Oakland County, which includes Farmington and Farmington Hills, has recorded at least 396 confirmed cases of cyclosporiasis as Michigan battles what state health officials call likely the largest cyclospora outbreak in U.S. history, with 6,571 cases statewide as of Monday, July 21.

State and federal investigators have epidemiologically linked the parasite to shredded iceberg lettuce from Taylor Farms de Mexico, supplied to Taco Bell restaurants in five states and distributed to grocery stores across 27 states, including Michigan. Lab confirmation of cyclospora in the lettuce itself remains pending. Taylor Farms initiated a voluntary recall on Thursday, July 17, covering lettuce shipped between June 29 and July 16.

The Oakland County case count of 396 is from July 15 data reported by the Michigan Department of Health and Human Services and has likely grown since then. No statement from the Oakland County Health Division specifically addressing the local outbreak has been released.

Dr. Bruce Ruben, an infectious disease physician and medical director of Encompass Healthcare and Wound Medicine in West Bloomfield, said the illness strikes fast.

"It comes on out of nowhere," Ruben told the Jewish News on Tuesday, July 22. "That's what really tells you what it is."

How it spreads

Cyclospora cannot pass from person to person. The parasite must sit in the environment for two to three weeks after being excreted before it becomes infectious, Ruben said. People get sick by eating contaminated produce.

Of 190 Michigan patients who reported eating at Taco Bell before falling ill, 90% said they ate iceberg lettuce, according to the FDA's traceback investigation released July 17.

Symptoms and treatment

Symptoms appear two days to two weeks after eating contaminated food and include severe watery diarrhea, intense stomach cramping, bloating, nausea, fatigue, and weight loss, according to the CDC. Without treatment, symptoms can last a month or longer.

Ruben said dehydration is the primary danger, particularly for older adults. At least 102 people in Michigan had been hospitalized as of Wednesday, July 16, according to the state health department. No deaths have been reported.

The first-line antibiotic is Bactrim. Patients allergic to sulfa drugs may receive Cipro instead, Ruben said. He urged anyone with persistent watery diarrhea to seek medical care and begin replacing fluids immediately.

Routine stool tests do not always screen for cyclospora, the CDC noted. Patients may need to specifically request the test.

How to protect yourself

Michigan health officials advised residents to buy whole heads of lettuce, discard the outer layers, and wash thoroughly. They also recommended avoiding bagged lettuce and pre-mixed salad kits.

Ruben cautioned that rinsing alone is not enough. Scrubbing produce is essential, he said, though washing cannot guarantee removal of the parasite. Cooking produce to at least 158°F kills cyclospora, according to the CDC.

Anyone who purchased recalled Taylor Farms iceberg lettuce should discard it immediately. Refunds are available at the place of purchase. Consumers with questions can call Taylor Farms customer care at 855-455-0098, Monday through Friday, 8 a.m. to 5 p.m. Pacific time.

What's ahead

Michigan's chief medical executive, Dr. Natasha Bagdasarian, said on Friday, July 18, that Michigan's numbers alone "likely make this the biggest cyclosporiasis outbreak in U.S. history." The state typically records about 50 cases per year.

The CDC expects case counts to continue rising through August because of a six-week reporting lag and the ongoing summer produce season.