Speaker 1: Hi, I'm erin Welsh and I'm erin on an updike
Speaker 1: and this is this podcast will kill you.
Speaker 2: We're coming to you with a very rapid fire episode, rapid.
Speaker 3: Fire episode on cyclospora because it's better the news you've
Speaker 3: seen in the news. Many of you have asked us
Speaker 3: about it and we had not yet covered it. So, yeah,
Speaker 3: we wanted to kind of like put some stuff together
Speaker 3: really quickly to get information out to you about what
Speaker 3: this thing is, where it came from, and what's going
Speaker 3: on with the current outbreak a little bit of that.
Speaker 4: We will note.
Speaker 3: That we are recording this on Sunday, July twelfth, and
Speaker 3: so this will come out, you know, in a week
Speaker 3: and a few days and things. The numbers will probably
Speaker 3: have shifted by then.
Speaker 1: Maybe one.
Speaker 2: We will be different.
Speaker 4: It will be different.
Speaker 3: We might know more about like what foods are linked
Speaker 3: to this outbreak.
Speaker 2: Potentially I doubt it, maybe.
Speaker 3: But you know, we will be giving you some information
Speaker 3: that is sort of evergreen in terms of what this
Speaker 3: parasite is and why it's a food borne illness that
Speaker 3: we have been looking out for for a number of
Speaker 3: years and then stopped looking out for kind of kind
Speaker 3: of yeah.
Speaker 4: We'll get to all of that.
Speaker 2: First. It's quarantine any time.
Speaker 3: It is, you know, we're still going to do one.
Speaker 3: Even for this, I think we ended up we landed
Speaker 3: on This stinks. This stinks.
Speaker 4: The stinks.
Speaker 2: It's so accurate on so many levels.
Speaker 3: Arin Yep, it really stinks. And it's basically like, honestly,
Speaker 3: it's water plus your favorite electrolytes.
Speaker 2: Non branded, non proprietary, and I want everyone to know
Speaker 2: you probably don't actually need electrolytes in your life unless
Speaker 2: you are actually having profuse watery diarrhea or working out
Speaker 2: way more than most of us actually work out.
Speaker 3: So we do not supplements and branded supplements.
Speaker 2: So it's just quarantiny time, quarantiny time.
Speaker 3: We'll post the full recipe, not that you need one
Speaker 3: for this honestly, on our website and on our social media.
Speaker 3: Make sure you're following us there if you're not.
Speaker 4: Already on our website. There's all sorts of things.
Speaker 3: I don't think we'd really need to get into it
Speaker 3: for this rapid fire episode. I think people want the information,
Speaker 3: so let's hit a break and begin.
Speaker 2: So the disorder, the disease we're talking about today, is
Speaker 2: known as cyclosporiasis if caused by a parasite called Cyclospora caiatenensis.
Speaker 2: I think I'm saying that right. There are a number
Speaker 2: of other species of this passogen that infect snakes and
Speaker 2: insectivorous animals, some that infect monkeys, but it's only this
Speaker 2: one species that seems to be important for humans and
Speaker 2: which infects only humans as far as we know. It's
Speaker 2: a type of parasite called an apicomplexin okay, which I
Speaker 2: know that we've talked about parasites in this in this
Speaker 2: phylum before, but I don't know that we've actually said
Speaker 2: that word. But it's the same group that includes malaria parasites, toxoplasmosis, cryptosperdium,
Speaker 2: which we have not done yet.
Speaker 4: Nope.
Speaker 2: And of course there are lots of other protozoan parasite
Speaker 2: friends that we've covered on this podcast, like shaugust disease
Speaker 2: you're already at, et cetera. Those are just sort of
Speaker 2: slightly different vibes, right, Yeah, So we get exposed to
Speaker 2: the infectious stage of this parasite from either food or
Speaker 2: water in our mouths that has been contaminated with old poop.
Speaker 4: Tell me about old.
Speaker 2: We'll get there erin Okay, but I wanted you to
Speaker 2: ask that because it's an important part. Okay, old poop,
Speaker 2: not just any poop.
Speaker 4: Set me up.
Speaker 2: I did so. The infectious stage of this parasite, these
Speaker 2: are single cell parasites, by the way, like, yeah, okay,
Speaker 2: And the infectious stage are these teeny tiny little balls,
Speaker 2: little spherical balls. And by teeny tiny, I mean they're
Speaker 2: like eight to ten microns. They're very small. You cannot
Speaker 2: see them with your eyes, okay. And these balls are
Speaker 2: filled with these two bunches of bananas, like they these
Speaker 2: little critters that are shaped like bananas. We eat these
Speaker 2: little little tiny balls filled with four bananas total. Okay, Okay.
Speaker 2: Once these banana filled balls pass through our stomach and
Speaker 2: get to our small intestine, they punch their way out
Speaker 2: of the ball, and these bananas, these borozoites invade the
Speaker 2: cells that line are small intestine.
Speaker 4: Okay, question real quick.
Speaker 3: So within the ball once once it lands safely, these
Speaker 3: bunches of four bananas, that's still one individual like is
Speaker 3: that still one individual thing?
Speaker 4: Or is it multiple?
Speaker 2: It's four sporozoites okay, yeah, in each one of these.
Speaker 4: How interesting? I know?
Speaker 2: It gets better erin Okay, this is a really interesting parasite.
Speaker 2: Once they are inside the cells, So these are intracellular parasites.
Speaker 2: They're invading the cells inside our small intestine, and there
Speaker 2: they start to reproduce asexually. So they're making a bunch
Speaker 2: more of these banana shaped critters. They now have a
Speaker 2: different name. Again why because they're different. And then at
Speaker 2: some point, some of these bananas that are invading our
Speaker 2: cells replicating and then going out to invade more and
Speaker 2: more of the cells in our small intestine. At some
Speaker 2: point some will differentiate into a form that actually undergoes
Speaker 2: sexual reproduction.
Speaker 4: What proportion?
Speaker 2: Oh, I have no idea Aron, it doesn't, not a clue.
Speaker 4: Yeah, but some of them do.
Speaker 2: And so they form these basically like micro and macro
Speaker 2: gamma eats, and then they fertilize each other to form
Speaker 2: a zygoat the same way that we think of a
Speaker 2: zygoat in humans, except completely different because it's a single
Speaker 2: celled parasite. And then these zygoats become oocysts. These are
Speaker 2: what will pop out of our small intestine cells, travel
Speaker 2: the rest of the way through our guts, and be
Speaker 2: pooped out in an explosive fashion. Yea and then these balls,
Speaker 2: these oocysts have to live in the environment for at
Speaker 2: least a week before they grow those banana things inside
Speaker 2: of them and actually become infectious. That's why I said,
Speaker 2: old poop.
Speaker 4: Yeah, okay, so just so I understand.
Speaker 3: So what happened is you consume these little these little
Speaker 3: banana banana filled balls. Yep, those then invade Once they're
Speaker 3: safely in your gut, they invade your cells. There they
Speaker 3: replicate asexually until a certain point point they begin to
Speaker 3: some will differentiate so that they can undergo sexual reproduction
Speaker 3: correct and then those the offspring produced by those are
Speaker 3: the ones that make it into the environment for to
Speaker 3: then mature and infect other potentially other people.
