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Cyclospora, the nasty parasite known for causing “explosive diarrhea,” has sickened an estimated 18,000 people across the United States this summer. Health officials are investigating six separate outbreaks so far, as well as clusters in multiple states
Current evidence points to iceberg lettuce as a possible culprit, but it’s unclear if other produce could be fueling the surge
Cases of the intestinal infection, aka cyclosporiasis, started ramping up in May, which matches the typical seasonal pattern of the disease in the U.S. But this summer, the U.S. has already seen dramatically more cases than its usual 3,000 per year
At least 423 people have been hospitalized for cyclosporiasis nationwide. No deaths have been reported so far
In July, officials identified a large, multistate cyclosporaisis outbreak in the Midwest, which has since expanded to nine states, according to the Centers for Disease Control and Prevention. Cases in other parts of the country are also rising
The CDC and U.S. Food and Drug Administration have zeroed in on shredded lettuce served at Taco Bell as a potential berg lettuce
The recall affects lettuce served in restaurants and sold at retailers, including Walmart
Health authorities are still investigating why cases have hit record-high levels this summer, where the contaminated lettuce was sold, and whether there are other outbreak
Here’s where cyclosporiasis are surging in the U.S., what to know about the stomach-churning infection and how to stay safe during peak fresh produce season
Cyclosporiasis is an intestinal infection caused by Cyclospora cayetanensis, a microscopic parasite carried in human feces. The parasite is not new, and cases normally increase in the summer in the U.S
People become infected with cyclospora by consuming food or water contaminated with particles of feces from an infected person, Kali Kniel, Ph.D., professor of microbial food safety at the University of Delaware, tells TODAY.com
The parasite infects the small intestine, causing severe bowel upset. The hallmark symptom of cyclosporiasis is watery and sometimes “explosive” diarrhea, per the CDC. Other signs include abdominal cramping, bloating and fatigue
If left untreated, the diarrhea can last for weeks, but cyclosporiasis isn’t usually life-threatening, says Kniel. Doctors can treat the infection with a combination antibiotic
Person-to-person spread is very unlikely. That’s because after the parasite is shed in feces, it takes one to two weeks living outside the body to mature and become infectious, says Kniel
Cyclospora can get into produce if it’s grown in soil or washed with water contaminated with feces; fresh fruits and vegetables are common culprits, says Kniel
Nearly 18,000 confirmed or probable cases of cyclosporiasis have been reported in 45 states since May 1, per the latest CDC data as of July 28
Of these, the CDC has confirmed 6,707 cases and another 11,500 are under investigation, such as ruling out international travel, agency said
The people infected range in ages from 1 to 98, and the median date when their symptoms began was July 2, per the CDC
This includes the cases reported as part of the massive, multistate outbreak in the Midwest. It initially spanned five states — Indiana, Kentucky, Ohio, Michigan and West Virginia — but onJuly 24, the CDC announced that the outbreak expanded to four more states: Illinois, Kansas, Oklahoma and Pennsylvania
The FDA is also investigating five smaller cyclosporiasis outbreaks in the U.S., though it has not specified where they are
Here’s which states are reporting the most cases:
Michigan is being hit the hardest. As of July 31, the state has reported 10,773 cyclosporiasis cases and 193 hospitalizations, per the Michigan Department of Health and Human Services
There are some promising signs that cases may be peaking in Michigan, but the outbreak is still not over, Dr. Natasha Bagdasarian, the state’s chief medical executive, told NBC News
In the meantime, infections are still spiking in other states
Ohio has reported over 4,000 cases, and Indiana has recorded nearly 1,200 so far. North Carolina is nearing 750 infections, and cyclosporiasis case counts have surpassed 500 in New York, Illinois and Missouri, based on data from state health departments provided to NBC News
