Cyclosporiasis Outbreak Spreads to 18 States With No Recall in Sight

The Centers for Disease Control and Prevention is monitoring a cyclosporiasis outbreak that has spread to at least 18 states, with the agency’s June 16 surveillance snapshot recording 145 confirmed cases, 20 hospitalizations, and no deaths. Sick people ranged in age from 5 to 86, with a median age of 42, and 61% were female, the CDC said in its July 1 update. The parasite spreads through food or water contaminated with feces, and the agency has not yet identified a single food source connecting the cases.

State-level reports filed after the CDC’s snapshot show the picture is already larger. Michigan alone has logged a surge that the state’s health department described as sudden and large.

Beyond the CDC’s 145-Case Snapshot

The CDC’s June 16 surveillance snapshot is the official tally the agency publishes on the national cyclosporiasis surveillance page, last updated July 1. It lists 145 domestically acquired cases, 20 hospitalizations, zero deaths, and 17 reporting states, with a median illness onset date of May 13, 2026. Patients ranged in age from 5 to 86, with a median age of 42, and 61% were female. The CDC emphasizes that this is a surveillance count, not a single multistate outbreak, and that the true number of sick people is likely higher than reported.

That snapshot predates Michigan’s June 22 surge. The state’s health department said the count had been climbing fast and was running about 13.5 times the state’s typical annual tally of around 50 cases. Dr. Natasha Bagdasarian, Michigan’s chief medical executive, described the increase as “sudden and large.” The surge has been concentrated in Wayne, Monroe, Lenawee, Washtenaw, Shiawassee, Jackson, Oakland, and Livingston counties. Most of those counties sit in southeast Michigan, where Wayne County alone includes Detroit.

Several other states have also seen significant post-snapshot increases. Ohio and New York have each logged large recent jumps, with both states running well above their 2025 pace. North Carolina, Texas, and Illinois have all reported new case clusters since the CDC’s June 16 cutoff.

The CDC has not yet integrated Michigan’s separate count into its national surveillance page, and Ohio’s surge has continued past the snapshot’s cutoff. Local, state, and federal investigators are pursuing several clusters with potentially distinct food sources. No single product has been tied to the cases, leaving no recall to issue. Each cluster is being investigated as a separate traceback effort with the FDA.

How a Microscopic Parasite Reaches the Kitchen

Cyclosporiasis is caused by the single-celled parasite Cyclospora cayetanensis, which infects the small intestine and travels in human feces. People become infected when they consume food or water contaminated with feces from someone shedding the parasite, according to the federal Cyclospora parasite explainer. The unsporulated form of the parasite must spend 1 to 2 weeks outside the body in favorable conditions before it becomes infectious, which is why person-to-person transmission is unlikely.

In the United States, the parasite shows up most often in fresh produce irrigated with contaminated water. Past outbreaks have been linked to basil, cilantro, raspberries, snow peas, and leafy greens imported from countries where Cyclospora is endemic. A 2018 outbreak tied to a fast-food chain’s salad mix sickened more than 511 people across the Midwest, and a 2020 cluster in Alabama was traced to fresh cilantro from a Texas distributor sourcing from Mexico. In 2022, a Florida cluster was attributed to a Caesar salad kit containing bagged romaine lettuce.

The CDC tracks cyclosporiasis year-round, but case counts rise sharply each summer when fresh produce consumption peaks. The agency’s official cyclosporiasis season runs May 1 through August 31. In 2019, an unusually high year, the United States recorded 4,703 confirmed cases, the largest annual tally on record, and cyclosporiasis is a nationally notifiable disease in 47 states plus the District of Columbia and New York City.

Symptoms Take a Week or More to Surface

The hallmark of cyclosporiasis is watery diarrhea that can come in frequent, sometimes explosive bouts. The CDC and state health departments repeat that description in their public guidance. Symptoms typically start about 7 days after exposure, though the CDC’s range runs from 2 days to 2 weeks. The Georgia Department of Public Health lists the same incubation window on Georgia’s Cyclospora disease information page, noting that the lag between exposure and first symptoms is part of what makes the parasite hard to trace.

Other symptoms, per the CDC and the Georgia DPH, include:

• Loss of appetite and weight loss
• Stomach cramps, bloating, and increased gas
• Nausea and vomiting
• Fatigue
• Low-grade fever
• Body aches and headache

Symptoms can last a few weeks or stretch past a month, and they often come in waves, the CDC said. The Georgia Department of Public Health notes that symptoms sometimes go away and then return after a few days or a week, a pattern the agency calls “relapses.” Most healthy people recover without antibiotics, but the infection can persist without treatment, and immunocompromised patients face the highest risk of prolonged illness.

Why No Food Recall Has Been Issued

The CDC says there is currently no evidence of a single, multistate Cyclospora outbreak linking all reported cases. The agency is pursuing multiple clusters with potentially distinct food sources through traceback investigations with the FDA. Without a single product identified, no recall has been issued. The parasite’s biology creates unusual hurdles for traceback even when investigators are pursuing a single cluster.

First, the 1-to-2-week incubation period means that by the time a patient sees a doctor, they often cannot accurately recall what they ate two weeks earlier. That makes the dietary recall interviews that drive most outbreak investigations unreliable compared to faster-acting pathogens like Salmonella. Cyclospora cases often drag on for months before investigators can match sick people to a likely food.

There is a significant lag time between exposure to contaminated produce or contaminated materials and development of symptoms. So it can take a week, sometimes even two weeks between exposure and development of symptoms.

The quote is from Dr. Natasha Bagdasarian, Michigan’s chief medical executive, speaking to ABC News on July 6.