Speaker 2: Nailed it.
Speaker 4: You've pooped out these parasites.
Speaker 2: Pooped them out.
Speaker 3: They then will in the environment in water like what,
Speaker 3: the environment.
Speaker 2: Wherever wherever they land. These are incredibly hardy parasites, so
Speaker 2: the osis which take a week to become infectious. But
Speaker 2: during that week and after once they are what they
Speaker 2: call spoulated and infectious, they I tried to get a
Speaker 2: number on exactly how long they can live, and I
Speaker 2: could not find that in the literature. Maybe I was
Speaker 2: not looking at the right terms. But I can assume
Speaker 2: based on the studies that I did read that it's
Speaker 2: a long time that they're able to persist in the environment.
Speaker 2: They also can withstand freezing to a certain degree. Freezing
Speaker 2: is not guaranteed to kill them. They also withstand most
Speaker 2: of the disinfection techniques that we use, including chlorination. So
Speaker 2: the only way to actually rid them of let's say
Speaker 2: our water sources, if you know poop is contaminating water sources,
Speaker 2: is with physical filtration to literally remove them, get them
Speaker 2: stuck on a filter, or with like UV filtration.
Speaker 4: What about like boiling?
Speaker 2: Boiling will do it? Yees, So heat does kill them.
Speaker 2: Same thing with cooking your foods if your foods and
Speaker 2: food can get contaminated, both because the soil can be contaminated.
Speaker 2: If you're using reclaimed water or you know, unfiltered water
Speaker 2: to irrigate your crops, then they can get contaminated that way.
Speaker 2: And apparently they're quite sticky, the oocysts, and so they
Speaker 2: really glom on to let's say the tiny bumps and
Speaker 2: hairs covering a rasp berry cerious.
Speaker 4: Ye, yeah, raspberries are culprits.
Speaker 3: Often speaking of timeline from ingestion of these parasites to
Speaker 3: symptoms to the diarrhea. How long is that taking? And
Speaker 3: then how long does it take for symptoms to resolve?
Speaker 3: How do all the rest of that stuff?
Speaker 2: So glad you asked, that's the next thing I have
Speaker 2: written there. And so the incubation period usually it's about
Speaker 2: a week, but it could be as short as two days.
Speaker 2: It could be as long as two weeks, but on
Speaker 2: average it's a week, which for a food born infection
Speaker 2: is a very long time. And we'll talk about the
Speaker 2: importance of that when we try it, when we talk
Speaker 2: about like tracing what was the source of this outbreak? Right,
Speaker 2: it's also very possible and very probably more common than
Speaker 2: we know that people have asymptomatic infections. So they're not
Speaker 2: getting sick at all, does not mean that they're not
Speaker 2: infecting others, because they can still be excreting oocysts in
Speaker 2: their stool. And again we do not have great numbers
Speaker 2: on like how often are we having asymptomatic versus symtomatic
Speaker 2: infections the symptoms themselves. So after that week, in the literature,
Speaker 2: never so often have I seen the words explosive, foul
Speaker 2: smelling diarrhea.
Speaker 4: Not even with sediff or Nora.
Speaker 2: I don't remember seeing specifically the words explosive quite as
Speaker 2: often as I do with this parasite in particular. Okay,
Speaker 2: we can get a little bit more into the symptoms.
Speaker 2: It's a very watery diarrhea, hence the explosiveness. We talked
Speaker 2: in our poop episode about how our anal canal has
Speaker 2: sensors to detect between a poop and a fart, and
Speaker 2: they're really not good at detecting liquid. So when we
Speaker 2: have like very watery stools.
Speaker 3: This is when that's part trusting a fart is not
Speaker 3: the way to go the wrong way.
Speaker 2: Yep. We also see a lot of abdominal cramping, bloating,
Speaker 2: People can have nausea or like a headache. Not often
Speaker 2: do we see vomiting, but sometimes people might have vomiting,
Speaker 2: and sometimes people might have a fever. But it's not
Speaker 2: super common that you get a fever with this particular parasite.
Speaker 2: But it can last for quite a long time. So
Speaker 2: we can see like weight loss because of how just
Speaker 2: like yucky people are feeling and that they're not really eating.
Speaker 2: Their appetite is down. And when I say it can
Speaker 2: go on for a long time, I mean this can
Speaker 2: go on for weeks to a month to six weeks
Speaker 2: if it's untreated. WHOA, yes, So it's usually at least
Speaker 2: two weeks of illness and like five to fifteen explosive
Speaker 2: liquidity stools a day, not minor. That can go on
Speaker 2: for at least two weeks if it's untreated, but often
Speaker 2: it's lasting longer than two weeks, right, like a month,
Speaker 2: five six weeks.
Speaker 3: I have two questions about numbers. Give it to me
Speaker 3: how much how many parasites does it take to get sick?
Speaker 3: And then how much are you pooping out during this process?
Speaker 2: I love that you asked me this question. I don't know.
Speaker 2: The only thing I saw in the literature of how
Speaker 2: many parasites does it take is that we think I
Speaker 2: wish I had written the exact quote, but it was like,
Speaker 2: we think that it's quite low. So we don't really know.
Speaker 2: But it's probably just a handful of these individual oocysts, right,
Speaker 2: each one has four sporozoites that are causing infection. Then
Speaker 2: they're replicating asexually before doing the sexual reproduction things. So
Speaker 2: I couldn't find a specific infectious dose. And similarly, I
Speaker 2: don't have an exact number on how many oocytes are
Speaker 2: you pooping out. But what makes this really challenging is
Speaker 2: that it's not a lot. This is not cholera where
Speaker 2: you or neurovirus where you're releasing you know, thousands, tens
Speaker 2: of thousands. It is low numbers of these oocytes, and
Speaker 2: it can be sporadic, so you might even though you're
Speaker 2: having diarrhea continuously, you might not be releasing oocytes in
Speaker 2: every stool. And it's part because of this. It's not
Speaker 2: every single parasite that's getting extreated, right, Like, it's only
Speaker 2: the osiites that they're producing.
Speaker 3: That's kind of I mean, that's so rude, right, just
Speaker 3: save the save the osides, save the diarrhea for the os.
Speaker 2: Or the Nope. They're like, no, no, no, We're just
Speaker 2: going to keep it continuous, keep it, keep it moving.
Speaker 2: And so that can make it really hard to diagnose
Speaker 2: because if you're looking in the stool for these osiites,
Speaker 2: they might be in very low numbers and they might
Speaker 2: not be there on one day, and so you might
Speaker 2: have to look for multiple days in a row. They're
Speaker 2: also hard to detect on like typical stool studies don't
Speaker 2: actually look for them, and they don't stain the same
Speaker 2: way that other parasites do, which means you actually have
Speaker 2: to use like special stains to find them. They're easier
Speaker 2: to detect with PCR based methods, and so I did
Speaker 2: check they are on our like GI pathogen panel that
Speaker 2: I order when someone has unexplained diarrhea that I don't
Speaker 2: know if I need to treat or not. It is
Speaker 2: on ours. But again, even though PCR helps, because you're
Speaker 2: increasing the number, like the amount of DNA in the sample,
Speaker 2: it makes it easier to detect. If you only have
Speaker 2: a couple of osides there, you still might not pick
Speaker 2: it up. You might pick it up.
