19 News partners with MetroHealth to answer questions about produce parasite, air quality alert

CLEVELAND, Ohio (WOIO) - 19 News partnered with health experts Thursday to answer your questions about cyclosporiasis, a parasitic illness that can cause severe, sometimes “explosive,” diarrhea and other stomach symptoms.

Local doctors also addressed air quality, which has risen to hazardous levels at times Thursday, due to wildfire smoke from Canada. The smoke is not expected to clear until Friday.

Digital Anchor Dan DeRoos spoke with Dr. David Margolius, Cleveland’s Director of Public Health, as well as MetroHealth doctors Melissa Jenkins and Jeremiah Escajeda.

19 News received dozens of viewers questions during hours of live coverage. Watch the attached videos, or stay scrolling for a summarized Q&A.

Understanding the Cyclospora Parasite and the Outbreak

Q: What is Cyclospora, and what disease does it cause?

A: Cyclospora cayetanensis is a microscopic, single-celled parasite. When ingested, it causes an intestinal illness known as cyclosporiasis. The most hallmark symptom is severe, frequent, and sometimes “explosive” watery diarrhea.

Q: How widespread is the outbreak in Ohio right now?

A: The outbreak is experiencing a major surge. The Ohio Department of Health reports 1,246 confirmed cases statewide as of Thursday.

Q: How is the parasite transmitted? Can I catch it from another person?

A: Cyclospora is transmitted through the fecal-oral route—meaning a person must consume food or water contaminated with microscopic amounts of feces containing the parasite.

• Important: It is not spread directly from person to person. The parasite passed in a sick person’s stool requires days to weeks in the environment to become infectious to someone else.

Q: Are pools or splash pads safe during this outbreak?

A: There is emerging concern because Cyclospora is highly chlorine-resistant. It can survive in standard chemically treated pool water and splash pads, meaning public aquatic facilities could potentially serve as secondary sources of transmission.

Symptoms, Incubation and Medical Care

Q: What are the main symptoms of cyclosporiasis?

A: While watery, explosive diarrhea is the most common symptom, others include:

• Loss of appetite and significant weight loss
• Severe stomach cramps, bloating, and increased gas
• Nausea and fatigue
• Low-grade fever and flu-like aches

Q: How long does it take to get sick after exposure?

A: The incubation period is typically 1 to 2 weeks. Symptoms do not start immediately after eating contaminated food.

Q: How long do symptoms last if untreated?

A: If left untreated, cyclosporiasis can persist from several days to a month or more. Symptoms may also be cyclical—seeming to improve or disappear, only to return a few days later.

Q: How is it treated? Can I use over-the-counter anti-diarrheal medicine?

A: Standard over-the-counter anti-diarrheals are generally ineffective because they do not clear the parasite.

• Cyclosporiasis is highly treatable but requires a specific prescription antibiotic (typically trimethoprim-sulfamethoxazole, commonly known as Bactrim, Septra, or Cotrim).
• Patients with sulfa allergies should consult their doctor for alternative therapies.

Q: When should I seek professional medical care or contact MetroHealth?

A: You should consult a healthcare provider if you have:

• Diarrhea lasting more than a few days
• Signs of dehydration (severe thirst, dry mouth, little to no urination, extreme dizziness)
• Inability to keep fluids down

Food Safety and Produce Washing Guidelines

Q: What fruits and vegetables are at the highest risk?

A: Produce with complex structures and “nooks and crannies” are the most difficult to clean and pose the highest risk:

• High-Risk: Bagged lettuce, romaine, broccoli, cauliflower, romesco, and other cruciferous greens.
• Fragile Items: Berries (strawberries, raspberries, blackberries).
• Herbs: Cilantro and green onions (scallions).

Q: Can I trust “pre-washed” or “triple-washed” bagged lettuce?

A: No. You should not rely on pre-washed labels during an active outbreak. If the water used in a commercial processing facility is contaminated, it can actually distribute the parasite across a wider batch of produce. Re-washing bagged greens at home is highly recommended.

Q: Why is Cyclospora so difficult to wash off?

A: The parasite forms a highly resilient, thick-walled protective shell (a zygote or oocyst). This shell makes it immune to standard chemical veggie washes and chlorine. Physical friction is required to mechanically dislodge it from the food’s surface.

Q: What is the step-by-step method to safely wash produce at home?

Based on food safety protocols highlighted by health officials:

1. Sanitize First: Wash hands with soap and water for at least 30 seconds (remove rings first). Thoroughly clean knives, cutting boards, colanders, and countertops.
2. Wash Under Running Water: Always rinse produce under cool, running tap water. Do not submerge or soak produce in stagnant sink water, as this can spread the parasite.
3. Apply Physical Friction: Use your hands and fingers to vigorously rub the surfaces of produce (especially leafy greens, berries, and herbs) to physically dislodge the parasite.
4. Scrub Hard-Skinned Items: For firm produce like melons, cucumbers, and tomatoes, use a clean scrub brush with mild dish soap and running water, then dry with a disposable paper towel.
5. Wash Before You Cut: Always wash the outer skin or rind before cutting. Cutting an unwashed melon or head of lettuce will transfer surface parasites directly onto the knife blade and into the edible flesh.
6. Post-Prep Sanitization: Wash all equipment and your hands again with hot, soapy water immediately after preparation is complete.

Q: Should I prepare food for my family if I’ve been sick?

A: Absolutely not. If you are experiencing symptoms or are currently recovering from cyclosporiasis, do not prepare food or beverages for others. This is critical to preventing the accidental introduction of pathogens into household meals.

Air Quality Alert

The Ohio Environmental Protection Agency (EPA) issued a statewide air quality alert Wednesday until further notice for smoke from the Ontario wildfires moving into Ohio.

The smoke entered northern Ohio early Thursday morning and could extend into the entire state by the end of the day.

Dr. David Margolius, Director of the Cleveland Department of Public Health, said as of 12:30 p.m. Thursday, the air quality levels are worse than it ever was in 2023 with that round of Canadian wildfires.

The EPA advised that the smoke is causing reduced air quality and people may experience health effects.