Arkansas, Florida, Missouri, and New York City have reported their first Cyclospora infections with possible ties to a multistate outbreak, raising the nation's total to as many as 373, according to the latest information from federal and state sources.

The US Centers for Disease Control and Prevention (CDC) in an update today said it had received reports of 353 cases as of Jul 26, but Iowa, Nebraska, and Texas have reported more cases since then.

So far 21 patients from three states have been hospitalized, but no deaths have been reported. The CDC said illness onset dates have ranged from the middle of June to early July.

No food source has been identified yet, but health officials in Iowa—the state reporting the most cases—have said they suspect imported vegetables. Cyclospora is an extremely rare parasite, and past outbreaks have been linked to imported fruit or vegetables.

The Food and Drug Administration (FDA) said in a Jul 26 notice that it, along with the CDC and state and local departments, was investigating the multistate outbreak.

So far it's not clear if cases from all of the states are part of the same outbreak. Some of the cases in Iowa and Nebraska have tentative links to foreign travel, and some of the sick patients in Illinois, Kansas, and Missouri may have become ill after travel to other states that have reported dozens of cases.

The Florida Department of Health (FDH), which reported its first cases on Jul 26, said its epidemiologists are coordinating with the CDC to identify the source of the cases. Carina Blackmore, DVM, PhD, interim state epidemiologist, said in a statement, "Staff are re-interviewing those affected to carefully examine food items and the ingredients those patients were exposed to."

The FDH said no common links to restaurants, food items, or events have been identified among the sick patients.

Meanwhile, the Missouri Department of Health and Senior Services (MDHSS) said its two cases were reported by healthcare providers in Jackson and Taney counties. It said it is working with the CDC and other agencies to determine if the cases are linked to the infections in other states.

Nebraska and Iowa—two states that have reported many of the outbreak cases—both reported additional cases today above their numbers reflected in the CDC's most recent update. The Iowa Department of Public Health (IDPH) reported 5 more cases, boosting its total to 145. The Nebraska Department of Health and Human Services (DHHS) announced 6 more cases, raising its total to 77.

Also, the Texas Department of State Health Services (TDSHS) said on Jul 26 that a total of 101 Cyclospora infections have been reported in that state so far, 9 more than reflected in the CDC update. State health officials are investigating the cases to identify possible common exposures. It added that although cases have been reported in 20 of the state's 254 counties, so far the majority of cases are from the Dallas and Fort Worth area.

The CDC said more cases are under investigation, and so far 33 of the infections have been confirmed in CDC labs.

Cyclosporiasis is a rare parasitic disease that is spread through tainted food or water. If untreated, the disease can cause watery diarrhea that can last as long as 57 days. Other symptoms may include fatigue, anorexia, bloating, stomach cramps, vomiting, muscle aches, and a low-grade fever.

See also:

Jul 29 CDC outbreak update

Jul 29 IDPH statement

Jul 29 MDHSS statement

Jul 29 NDHHS update

Jul 26 FDA statement

Jul 26 TDSHS statement

Jul 26 FDH statement