Speaker 3: That's interesting, and it's really interesting. How does it resolve?
Speaker 2: I mean either with time, though some people can have
Speaker 2: a kind of relapsing remitting course. So we do see
Speaker 2: that some people, you know, recover and then weeks later
Speaker 2: might have more symptoms or the symptoms are just like
Speaker 2: really really prolonged. We also see especially in people who
Speaker 2: are immunal compromised, so whether they are on immunosuppressive medications
Speaker 2: or maybe have uncontrolled HIV, the disease can spread outside
Speaker 2: of just the intestine and cause disease elsewhere, like say
Speaker 2: the biliary system that's the gall bladder and liver, or
Speaker 2: we sometimes see these kind of post infectious inflammatory type
Speaker 2: syndromes that we see after other food borne illnesses like
Speaker 2: salmonella or Camplia bacter and these are things like inflame
Speaker 2: in the eye, joint pain and inflammation, bladder inflammation, and
Speaker 2: so that's kind of an interesting component that like we
Speaker 2: don't really have a handle on, and it doesn't happen
Speaker 2: all that often, but it certainly can happen where you
Speaker 2: have this prolonged extra intestinal illness as a result of
Speaker 2: like inflammatory response to this parasite. The good news is
Speaker 2: that it is treatable and we use actually an antibiotic. Yeah,
Speaker 2: even though it's not a bacteria. I double checked the
Speaker 2: mechanism of action of the main antibiotic that we use,
Speaker 2: which is trimethiprine sulfa mythsoxicide or backdrum arcepter in the US.
Speaker 3: So glad that you pronounce that because I just wrote
Speaker 3: like to whatever the initials are, that that's appreciated, Like
Speaker 3: Eron's going to handle this.
Speaker 2: The mechanism of it is that it's a foll late blocker.
Speaker 2: It blocks a synthesis of fol late, and so like
Speaker 2: all organisms need fol late, and most single celled organisms,
Speaker 2: including bacteria and many parasites make their own fold late,
Speaker 2: and we don't. We get it from our diet, and
Speaker 2: so by blocking the synthesis of full late, they this
Speaker 2: particular antibiotic can also work against some parasites, though not all, So.
Speaker 4: That's very cool.
Speaker 2: I know, I relooked it up, and I was like,
Speaker 2: I love learning things like that that I knew once before.
Speaker 2: So it is treatable if you can detect it. So
Speaker 2: really a lot of times it's diagnosis that is one
Speaker 2: of the biggest challenges. The good news, too, is that
Speaker 2: even though it's hard to detect and it can last
Speaker 2: for such a long time, it usually is a self
Speaker 2: limited illness in that the mortality rate is very low.
Speaker 2: I do not have an exact number, but for example,
Speaker 2: in the US in the last few years, there have
Speaker 2: been only a small handful, like single digit number of
Speaker 2: deaths associated with Cyclospora. Globally, it probably contributes much more
Speaker 2: than we realize to mortality rates. However, because this is
Speaker 2: a parasite that is endemic in a lot of tropical
Speaker 2: and subtropical regions in the world where diarrheal illnesses kill
Speaker 2: children under age five, it's the leading cause of death.
Speaker 2: So the dehydration that can accompany any kind of diarrheal
Speaker 2: illness is something to take very seriously, especially in small
Speaker 2: kids and the elderly. So I don't want to say
Speaker 2: that this is like not an important illness. It definitely is,
Speaker 2: and we're probably underestimating it overall.
Speaker 3: Oh absolutely, yeah, I mean for sure, and I'm sure
Speaker 3: that you'll get into some of the reasons for that
Speaker 3: in like the current and what's going on. And also
Speaker 3: I think that, yeah, there's a lot more when it
Speaker 3: comes to like the shape of outbreaks, yes, associated with cyclospora.
Speaker 2: Yeah, it's really it's really interesting, and like what who
Speaker 2: is getting the most seck? Like here in the US
Speaker 2: it's mostly adults, whereas in other parts of the world
Speaker 2: it's mostly children and not super young children, but like
Speaker 2: you know, children aged two to five, ten, twelve, And
Speaker 2: so that kind of gives us ideas as to like
Speaker 2: how endemic this parasite really is. How much is it
Speaker 2: just something that we live with versus something that is
Speaker 2: only their occasion. Yeah, it's also interesting, it is I
Speaker 2: have a.
Speaker 3: Question about symptoms during you know, all these things. So
Speaker 3: diarrhea can be caused by a lot of different things,
Speaker 3: and it can resolve on its own quite you know,
Speaker 3: sooner rather than later. At what point with an illness
Speaker 3: like this with cyclospora should someone And I know this
Speaker 3: is not a medical advice podcast, but like, at what
Speaker 3: point is going to the doctor for a diagnosis like
Speaker 3: something that like.
Speaker 4: You know, that's that's a good idea.
Speaker 2: Yeah, that's such a such a good question, Aaron. There's
Speaker 2: not like a perfect answer to it. It so much
Speaker 2: depends on how severe your symptoms are. I would say
Speaker 2: probably on average, like two to three days of severe
Speaker 2: diarrhea that's not going away or getting.
Speaker 3: Better, okay, like not being able to keep anything down,
Speaker 3: not being able to set things down.
Speaker 2: It's going to differ if you're having a lot of
Speaker 2: fevers or if you're super super sick. But I would
Speaker 2: say probably two to three days is the point at
Speaker 2: which we know it's probably not neuro it's probably not
Speaker 2: something it might be something that we need to treat,
Speaker 2: is really the question. Yeah, okay, And it is hard
Speaker 2: because this isn't necessarily something that's always tested for or
Speaker 2: picked up on on the first try.
Speaker 3: Yeah, well, and I imagine too it's different for you know,
Speaker 3: different people of like if it's your a small child
Speaker 3: or if you're you know, elderly, then it could be
Speaker 3: more severe, more quickly, and.
Speaker 2: So exactly exactly, Okay, okay, cool, trying to think if
Speaker 2: there was anything else I wanted to make sure that
Speaker 2: you knew. I feel like there's a lot more. But Aaron,
Speaker 2: can you tell me where the heck this thing came from?
Speaker 4: Let's give it a go.
Speaker 3: If this current outbreak is the first time that Cyclospora
Speaker 3: has been on your radar, first of all, count yourself lucky, because,
Speaker 3: as you just shared Aarin, it is not something that
Speaker 3: anyone wants to deal with. And second, it's totally understandable
Speaker 3: if you had never heard of this parasite before, because
Speaker 3: it was not actually that long ago that researchers first
Speaker 3: identified Cyclospora as infecting humans, as a parasite capable of
Speaker 3: infecting humans.
