I am 72 and been shitting my brains out for 13 days now. I don't travel. I don't eat at fast food restaurants. I don't buy packaged produce. Nearly all my produce is from farmers markets. Awaiting test results. I did have to beg my provider. At least I don't feel sick!
There are other causes. I had diarrhea for weeks and tests revealed a bug my doc said must have come from traveling. I had not traveled. But my produce often travels a long way to get to me!
Yes I had antibiotics, and they got rid of it. I think it was called Plesiomonas or something like that. It wasn't "explosive" but I did have diarrhea for about 4 weeks before I got on the meds - lost 10 lbs. But the antibiotic took care of it quickly as I recall.
I was told that test results for other parasites is a week or more, which puts me at Tuesday. I don't know what the testing timing is for this. I will certainly let people know!
A note for clinicians and others — Bactrim and Septra are the most common U.S. trade names for the antibiotic combination Trimethoprim-Sulfamethoxazole (TMP-SMX). For an adult with a normal immune system, the standard CDC clinical guidance is one double-strength tablet (160 mg TMP / 800 mg SMX) taken twice daily for 7 to 10 days. While the Cyclospora cayetanensis parasite is highly vulnerable to TMP-SMX, this sulfa-based medication works by blocking the parasite's ability to use folate to synthesize necessary energy. That means it isn't safe to use (Drug Category D, my mnemonic is "Dangerous") in the first and third trimester of pregnancy, because it poses serious risks to the fetus. Folate deficiency can cause major defects in the early development of the central nervous system (neural tube defects), and can cause severely high bilirubin and kernicterus in newborns and young infants or those with severe kidney/liver disease. There aren't good alternatives, so the best treatment option is usually to focus on hydration and wait it out. Because dehydration also has high risks in pregnancy and for infants, IV fluids and hospitalization can be needed. As always in clinical practice, the potential risks, benefits, and alternatives have to be weighed and discussed with patients, parents, or guardians. Folate supplements are one possibility. I searched OpenEvidence online and found excellent information with sources, but I didn't find specific guidelines.
Maybe you can answer this question, Dr. Mandell. I seem to be recovering from a GI bug, nausea, diarrhea for about 3 weeks on and off. My labs are in process--so far negative for stool leukocyte and Giardia. Cyclospora still in progress. AI says if test comes back positive for Cyclospora, I should still take a course of Bactrim even if I've been feeling OK due to the relapsing/remitting pattern of this bug. What say you?
Can you inform us about the heating process to kill it on vegetables? I've read 160 degrees, but for how long? Does it work regardless of if it's boiled, stir-fried, microwaved, or baked? For something like tomatoes, can we do a quick blanching in boiling water (under 30 seconds) and that's enough or needs longer? What about foods that can be peeled without cutting (bananas, oranges, tangerines)? If TOUCH a veggie (like to cut and boil) that has the parasite, if only heat removes it, won't it now live in our hands for who-knows how long? or does soap work on skin, but not the fruit? Anyway, nitpicky questions, but this is the information that would actually help our household handle foods to avoid this - we don't mind doing the work, but the details are lacking everywhere. Thanks.
Yes! High-risk patients should cook produce when possible heating to 158°F/70°C. this is what internal temp needs to get to and it’s killed immediately. Microwaving doesn’t work as well because heat is inconsistent throughout the food, but needs *min* 45 seconds
I read an article about the issue in a local Bay Area newspaper and decided to investigate further. From what I can tell, the cases in California are all travel related. I imagine this is not the case in Michigan. Until it starts becoming more widespread, I plan to eat fresh local fruits and vegetables (washing them thoroughly of course, as I always do)
"Severe cases can be treated with antibiotics (called Bactrim)."
FWIW, several years ago, I had an adverse reaction to Bactrim (Stevens-Johnson) that was Rx-ed for a UTI. A very sensitive part of me was peeling. So, if you take Bactrim, watch your symptoms carefully.
Both of us tested positive this week for Covid and I’m having some Gi issues along with it. Not explosive diarrhea thankfully. The only reason we know we both have Covid is on Monday night my husband had chills, but felt better by the next morning. My mother is elderly so I gave him a Covid test out of an abundance of caution and sure enough, he tested positive. I was surprised. Other than some sinus pressure, I had no symptoms, until today (Saturday) with moderate diarrhea/Gi issues. Just thought I’d mention it in case anyone else had similar symptoms.