Second, standard clinical stool tests do not detect Cyclospora at all. A doctor has to specifically order a modified acid-fast stain, a direct fluorescence assay, or a PCR test, none of which most primary care and emergency physicians reflexively include when a patient walks in with summer diarrhea. Most Cyclospora cases go undiagnosed as a result. The ones that are caught often experience significant delays before the right test is ordered.

Third, contamination usually happens at the farm or irrigation level, not at a processing facility where investigators can pinpoint a specific batch. The same contaminated water source can affect multiple products from the same farm, complicating any single suspect item. By the time investigators identify a source, the implicated product has often already moved through the supply chain and been consumed.

Where Cases Are Heaviest

States with confirmed or reported cyclosporiasis cases in the 2026 outbreak season now stretch across at least 18 states, from Alaska to Massachusetts. Michigan has absorbed the bulk of the new cases since the CDC’s June 16 cutoff. Georgia sits among the lower-count states, with between 1 and 10 cases per CDC reports. The hardest-hit areas cluster in the Midwest and Northeast.

The full list of affected states:

• Alaska
• Colorado
• Connecticut
• Florida
• Georgia
• Illinois
• Louisiana
• Massachusetts
• Michigan
• New Jersey
• New York
• North Carolina
• Ohio
• Pennsylvania
• Tennessee
• Texas
• Virginia
• Wisconsin

In Georgia, between 1 and 10 people have been reported ill with cyclosporiasis, per the CDC’s surveillance map. The Georgia Department of Public Health tracks the disease as notifiable and reports most cases in June and July, the peak of fresh produce consumption.

Michigan’s Wayne County, home to Detroit, has absorbed most of the state’s reported surge. New York State has logged 107 cases since May 1, and New York City saw case counts roughly double the same period in 2025, per Global Biodefense reporting. Texas and Illinois each reported up to 30 cases in the CDC’s snapshot, while Ohio’s late-June surge pushed its state tally past 170 cases. The CDC’s June 16 snapshot does not yet reflect the post-cutoff increases from Michigan, Ohio, or New York.

Doctors Need a Specific Test to Find It

The standard treatment for cyclosporiasis is a 10-day course of trimethoprim-sulfamethoxazole, sold under the names Bactrim, Septra, and Cotrim. The antibiotic is FDA-approved for the infection and is the regimen the CDC lists in its clinical guidance. Most people with healthy immune systems recover without antibiotics, but treatment can shorten the illness and prevent relapses.

Patients can wait weeks before the right test is ordered. Standard stool cultures do not detect Cyclospora, so many sick people cycle through false negatives first. That delay helps explain why reported case counts lag the actual spread of the illness. It also means many cases never make it into the official tally.

If you believe that you could have cyclosporiasis, it’s really important to see your healthcare provider and to mention cyclosporiasis, just in case they haven’t heard about this outbreak happening right now, and ask for stool testing, because not all stool testing routinely will include cyclosporiasis.

The quote is from Dr. Natasha Bagdasarian, Michigan’s chief medical executive, in remarks to ABC News.

Prevention centers on washing. The CDC recommends washing hands with soap and water before and after handling fresh produce, washing produce under running water, and refrigerating pre-cut items. Alcohol-based hand sanitizer does not reliably kill Cyclospora, so plain handwashing is the better choice.

Dr. Darien Sutton, an emergency medicine physician and ABC News medical correspondent, told “Good Morning America Weekend” that a scrub brush can help with leafy greens and herbs. Cut away bruised or damaged parts of fruits and vegetables before eating, the CDC advises. Cooking kills Cyclospora, though most cases are tied to raw fresh produce, so that protection is limited. Until investigators name a specific source, the practical guidance remains general: wash thoroughly, cook when possible, and call a doctor if symptoms drag on past a few days or come in waves.

Frequently Asked Questions

What is cyclosporiasis?

Cyclosporiasis is an intestinal infection caused by the single-celled parasite Cyclospora cayetanensis. People get it when they consume food or water contaminated with feces from someone shedding the parasite, and the unsporulated form needs 1 to 2 weeks outside the body before it can infect a new host. The parasite is endemic in many tropical and subtropical regions, including countries that export fresh produce to the United States.

What are the main symptoms of cyclosporiasis?

The hallmark is watery diarrhea that can become explosive and last for weeks, often accompanied by loss of appetite, weight loss, stomach cramps, bloating, increased gas, nausea, vomiting, fatigue, low-grade fever, body aches, and headache. Symptoms typically start about a week after exposure and often come and go in waves.

Is there a food recall linked to the outbreak?

No. The CDC says there is currently no evidence of a single multistate outbreak linking all cases, so investigators cannot pinpoint one product to pull. The parasite’s 1-to-2-week incubation and farm-level contamination make traceback far slower than for typical foodborne pathogens.

How is cyclosporiasis treated?

The standard regimen is a 10-day course of the oral antibiotic trimethoprim-sulfamethoxazole, sold as Bactrim, Septra, and Cotrim. Most healthy people recover on their own, but treatment is recommended to shorten the illness and prevent relapses. Patients with sulfa allergies need an alternative regimen prescribed by a specialist. Generic trimethoprim-sulfamethoxazole is inexpensive, often available for less than $10 with a discount card at most pharmacies.

Should I see a doctor if I think I have it?

Yes, especially if you have had watery diarrhea for more than a few days or if it has come in waves. Standard stool cultures do not detect Cyclospora, so patients need to specifically ask for a modified acid-fast stain, a direct fluorescence assay, or a PCR test. Anyone with severe dehydration, blood in the stool, or an inability to keep fluids down should seek emergency care.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. If you suspect you have cyclosporiasis or another foodborne illness, contact a qualified healthcare provider. Case counts and guidance reflect information available at the time of publication.