Speaker 2: I was shocked, and I couldn't avoid some of the
Speaker 2: numbers because they're just so recent and in every single paper, but.
Speaker 4: Like so recent. What I know, nineteen seventy nine.
Speaker 2: That's like, that's so recent.
Speaker 3: So recent, So what happened that year. In nineteen seventy nine, R. W. Ashford,
Speaker 3: who was a British parasitologist who was in the Department
Speaker 3: of Pathology at the University of Papua New Guinea, he
Speaker 3: reported that he had come across three cases of what
Speaker 3: appeared to be a new species of Coccidian in routine
Speaker 3: stool samples from two patients over the years of nineteen
Speaker 3: seventy seven and nineteen seventy eight. Two of the three
Speaker 3: at least had been experiencing diarrhea and general malaise like
Speaker 3: flu like symptoms for some time, but a week or
Speaker 3: two and the infection over time begins like seem to
Speaker 3: resolve on its own. And at the time of finding
Speaker 3: these parasites, he was like, well, it's possible that this
Speaker 3: parasite is causing diarrhea, but it's not conclusive by any means,
Speaker 3: given that, you know, one patient was also coinfected with
Speaker 3: giardia and the other could have had diarrhea from something
Speaker 3: else of you know, just something they ate, virus, whatever.
Speaker 4: And he also had difficulty.
Speaker 3: Yeah, categorizing it, like it looked like a coxidian parasite,
Speaker 3: but he wasn't sure about the genus, and so the
Speaker 3: parasite remained unnamed and unclassified in that initial report. Wow,
Speaker 3: and owing in part to this sort of unclassification as
Speaker 3: well as just the relative obscurity of a three case
Speaker 3: case report, you know, in from like a journal of
Speaker 3: Tropical medicine or whatever, it's a pretty niche area of study,
Speaker 3: his initial paper mostly went unnoticed until sporadic reports over
Speaker 3: the next decade the nineteen eighties of a coxidyan parasite
Speaker 3: infecting humans and that show these these reports showed that
Speaker 3: this might not be one off infections. These cases might
Speaker 3: be indications of a more widespread disease or a widespread parasite.
Speaker 3: And the researchers who worked on these cases throughout the
Speaker 3: nineteen eighties, they also struggled with what this parasite was like.
Speaker 3: Some thought, you know, it kind of looks like fungal
Speaker 3: spores in certain settings, so they'd be like its fungal like.
Speaker 3: Others felt that it resembled blue green algae, and so
Speaker 3: they called it Cyanobacterium like body or CLB. We were
Speaker 3: like a few papers from the eighties that show that,
Speaker 3: and it didn't get its final name, Cyclospora kyatenensis until
Speaker 3: nineteen ninety four, and Kyatenensis comes from the Peruvian university
Speaker 3: where the research had been carried out, but it was
Speaker 3: by Ortega at all. They'd conducted studies on the parasite
Speaker 3: and been like, okay, this is this is what it is,
Speaker 3: what it is, Yeah, we named it ninety four. Ninety
Speaker 3: four is when it got its final name. It's surprisingly recent.
Speaker 3: But the genus also was a little bit of a
Speaker 3: surprise too, because, as you mentioned Cyclospora, this genus had
Speaker 3: been around since eighteen eighty one, and all members up
Speaker 3: to this point of this genus, Cyclospora infected only non
Speaker 3: human animals, like you said, you know.
Speaker 1: Voles or.
Speaker 4: Reptiles or whatever.
Speaker 3: So does that mean that Cyclospora jumped into humans recently?
Speaker 4: I mean, probably not.
Speaker 3: It's probably just I think, I mean, this is what
Speaker 3: people have suggested in the literature. It's probably just that
Speaker 3: it had been masquerading as other pathogens. And given that
Speaker 3: the course of disease is mostly self limited, resolves on
Speaker 3: its own, given that it is also difficult to detect,
Speaker 3: seems to be difficult to detect. It was probably just
Speaker 3: lurking and causing periodic outbreaks or sporadic cases and or
Speaker 3: just sort of like endemic. And you know, in the
Speaker 3: places where cyclospora is endemic, it tends to be most common,
Speaker 3: as you said, in children, and in these children it
Speaker 3: tends to be more mild and asymptomatic. And it also
Speaker 3: might provide some protection later in life, meaning that an
Speaker 3: outbreak like you might not see outbreaks take shape the
Speaker 3: way that they do in countries where this parasite is
Speaker 3: not endemic.
Speaker 2: Yes, which is super interesting that like usually people who
Speaker 2: live in non endemic areas and then travel to somewhere
Speaker 2: endemic get way sicker, way sicker from this parasite than
Speaker 2: people who live there.
Speaker 4: Yeah, exactly.
Speaker 3: And as far as I read it, sounds like as
Speaker 3: far as you read too, there's no currently known animal
Speaker 3: reservoir for cyclospora. There could be one, it could be,
Speaker 3: just haven't we just haven't found it yet.
Speaker 2: Yeah, but it.
Speaker 3: Seems to be like pretty hardy, pretty chill on its
Speaker 3: own in the environment, you know, just hanging out and
Speaker 3: contaminated soil and water.
Speaker 2: Right.
Speaker 3: And another thing that points towards a longer history of
Speaker 3: cyclospora in humans is just how far ranging these case
Speaker 3: reports in the nineteen eighties and nineteen nineties were so
Speaker 3: you see reports of travelers, a lot of travel associated illness,
Speaker 3: people returning from Haiti, from Peru, from Mexico, from Nepal.
Speaker 3: Also studies showing that residents of Nepal and Peru were
Speaker 3: infected with the cyclospora and also patients who had AIDS.
Speaker 3: These made up the bulk of these early reports, so
Speaker 3: it's kind of it was like all over the place.
Speaker 3: And in addition to showing that this is a pretty
Speaker 3: geographically widespread parasite, these also indicated that the parasite can
Speaker 3: cause a range of infections from asymptomatic to symptomatic. It
Speaker 3: can impact both immunocompetent and immunocompromised individuals in a pretty
Speaker 3: relatively short period of time decade and a half or so,
Speaker 3: by the mid nineties, scientists had a pretty good handle
Speaker 3: on the distribution of the parasite. The clinical picture treatment
Speaker 3: like studies had identified TMPSMZ as an effective therapy, and
Speaker 3: they also had some clues as to its transmission. Contaminated
Speaker 3: water seemed very viable as a source of infection, and
Speaker 3: there were some early hints that contaminated food could also
Speaker 3: lead to illness. In nineteen ninety six, those hints about
Speaker 3: food borne illness turned into shouting from the rooftops when
Speaker 3: the first major outbreak occurred in North America. And so
Speaker 3: this resulted in at least four hundred and sixty five
Speaker 3: cases of cyclosporiasis reported by twenty different US states, the
Speaker 3: District of Columbia, and two Canadian provinces over at least
Speaker 3: a month, likely an underestimate of true totals for sure,
Speaker 3: and very widespread from a geographic sense. The outbreak was
Speaker 3: ultimately linked to raspberries from Guatemala, and crucial to the
Speaker 3: epidemiological tracing were several dozen events like gatherings where raspberries
Speaker 3: were served, and so with those clusters, those really helped
Speaker 3: to narrow down the exposure and like the specific exposure.
