora. Diagnosis can be delayed, as symptoms may appear up to 14 days after exposure. While the outbreak in nine states has been firmly tied to shredded lettuce, investigations continue into other possible sources, with experts suspecting multiple foods or water sources could be involved. North Carolina, for example, is also investigating clusters possibly tied to parsley and cilantro.
The CDC and Food and Drug Administration (FDA) continue to monitor the situation and advise consumers to avoid eating recalled lettuce products. Cooking produce to at least 158°F can destroy the parasite, but washing alone may not eliminate it. Person-to-person transmission is unlikely, as the parasite needs one to two weeks outside the body to become infectious.
With the outbreak ongoing and investigations still active, health officials urge consumers to pay attention to recall notices and consult their doctors if they develop symptoms. Lawsuits related to the outbreak have already begun, and additional states could still be added as new information emerges.
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