Delicate, soft fruits (e.g. raspberries) have been implicated in the past with outbreaks of Cyclospora infection, and of course these fruits simply don't survive vigorous washing. Best to use raspberries in cooked forms (jams, jellies, sauces, dried, baked granola), at least until the outbreak is over. Completely agree with avoiding pre-cut bagged salad greens (also for avoiding enterohaemorrhagic E. coli), because many pathogens cling to the cut edges. Use whole lettuce leaf, preferably iceberg varieties, vigorously washed before cutting/shredding. In areas where typhoid fever was endemic, we used a 1-in-100 dilution of household bleach (sodium hypochlorite) for 5 minutes as a rinse, followed by a fresh water rinse. Absolutely no taste, no health issue, but guaranteed safe.
In the past 3 weeks I've had watery diarrhea twice but always preceded by lots of vomiting. I'm still not back to eating after the second time. Both occurred one day after a potluck. From what I read this isn't Cyclospora due to the vomiting. I would love to know what it is and how to prevent it.
I once had norovirus and it started with fever then vomiting then ended with diarrhea. The whole thing lasted 36 hours for me but other people have had it much longer and worse than I did.
Norovirus has an incubation period of about a day and symptoms (diarrhoea and vomiting) last 24 to 36 hours. One common feature with this virus is headache.
Our lettuce and fresh basil come from a hydroponic farm on a rooftop above a Method Soap factory on the far south side of Chicago, Gotham Greens. We are fine!
Great review, but please set a standard of always listing the generic name of a medication and brand names following that as needed. Bactrim is a combination antibiotic containing sulfamethoxazole and trimethoprim.
Oh, thanks so much for the info re: Taco Bell. Pico de gallo and guac both have cilantro so that seems like their prime suspect - I wonder if that is just because it's been the problem in the past or for a more particular, current reason (connected to interviews with sick people about their diets).
I am 72 and been shitting my brains out for 13 days now. I don't travel. I don't eat at fast food restaurants. I don't buy packaged produce. Nearly all my produce is from farmers markets. Awaiting test results. I did have to beg my provider. At least I don't feel sick!
There are other causes. I had diarrhea for weeks and tests revealed a bug my doc said must have come from traveling. I had not traveled. But my produce often travels a long way to get to me!
That's weird! They are certainly testing for other parasites. Did you take antibiotics?
Yes I had antibiotics, and they got rid of it. I think it was called Plesiomonas or something like that. It wasn't "explosive" but I did have diarrhea for about 4 weeks before I got on the meds - lost 10 lbs. But the antibiotic took care of it quickly as I recall.
Glad you saw a doctor and had tests run. Hope the diarrhea ends soon.
I’m so sorry Katie. Keep us posted on results.
Thank you. That is very kind. I sure hope to have answers by mid week.
Noooo i’m so sorry! Will be very curious to hear what your results say
I was told that test results for other parasites is a week or more, which puts me at Tuesday. I don't know what the testing timing is for this. I will certainly let people know!
Thank you. Valid and reliable information is vital, in this and in many of the other issues you report on.
Thanks SO much for interrupting your vacation to get this out to us. News, even from the NYT, has been confusing.
A note for clinicians and others — Bactrim and Septra are the most common U.S. trade names for the antibiotic combination Trimethoprim-Sulfamethoxazole (TMP-SMX). For an adult with a normal immune system, the standard CDC clinical guidance is one double-strength tablet (160 mg TMP / 800 mg SMX) taken twice daily for 7 to 10 days. While the Cyclospora cayetanensis parasite is highly vulnerable to TMP-SMX, this sulfa-based medication works by blocking the parasite's ability to use folate to synthesize necessary energy. That means it isn't safe to use (Drug Category D, my mnemonic is "Dangerous") in the first and third trimester of pregnancy, because it poses serious risks to the fetus. Folate deficiency can cause major defects in the early development of the central nervous system (neural tube defects), and can cause severely high bilirubin and kernicterus in newborns and young infants or those with severe kidney/liver disease. There aren't good alternatives, so the best treatment option is usually to focus on hydration and wait it out. Because dehydration also has high risks in pregnancy and for infants, IV fluids and hospitalization can be needed. As always in clinical practice, the potential risks, benefits, and alternatives have to be weighed and discussed with patients, parents, or guardians. Folate supplements are one possibility. I searched OpenEvidence online and found excellent information with sources, but I didn't find specific guidelines.
Maybe you can answer this question, Dr. Mandell. I seem to be recovering from a GI bug, nausea, diarrhea for about 3 weeks on and off. My labs are in process--so far negative for stool leukocyte and Giardia. Cyclospora still in progress. AI says if test comes back positive for Cyclospora, I should still take a course of Bactrim even if I've been feeling OK due to the relapsing/remitting pattern of this bug. What say you?