Speaker 3: So they were like, oh, here's you know, this banquet,
Speaker 3: there was a raspberry dessert and this person had raspberries
Speaker 3: there and this person didn't, which is so interesting.
Speaker 2: It's so interesting. All of this, like contact tracing and
Speaker 2: like questionnaires and trying to identify the source is so
Speaker 2: so interesting. Yeah, and so hard. It's very hard.
Speaker 3: It's very hard, especially with the week the week from
Speaker 3: you know who remembers what they ate a week ago.
Speaker 2: I can't barely remember what I ate two days ago. Okay,
Speaker 2: a week I literally have no clue, not a clue.
Speaker 3: I do I remember, but only because I was traveling
Speaker 3: back from Wyoming, so I remember where we stopped to
Speaker 3: eat and stuff and what we had for camp breakfast.
Speaker 2: I can't even think where I was.
Speaker 3: But yeah, it's hard, Like this is why I mean,
Speaker 3: food born food born outbreaks can be very difficult to
Speaker 3: get a handle on. And it turned out that with
Speaker 3: continued study, the rasberries were actually being exported during a
Speaker 3: time of year that cyclospora is more prevalent, so it
Speaker 3: tends to be seasonal in endemic countries. And while the
Speaker 3: precise method of contamination, like how did these raspberries get
Speaker 3: contaminated in the first place, it was never figured out.
Speaker 3: Researchers narrowed it down to a handful of farms, and
Speaker 3: they suggested that it was likely from contaminated water. So
Speaker 3: maybe either irrigation, maybe fertilizers or pesticides were diluted with
Speaker 3: contaminated water and then sprayed over the crops, and this
Speaker 3: would help to explain the sheer number of raspberries that
Speaker 3: had been contaminated. But again, it doesn't take that many
Speaker 3: oocytes to cause infection. So why raspberries. We touched on
Speaker 3: this a bit, but raspberries have been one of the
Speaker 3: things implicated in this current outbreak, also cilantro and let us.
Speaker 3: We'll get there in a bit. But raspberries are difficult
Speaker 3: to scrub clean. You can't just run them under the
Speaker 3: water and expect the cyclost bar of the OAF sites
Speaker 3: to just pop off all those nooks and crannies.
Speaker 2: It's hard, teeny tiny hairs, yeah, and so grabing on.
Speaker 4: Yeah.
Speaker 3: Raspberries are often are often the culprits in these and
Speaker 3: the nineteen ninety six epidemic it acted as somewhat of
Speaker 3: a wake up call and certainly a warning bell. More
Speaker 3: cyclost war outbreaks were on the way and they would
Speaker 3: only get worse unless we did something about it. Nineteen
Speaker 3: ninety seven and nineteen ninety eight both saw outbreaks in
Speaker 3: North America associated again with raspberries and other berries. There
Speaker 3: was a cruise ship that had over two hundred people
Speaker 3: report infections. There was a wedding in two thousand in
Speaker 3: Philadelphia that sickened eighty three attendees, again linked though not
Speaker 3: definitively to raspberries. Poor raspberries. Raspberries, and they're not the
Speaker 3: only culprit by any means. There have been outbreaks linked
Speaker 3: to basil, snowpeas, cilantro, green onions, and salad mix, and
Speaker 3: in fact, a large outbreak in twenty nineteen involving over
Speaker 3: twenty four hundred cases across North America was associated.
Speaker 4: With fresh basil.
Speaker 3: The lesson from all of these outbreaks is pretty clear,
Speaker 3: and it was summed up nicely in the last few
Speaker 3: sentences of the New England Journal of Medicine article detailing
Speaker 3: the situation in the nineteen ninety six outbreak. Quote in summary,
Speaker 3: Cyclospora has now been established to be a food borne pathogen.
Speaker 3: This outbreak is a reminder that our supply of fresh
Speaker 3: produce has become increasingly international and underscores the need to
Speaker 3: identify and investigate food born outbreaks promptly, to consider that
Speaker 3: a local cluster of cases could be part of a
Speaker 3: widespread outbreak, and to pursue investigations to the source of
Speaker 3: the implicated vehicle. For imported vehicles, international collaboration is critical
Speaker 3: to the success of the investigation and to the identification
Speaker 3: of appropriate measures of prevention and control. Quote vehicle meaning
Speaker 3: food which food item? An incredibly clear, level headed and
Speaker 3: well reasoned response.
Speaker 2: Uh huh.
Speaker 4: Who could argue with that?
Speaker 2: Not me, not me, but but da da da.
Speaker 3: So, following the outbreaks in nineteen ninety six and nineteen
Speaker 3: ninety seven, the Guatemalan government has cooperated with the FDA
Speaker 3: and the berry industry to institute policies to reduce contamination
Speaker 3: of cyclospora to help identify the source of these outbreaks,
Speaker 3: and other countries where contaminated food was traced have also
Speaker 3: followed suit, which is great and no doubt has reduced
Speaker 3: exposures to food borne pathogens and parasites. But of course
Speaker 3: no policy is perfect, and so it is crucial to
Speaker 3: have a well functioning, well funded surveillance system in place
Speaker 3: in this country to gather data and report any food
Speaker 3: born parasites or pathogens that pop up.
Speaker 4: Seems pretty obvious. You're a would who want that.
Speaker 2: I want it.
Speaker 3: I want it too, And we did have something like that.
Speaker 3: Technically we still do, but it is kind of a
Speaker 3: shell of its former self. Let me tell you about
Speaker 3: food net.
Speaker 4: Yes, cyclospor was not the only.
Speaker 3: Food born infection popping up in the nineteen nineties in
Speaker 3: North America. E Coli OH one five seven was the
Speaker 3: real battie, having sickened over seven hundred people and killed
Speaker 3: four children in nineteen ninety two and nineteen ninety three.
Speaker 3: And in response to this, I mean, it was a
Speaker 3: horrifying outbreak, a lot of fear.
Speaker 4: Listen to our Ecola episode.
Speaker 2: I think you talk about it mostly what we talk about, Okay, okay.
Speaker 3: But the USDA was like, okay, we got to start
Speaker 3: testing some meat and produce, and we got to implement
Speaker 3: a certain inspection system, like we have to have some
Speaker 3: kind of system for this. But of course, in order
Speaker 3: to justify the continued funding of such a system, there
Speaker 3: needed to be a way to measure its efficacy. Did
Speaker 3: infections go down, did exposure go down? Thus food Net
Speaker 3: was born. So in nineteen ninety five, the Food Safety
Speaker 3: and Inspection Service of the USDA linked up with the
Speaker 3: CDC to create the Foodborne Disease's Active Surveillance Network food NET,
Speaker 3: which was intended to monitor the incidents of certain food
Speaker 3: borne pathogens across the country to get a sense of
Speaker 3: where infections were happening and estimate how many infections there were.