Beyond the nine-state outbreak linked to shredded lettuce, it’s unclear which clusters of cases in the U.S. may be connected, and investigations are ongoing, the CDC said
“There may be multiple unrelated outbreaks going on at the same time,” Donald Schaffner, Ph.D., professor of food microbiology in the Department of Food Science at Rutgers University, tells TODAY.com
The true number of cyclospora infections in the U.S. is likely higher than the numbers currently being reported — that’s because many people recover on their own and never get tested for cyclospora, per the CDC
“We anticipate continuing to see cases increase, possibly through the end of August,” Gwen Biggerstaff, deputy director of the CDC’s Division of Foodborne, Waterborne and Environmental Diseases, said
So far, the FDA and CDC have identified one possible hredded iceberg lettuce served at Taco Bell
Health officials zeroed in on the fast-food chain after interviewing over 1,900 people sickened in these states who reported eating at Taco Bell in June or July, the FDA said
Taco Bell has removed all affected lettuce from its supply chain. The supplier, Taylor Fresh Foods, issued a voluntary recall of all of its iceberg lettuce products
However, it’s possible that another re in the U.S. Officials in North Carolina said Tuesday that fresh parsley and cilantro may be behind the increase in cases in the state, which has surpassed 700 cases
Investigations are ongoing. “Additional implicated brands, restaurants, retailers, or distribution channels may be identified, reaching additional states,” the FDA said in a July 24 update
Schaffner and Kniel both suspect there’s more than one food or water
Past cyclosporiasis outbreaks in the U.S. have been linked to the following foods:
- Salad greens
- Cilantro
- Basil
- Raspberries
- Green onions
- Snow peas
Cyclospora is a particularly challenging parasite to track, food safety experts tell TODAY.com
As a result, only a small portion of cyclosporiasis cases every year get traced back to a particular food item
It’s also worth noting that, in July 2025, the CDC’s foodborne surveillance network made testing for cyclospora optional, which could be impacting the response, Schaffner says. Federal health authorities have denied that changes to surveillance are affecting the investigation
The only way to prevent cyclosporiasis is to avoid food and water that may be contaminated with feces
In the recall, 33 out of the 35 affected products were sent to food service locations and two were provided to Walmart and sold under the brand Marketside:
- Iceberg Salad: 12 oz., 24 oz.; best if used by July 18–Aug. 3, 2026
- Shredded Lettuce: 8 oz., 16 oz.; best if used by July 18–Aug. 3, 2026
The FDA is urging consumers not to eat any of the recalled lettuce, including at Taco Bell or other restaurants. It encourages consumers to ask about the
Still, experts are urging people not to panic
“Almost all servings of fresh fruits and vegetables that you can buy on the market today are not linked to this outbreak, and are not any more likely to cause illness because of the outbreak,” says Schaffner
“We know that fresh (produce is) part of a healthy diet, and I certainly don’t want to discourage that,” adds Schaffner, who still plans to enjoy his favorite fruits and vegetables this summer
The experts encourage people to stay up to date on recalls and food safety alerts
Cooking food to least 158 degrees Fahrenheit is the best way to protect yourself, as heat destroys the parasite. Freezing can also inactivate cyclospora, but it’s not a guarantee
Washing produce thoroughly can reduce the risk of foodborne illness, but it won’t eliminate cyclospora entirely
Health authorities have offered a few more tips to prevent cyclospora infection:
- Wash your hands well with soap and hot water before and after handling raw produce.
- Scrub all fresh vegetables and fruits with a produce brush under clean, running water. Do not use soap.
- Remove the outer layer of leaves or the peel, if possible. Run the inner leaves under running water.
- Cut or peel off damaged areas of produce before eating.
People with weakened immune systems may need to take extra precautions and should consult their doctor about how to avoid foodborne illness, says Kniel
“We are seeing hospitalizations, so if you do get sick, good hydration is critical, and so is getting clinical care because this can be treated,” Kniel adds
If you develop symptoms of cyclosporiasis, contact your doctor