Can you inform us about the heating process to kill it on vegetables? I've read 160 degrees, but for how long? Does it work regardless of if it's boiled, stir-fried, microwaved, or baked? For something like tomatoes, can we do a quick blanching in boiling water (under 30 seconds) and that's enough or needs longer? What about foods that can be peeled without cutting (bananas, oranges, tangerines)? If TOUCH a veggie (like to cut and boil) that has the parasite, if only heat removes it, won't it now live in our hands for who-knows how long? or does soap work on skin, but not the fruit? Anyway, nitpicky questions, but this is the information that would actually help our household handle foods to avoid this - we don't mind doing the work, but the details are lacking everywhere. Thanks.
Yes! High-risk patients should cook produce when possible heating to 158°F/70°C. this is what internal temp needs to get to and it’s killed immediately. Microwaving doesn’t work as well because heat is inconsistent throughout the food, but needs *min* 45 seconds
We just tested it and 1.5min gets spinach to 160. Hope that helps!
I read an article about the issue in a local Bay Area newspaper and decided to investigate further. From what I can tell, the cases in California are all travel related. I imagine this is not the case in Michigan. Until it starts becoming more widespread, I plan to eat fresh local fruits and vegetables (washing them thoroughly of course, as I always do)
Please advise if this is unwise. Thanks
"Severe cases can be treated with antibiotics (called Bactrim)."
FWIW, several years ago, I had an adverse reaction to Bactrim (Stevens-Johnson) that was Rx-ed for a UTI. A very sensitive part of me was peeling. So, if you take Bactrim, watch your symptoms carefully.
Stevens-Johnson syndrome is no joke! (That, and the less serious form called erythema multiforme often related to infection or medication reactions).
Thanks. It sure was not a joke for me. Now I have to remember the name Bactrim when I list any medication’s with which I have serious reactions.
Just thought I’d mention this….
Both of us tested positive this week for Covid and I’m having some Gi issues along with it. Not explosive diarrhea thankfully. The only reason we know we both have Covid is on Monday night my husband had chills, but felt better by the next morning. My mother is elderly so I gave him a Covid test out of an abundance of caution and sure enough, he tested positive. I was surprised. Other than some sinus pressure, I had no symptoms, until today (Saturday) with moderate diarrhea/Gi issues. Just thought I’d mention it in case anyone else had similar symptoms.
Delicate, soft fruits (e.g. raspberries) have been implicated in the past with outbreaks of Cyclospora infection, and of course these fruits simply don't survive vigorous washing. Best to use raspberries in cooked forms (jams, jellies, sauces, dried, baked granola), at least until the outbreak is over. Completely agree with avoiding pre-cut bagged salad greens (also for avoiding enterohaemorrhagic E. coli), because many pathogens cling to the cut edges. Use whole lettuce leaf, preferably iceberg varieties, vigorously washed before cutting/shredding. In areas where typhoid fever was endemic, we used a 1-in-100 dilution of household bleach (sodium hypochlorite) for 5 minutes as a rinse, followed by a fresh water rinse. Absolutely no taste, no health issue, but guaranteed safe.
In the past 3 weeks I've had watery diarrhea twice but always preceded by lots of vomiting. I'm still not back to eating after the second time. Both occurred one day after a potluck. From what I read this isn't Cyclospora due to the vomiting. I would love to know what it is and how to prevent it.
I just looked up norovirus and it has the vomiting. That is likely what I have.
Sorry you had to go through this! Hope you are better soon!
I once had norovirus and it started with fever then vomiting then ended with diarrhea. The whole thing lasted 36 hours for me but other people have had it much longer and worse than I did.
Norovirus has an incubation period of about a day and symptoms (diarrhoea and vomiting) last 24 to 36 hours. One common feature with this virus is headache.
Norovirus doesn't ordinarily last that long.
Very helpful. Thanks so much.
Our lettuce and fresh basil come from a hydroponic farm on a rooftop above a Method Soap factory on the far south side of Chicago, Gotham Greens. We are fine!
www.gothamgreens.com
Great review, but please set a standard of always listing the generic name of a medication and brand names following that as needed. Bactrim is a combination antibiotic containing sulfamethoxazole and trimethoprim.
Thank you, as always, for your thorough and very helpful information.
What ingredient did Taco Bell pull? It sounds like you think they will know the source soon. Will they tell us?
I was wondering the same thing and just looked this up. Taco Bell pulled lettuce, pico de gallo, cilantro, onions, and guac.
As for the signals Dr. J referred to, I too would really like to know what these are suspected to be ASAP.
Oh, thanks so much for the info re: Taco Bell. Pico de gallo and guac both have cilantro so that seems like their prime suspect - I wonder if that is just because it's been the problem in the past or for a more particular, current reason (connected to interviews with sick people about their diets).
Thank you