Speaker 3: Total food net started out small, collaborating with just a
Speaker 3: handful of state and local health departments, covering at the
Speaker 3: very beginning fourteen point three million total and then screening
Speaker 3: for just a few pathogens. But over the years, food
Speaker 3: net proved how valuable of a surveillance tool it was,
Speaker 3: and more and more areas were included in the surveillance
Speaker 3: and the overall surveillance network. The data collected by food
Speaker 3: net also went far beyond is this pathogen present or not?
Speaker 3: Is there an outbreak or not. It was used to
Speaker 3: assess things like how food prep at long term care
Speaker 3: facilities could improve, how long term effects of antibiotic resistance
Speaker 3: salmonella infections, how informed physicians are about certain types of E.
Speaker 3: Coli infections, And eventually online tools were launched, which then
Speaker 3: allowed users access to a huge array of data on
Speaker 3: food borne illness.
Speaker 4: I mean it was awesome.
Speaker 2: Yeah, like really the amount of work and the fact
Speaker 2: that it was all an active surveillance net, active surveillance,
Speaker 2: not just passive surveillance. Yes, is massive.
Speaker 4: Yep, was massive.
Speaker 1: Yeah.
Speaker 3: By twenty twenty four, food net surveillance area had expanded
Speaker 3: to cover sixteen percent of the US population, about fifty
Speaker 3: four million people and eight different infections and outcomes were
Speaker 3: required to be tracked, so Camplobacter, cyclospora, listeria, salmonella, shigella, shiga,
Speaker 3: toxin producing E Coli, Vibrio urcinea, and hemolytic uremia sin
Speaker 3: which is caused by sugatoxin producing E.
Speaker 4: Coli.
Speaker 3: I mean great, great, what a valuable and fantastic public
Speaker 3: health tool. Essential as you could say, you could say.
Speaker 3: On July first, twenty twenty five, the CDC announced that
Speaker 3: food Net was cutting back on the number of pathogens
Speaker 3: it monitored. Reporting became optional for all but two, so
Speaker 3: now the only required reporting was for salmonella and sugar
Speaker 3: producing ecoal I. Sigatoxin producing E. Coli. Cyclospora is, of
Speaker 3: course one of the ones on the optional list. Why
Speaker 3: make reporting optional? Funding was the reason given, It's it's
Speaker 3: I'm sure, I mean funding is a smoke screen for this.
Speaker 3: We don't value this. And so now, with cyclost Barias's
Speaker 3: cases rapidly rising and with no clear picture as to
Speaker 3: which food or foods are responsible, the American public is
Speaker 3: paying the cost. Right, so if the government is saving
Speaker 3: how much money like one minute of the military budget
Speaker 3: for a day or something.
Speaker 2: One of the papers that I read actually said that
Speaker 2: the food Net budget, like to fund all of the
Speaker 2: local sites where they were working as well as the
Speaker 2: central staff, was seven million dollars. And I don't it
Speaker 2: was only one paper that I read, But really, are
Speaker 2: you serious?
Speaker 3: Is that hit? I mean, it's it's It's the kind
Speaker 3: of thing where you expect something like this to grow
Speaker 3: and grow and grow over the years, to have the
Speaker 3: number of pathogens that you're screening for grow as you
Speaker 3: have increased technology capabilities of doing this, and increase desire
Speaker 3: to If you have the tools, why not use them
Speaker 3: to make the world a better place, to help the.
Speaker 2: General public, to make America healthier?
Speaker 3: I guess, and so yes, under the guise of cutting budget,
Speaker 3: food Net has now been diminished. When what was once
Speaker 3: a trust did governmental public health institution like the CDC
Speaker 3: makes a policy change that reduces protections for its citizens,
Speaker 3: How can we interpret that any other way than shifting
Speaker 3: the cost and the consequences onto us onto the general public.
Speaker 4: I mean, do you remember what.
Speaker 3: Trump said during the pandemic in twenty twenty, So on
Speaker 3: June fifteenth or sometime in June twenty twenty, he said,
Speaker 3: if we stop testing right now, we'd have very few cases,
Speaker 3: if any. Is that the same strategy that we're using
Speaker 3: the cyclost for If we.
Speaker 2: Just don't test for it, then it's not there, then
Speaker 2: we don't have it. That's not how the world works.
Speaker 3: I mean, yeah, it's it's shocking, but that doesn't actually
Speaker 3: prevent disease from spreading. No, you know, who knew, Many
Speaker 3: people knew, everyone knew. So many states in this current
Speaker 3: outbreak are still individually monitoring cyclosporaut like Michigan, which seems
Speaker 3: to be the epicenter of this current outu break and
Speaker 3: has now launched, you know, like an interface where you
Speaker 3: can actually see cases and the number of cases.
Speaker 2: Their website is incredible wait to be beautiful.
Speaker 3: Yeah, but other states, such as Colorado have suggested that
Speaker 3: without food net support, they may have to cut back
Speaker 3: on disease surveillance as well. I don't know if that
Speaker 3: has extended to cyclospora and this current outbreak, but I
Speaker 3: know that without with the loss of this federal monitoring system,
Speaker 3: we are not going to have and we do not have.
Speaker 3: This outbreak shows it as good ability to get a
Speaker 3: sense of the scope of an epidemic like this. We
Speaker 3: are scrambling in the dark without this former cornerstone of
Speaker 3: public health, and it makes it much more difficult to
Speaker 3: halt its spread to gather information that we need. And
Speaker 3: the general public is trying to make up for this
Speaker 3: federal failure by crowdsourcing information on like threads and other
Speaker 3: social media platforms, seeing if they can piece together anecdotes
Speaker 3: to identify like a particular fruit or veggie or far
Speaker 3: link to the cases, like oh, I got sick and
Speaker 3: I had these raspberries and this is on the label
Speaker 3: and this is the date and whatever. Maybe that's where
Speaker 3: the answer will eventually come from. You know, people can
Speaker 3: do amazing things when they work together.
Speaker 2: Yeah, we love it, we do.
Speaker 3: And at the same time, I don't want a future
Speaker 3: where public health is solely conducted on social media without
Speaker 3: any peer review, Like that is not what we should have.
Speaker 3: What I want is a future where public health is
Speaker 3: prioritized and valued and respected and funded. One of the
Speaker 3: long standing challenges in championing public health is that the
Speaker 3: money saved by public health programs like food net it's
Speaker 3: not always easy to calculate or visualize to see it
Speaker 3: as money saved, but the cost of cutting public health
Speaker 3: is very very clear. We're seeing it right now. And
Speaker 3: so with that, Aaron, I'll turn it over to you
Speaker 3: to tell me what's happening with this current outbreak.
