The belief that the American food system is safe has been sorely tested this summer, with the epidemic spread of the infection of a bubbly disc shaped parasite called Cyclospora cayetanensis. Of course, there are outbreaks all the time from contaminated food — traced back to farms, restaurants, or picnic baskets. But with over 22,000 confirmed or suspected cases since May, 517 hospitalizations, and two deaths, this is the worst cyclosporiasis outbreak in U.S. history.
Forty-seven states have now seen cases of infection by this parasite, including 147 cases in Massachusetts, as of Aug. 5. There are almost certainly thousands of cases going unreported, as doctors may simply prescribe treatment for cyclosporiasis — trimethoprim/sulfa (Bactrim) — over the phone; furthermore, the increasing numbers of people with symptoms but without adequate health insurance may worry about copays for visits, and the cost of state-of-the-art testing (polymerase chain reaction, costing over $500.)
Most cases have been traced to iceberg lettuce imported from Mexico by Taylor Farms, a huge food product company that supplies many supermarkets, and fast-food restaurants like Taco Bell, Chipotle, and McDonalds. (The North Carolina Department of Health suspects that some of the cases in that state may be due to cilantro or parsley.)
The symptoms of cyclosporiasis may be mild, with nausea, bloating, cramps, diarrhea, and low-grade fever lasting a few days, but the manifestations of this microbe may last over a month. The symptoms can be more severe and long lasting in the elderly and the immune suppressed. Young children are more at risk since they lick their hands more, and they are little and can dehydrate faster. The two people who died from cyclosporiasis, in Michigan, had “significant underlying health conditions,” according to the Michigan Department of Health and Human Services.
The parasite is not spread from person to person, since Cyclospora must live for one to two weeks outside the human body, in soil or water, to “sporulate” or multiply. The organism is spread through human feces and then multiplies in soil or water, and contaminates greens, herbs or fruits like lettuce, basil, cilantro, or raspberries (all major sources of outbreaks in the past.)
Irrigation water tainted by sewage runoff, contamination in the field, and biosolid (treated sewage waste) fertilizers are significant sources of contamination; the tough Cyclospora cayetanensis oocyte can survive the sewage treatment process.
Typically, cyclosporiasis outbreaks have been traced to less developed countries, mostly in central and South America. In recent years, Mexico has been the mecca for Cyclospora. Large factory farms in the U.S., like Taylor’s Farm, implicated in this summer’s outbreak, source products like leafy greens and fresh cut vegetables from Mexico and Central America. Driven by mergers and acquisitions, and top-down integration of growing, packing and shipping, Taylor Farms is one of only four companies that now control most of the U.S. fresh salad market, according to Farm Action, a non-partisan, non-profit, farmer led watchdog group.
One company, Driscoll Foods, controls a full 90% distribution and sale of raspberries.
The problem with centralization of produce production and distribution is if there is a recall in one state, then the same greens, herbs, or berries are being distributed all over the country, under different product names and various restaurant chains, as the recall occurs in that one locale.
The Food Traceability Rule, part of the Obama era Food Safety Modernization Act, was supposed to address this problem by requiring that companies that produce, process or distribute “high risk foods” like cheese, eggs, fruits, vegetables, seafood, or deli salads, keep detailed standardized records of sources, ingredients, and destination. They would be required to send all this information electronically to the FDA within 24 hours of an outbreak. The rule was finalized in 2022 and was supposed to go into effect this past January. But in March 2025, the FDA delayed implementation of this rule for 30 months. Six days after the FDA made this decision. the billionaire CEO of Taylor Farms made a million-dollar contribution to MAGA, Inc., a pro-Trump super PAC.
A few other factors have probably made the current outbreak worse. Though cooking (over 158 degrees F) kills Cyclospora, the organism likes warmer weather (the reason for the flare in infections in spring and summer) so climate change is making the environment friendlier for the bug. Consumers are eating more fresh produce year-round (a good thing) so more of it is imported from foreign countries, necessitating more handling along the way. Finally, the dramatic cuts in staff and programs at the CDC, including the dismantling of the Foodborne Diseases Active Surveillance Network (Food Net), whose goal was to trace trends in the reporting of outbreaks like cyclosporiasis, can hamper awareness of the extent of the problem.
The silver lining is that people are increasingly recognizing that buying local not only supports local farmers, and can prevent exposure to pesticide residues, it lessens the chance of exposure to poop particles with Cyclospora. Simply put: Buying local means you know who the producer is, and there are far fewer people handling the fruit or vegetable on the way to your table.
Sarah Voiland, co-owner of Red Fire Farms, told me that they and other local farms have strict hygiene and handwashing training, including “parts of the hands usually missed.” Surface and well water used for irrigation are tested frequently, as are intervals between irrigation and harvesting.
Meghan Hastings, co-owner of Dave’s Natural Foods adds that big, industrialized farms are “pipelines” for lettuce and “they don’t care. Local people care.”
In addition, huge operations like Taylor Farms subcontract a large percentage of their farmworkers — who may be treated poorly and paid piece work instead of hourly wage; they may not be able to take the time to get to a bathroom facility when needed.
Local farms “treating farmworkers like human beings,” Hastings said, makes food safer for customers.
That being said, both Voiland, Hastings, and physicians counsel everyone to properly wash all produce and fruit before consuming them.
Dr. David Gottsegen is a local pediatrician and author of the book “Mending the Body with the Mind: Harnessing Kids’ Superpowers to Heal and Stay Healthy.“