Speaker 2: I would love to. I'm going to take a step
Speaker 2: back and give us a broader picture of where cyclospora
Speaker 2: fits in, because it is probably something that most people
Speaker 2: never heard of until this year, despite the fact that
Speaker 2: we have had outbreaks in the past and globally I
Speaker 2: said already, this is a much more prevalent pathogen even
Speaker 2: than I realized. In some areas where it is endemic,
Speaker 2: like in parts of Latin America and in Southeast Asia,
Speaker 2: prevalences can range from ten to forty percent in some populations,
Speaker 2: meaning that that paraside is just around. It's just around.
Speaker 2: It's infecting people, some of them show symptoms and some
Speaker 2: of them don't. So far, in places like the US
Speaker 2: and Europe, it has not been considered endemic. However, there's
Speaker 2: a lot of questions as to whether or not it
Speaker 2: really is, because, like you said, Erin, in the past,
Speaker 2: a lot of times outbreaks have been associated with produce
Speaker 2: that has been imported, but in the last few years
Speaker 2: there have been well documented cases of outbreaks associated with
Speaker 2: produce grown here in the US.
Speaker 4: Yeah, or I.
Speaker 3: Think there was an outbreak in Germany associated with a
Speaker 3: salad mix that had been grown in France, and so
Speaker 3: they're like, okay, now it's in Europe potentially.
Speaker 2: Well in Italy. Ever, since twenty fifteen, there were like
Speaker 2: twelve percent of environmental samples that were testing positive for cyclospora,
Speaker 2: and prevalence in some studies in humans was up to
Speaker 2: twenty seven percent. So it's certainly around. We maybe just
Speaker 2: haven't been paying that much attention to it, but cases
Speaker 2: in the US have certainly been on the rise since
Speaker 2: at least twenty sixteen. So despite the fact that food net,
Speaker 2: how we can just say, has crumbled at this point,
Speaker 2: cyclosphora is still a nationally notifiable disease, which means that
Speaker 2: there is a system here in the US called the
Speaker 2: National Notifiable Disease Surveillance System. It's like the longest acronym.
Speaker 2: But it is still the case that when hospitals and
Speaker 2: clinics pick up on cyclospora, they have to report that
Speaker 2: to the CDC. This is a passive surveillance system. It's
Speaker 2: great that we have it. It is not the same
Speaker 2: thing as actively looking for cases of food borne illness
Speaker 2: the way that food Net did so, even though food
Speaker 2: net only covered what did you say, sixteen percent of
Speaker 2: the US something like that, it was actively looking for
Speaker 2: and identifying. Hey, these cases might actually represent a larger
Speaker 2: outbreak than what we're realizing, and that is what we
Speaker 2: have lost here.
Speaker 3: Yeah, passive surveillance is not a substitute for active surveillance.
Speaker 2: No, it's not. And I think that it's really easy
Speaker 2: to just well, at least on the CDC's website, what
Speaker 2: they have said is like, don't worry, We're still surveilling
Speaker 2: for these things, and we're not in this way period.
Speaker 4: We are not.
Speaker 2: So all of the data that I have right now
Speaker 2: is from the National Notifiable Disease Surveillance System, so the NNDSS,
Speaker 2: and they only have updated it as of July fourth,
Speaker 2: which is annoying because they were supposed to update it
Speaker 2: yesterday because that's the end of the week. But as
Speaker 2: of July fourth, according to the NNDSS, there were one thy,
Speaker 2: eight hundred and thirty eight cases so far in twenty
Speaker 2: twenty six, Okay, as of July fourth, and this is
Speaker 2: July fourth, Yeah, and this is just that had been
Speaker 2: reported to the CDC. There's always a delay between when
Speaker 2: something has been I shouldn't even say reported to the CDC.
Speaker 2: These have just been reported to this surveillance system. The
Speaker 2: CDC then has to like confirm whether or not that
Speaker 2: case is a confirmed case. By this same point in
Speaker 2: twenty twenty five, we can compare there were just over
Speaker 2: one thousand cases. So we're looking at over eight hundred
Speaker 2: more cases as of July fourth compare to twenty twenty five.
Speaker 2: But if we look at the beautiful state of Michigan,
Speaker 2: who is doing a phenomenal job of keeping the public
Speaker 2: informed and of updating what their case numbers are, they
Speaker 2: have reported as of July ninth, one thousand, five hundred
Speaker 2: and sixty two cases just in Michigan alone, forty four
Speaker 2: hospitalizations and several hundred of those cases happened just in
Speaker 2: the last week, so from July fifth to July eleventh.
Speaker 2: Ohio has also reported a number of cases, and the
Speaker 2: Ohio State Department of Health is not updating it on
Speaker 2: a regular basis. But the Toledo Lucas County has a
Speaker 2: really great active tracker, so way to go Toledo County. Toledo,
Speaker 2: they have reported four hundred and twelve cases in Lucas
Speaker 2: County and six hundred and sixty one in northwest Ohio.
Speaker 2: And that's compared to like Ohio as a state, which
Speaker 2: so far only reported one hundred and seventy seven as
Speaker 2: of July eighth.
Speaker 4: It's such a mess.
Speaker 2: It's a mess, and we are in the middle of it.
Speaker 2: We are not at the end of it. We are
Speaker 2: not at the beginning. We are smack in the middle
Speaker 2: of this. New York City, New York State has reported
Speaker 2: just under four hundred cases. Again, I couldn't get info
Speaker 2: from their exact website. It's all from news reports. North
Speaker 2: Carolina two hundred, Illinois one hundred and sixty one. And
Speaker 2: that's just the cases that seem to maybe be associated
Speaker 2: with these outbreaks. Here's the thing, we do not know
Speaker 2: if this is one outbreak, if this is one multi
Speaker 2: state outbreak, if this is many mini outbreaks. Cases are
Speaker 2: reported every single year, especially from May through August, which
Speaker 2: is cyclosporas season. So we've had cases in like over
Speaker 2: thirty one states, but that's not unusual. What's unusual is
Speaker 2: the sheer number that have happened in the last less
Speaker 2: than one month. Essentially record breaking. Yes, yes, guess it's
Speaker 2: getting there. It's getting there. If we look at overall numbers,
Speaker 2: like say yearly numbers, they have been increasing since twenty
Speaker 2: sixteen per the National Notifiable Disease Surveillance. Before twenty sixteen,
Speaker 2: it was usually just a couple of hundred cases a year,
Speaker 2: except for years when we had larger outbreaks. But every
Speaker 2: year since twenty seventeen there have been over two thousand cases.
Speaker 2: In twenty twenty five there was thirty nine hundred cases,
Speaker 2: twenty twenty four there was forty two hundred cases. But again,
Speaker 2: even knowing that at this point last year we had
Speaker 2: seen well under the number of cases that we're seeing
Speaker 2: right now. And if you look at the actual state
Speaker 2: level data like this is July twelfth, there's probably close
Speaker 2: to three thousand cases that have actually been reported to states,
Speaker 2: And the CDC is just really lagging on updating that
Speaker 2: data overall because their numbers on their official website say
Speaker 2: like eight hundred ah. So it's not just the loss
Speaker 2: of food net. It is also the massive reductions in
Speaker 2: force that we have seen at the FDA, the USDA,
Speaker 2: and the CDC that have all had major effects on
Speaker 2: our ability not just to identify and trace back the
Speaker 2: sources of these outbreaks, but also communicate with the public.
Speaker 2: A lot of the people that got laid off were
Speaker 2: in charge of this public facing communication, yep. And then
Speaker 2: the question of what is causing this particular outbreak or
Speaker 2: however many outbreaks are going on right now, we don't know. Historically, Arin,
Speaker 2: you mentioned a lot of the common culprits raspberries and
Speaker 2: other berries, things that you tend to maybe not wash
Speaker 2: that thoroughly or that are really difficult to completely wash.
Speaker 2: Same thing with pre washed, bagged salad mixes, and like
Speaker 2: fresh herbs, things like basil, cilantro, parsley. All of those
Speaker 2: have been implicated in the past. From what I could tell,
Speaker 2: there's absolutely nothing that has been identified at this point.
Speaker 2: We do not know period. Despite that, Taco Bell in
Speaker 2: Michigan is like not serving any fresh lettuce or onion
Speaker 2: or anything like that, and I'm like, go Taco Bell,
Speaker 2: be proactive. But places like Michigan have put together some
Speaker 2: really great resources on how people can try and protect themselves.
Speaker 2: Cooking your food does inactivate this parasite. So anytime that
Speaker 2: fruits and vegetables can be cooked, they're going to be
Speaker 2: safer than if you're eating them raw things that you're
Speaker 2: not going to cook or cannot cook for whatever reason.
Speaker 2: Washing them in a solution with vinegar, like completely submerging
Speaker 2: them and swishing them around and soaking them, they say
Speaker 2: maybe helps a little bit more than just a quick rinse.
Speaker 2: There's not like great data to support any of that,
Speaker 2: because again, none of the things that we typically use
Speaker 2: for disinfection, even like chlorine, are actually effective in killing this.
Speaker 2: So all of that is the goal is washing it away,
Speaker 2: not killing or inactivating the parasite. Even freezing doesn't completely
Speaker 2: kill it, because we have seen outbreaks associated with frozen
Speaker 2: raspberries in the past. Yeah, so yeah, I don't have
Speaker 2: a there's not a perfect answer here. Authorities are recommending
Speaker 2: that if people, especially in areas where there have been
Speaker 2: a lot of cases reported so far, so Ohio, Michigan,
Speaker 2: New York, Illinois, also North Carolina, if people are having
Speaker 2: more than two to three days of diarrhea, it's recommended
Speaker 2: that they go get tested, in parts so they can
Speaker 2: get treatment, and in parts so that we can get
Speaker 2: a better handle on what's actually going on and how
Speaker 2: large this outbreak really is. Yeah, that's what I got Arin.
Speaker 2: It's a bit of a mess. And if we do
Speaker 2: not invest in public health infrastructure, which is the same
Speaker 2: refrain that we say every single time the time, then
Speaker 2: we are going to continue to see outbreaks like this.
Speaker 2: Outbreaks happen no matter what, but our ability to get
Speaker 2: a handle on them and to be able to identify
Speaker 2: what factors led to this outbreak and then get them
Speaker 2: under control is severely hampered when we fail to adequately
Speaker 2: fund public health, especially to staff our agencies with knowledgeable
Speaker 2: people who know what the heck they're doing, right.
Speaker 4: Yep, I mean.
Speaker 3: And it's like it is it is not satisfying, no
Speaker 3: or pleasant in any way to say I told you
Speaker 3: so in a situation like this. It's it is really frustrating,
Speaker 3: and it is is tiring, It exhausts, it's exhausting, Like
Speaker 3: no one wants to have to say I told you
Speaker 3: so when it comes to matters of defunding public health.
Speaker 3: But this, in many ways, our lack of ability to
Speaker 3: understand the scope and the source of this outbreak is
Speaker 3: very much associated with the cuts and funding to food Net,
Speaker 3: to CDC, to other governmental institutions that you mentioned. No
Speaker 3: one wants to say, I told you so, but guess
Speaker 3: what people to people told.
Speaker 4: Us so.
Speaker 2: Yep, Aaron, that's cyclospora. Thus far keep refreshing your news
Speaker 2: feeds because there will be more.
Speaker 3: There will be more sources for this. So I have
Speaker 3: a bunch of different papers on cyclospora.
Speaker 4: There was a paper I think if.
Speaker 3: You would like to read about the nineteen ninety six
Speaker 3: outbreak and outbreak of in nineteen eighty six of cyclosporiasis
Speaker 3: associated with imported raspberries by her Waltz at All and
Speaker 3: then there are a few reviews in there. But if
Speaker 3: you would like to read about the food net, there's
Speaker 3: a paper from twenty fifteen that talks about food net
Speaker 3: and it's called It's by hanw Yeah, food Borne Diseases
Speaker 3: Active Surveillance Network, so check it out.
Speaker 2: My favorite paper for just an overview of cyclospora in
Speaker 2: general was from Lancet Infectious Disease twenty nineteen and it
Speaker 2: was called human cyclist boriasis. That one's a great overview.
Speaker 2: There was another one from Veterinary Parasitology in two thousand
Speaker 2: and four called Cyclospora kitenensis a food and waterborne cocidian parasite.
Speaker 2: A bunch of other reviews just of the parasite itself.
Speaker 2: I have a number that details some of the previous
Speaker 2: outbreaks as well as some of the data on surveillance
Speaker 2: prior to the last few years. So there was like
Speaker 2: an MMWR that was from twenty nineteen, looked at surveillance
Speaker 2: in the US from twenty eleven to twenty fifteen. I'll
Speaker 2: have links to the National Notifiable Disease Surveillance Systems. You
Speaker 2: can get updates every week on that. That data is
Speaker 2: not finalized by any means, but it's at least a
Speaker 2: sense of like where things are going, as well, of
Speaker 2: course as the Michigan Department of Health and the Toledo one.
Speaker 2: If I find others, I'll try and post them as
Speaker 2: well to you, just so that people know where they
Speaker 2: can find more up to date information. The CDC seems
Speaker 2: to be updating every two weeks. I'm not really sure
Speaker 2: how often they're updating, but you can find the list
Speaker 2: of sources from all of our episodes on our website,
Speaker 2: This podcast will Kill You dot com.
Speaker 3: You can thank you to Blobmobile for providing the music
Speaker 3: for this episode and all of our episodes.
Speaker 2: Thank you to Leanna and Tom and Mark and Pete
Speaker 2: and Jessica especially for getting this episode out on such
Speaker 2: a short timeline. Thank you all, sorry so much for
Speaker 2: making you work for you Sy, We really appreciate it.
Speaker 3: Thank you, thank you, and a big thank you to
Speaker 3: you listeners. Let us know what other questions you have
Speaker 3: about cyclist Boro. We're curious, yeah, let us.
Speaker 2: Have questions too, And as always, a shout out to
Speaker 2: our patrons. Thank you so much for your support over
Speaker 2: on Patreon. It means a lot.
Speaker 3: It really does, it really does well. Until next time,
Speaker 3: wash your hands
Speaker 2: You filthy animals.