Cyclosporiasis cases in Missouri reached 216 this week, with ongoing investigations into the intestinal infection. FDA issued a voluntary recall for iceberg lettuce linked to the outbreak. State Epidemiologist Nathan Koffarnus with the Department of Health and Senior Services reported the number has been increasing rapidly, yet the exact sources of transmission are uncertain.
He explains the origin of the hard-to-kill parasite that contaminates fresh produce and water.
“The problem with cyclospora and how it spreads to our food is, basically human waste makes its way into irrigation water for fruits and vegetables. And then these these sports are very hardy and they can cling to those items and, So it’s, it’s ultimately at the end of the day, it’s a problem of, you know, sewage handling and what water’s used for irrigation and some of those practices.
Koffarnus said more people are being diagnosed because of people’s awareness.
Koffarnus briefs media on Cyclosporiasis in Missouri July 20, 2026 (Missourinet photo)
“We have seen a, a tremendous amount of testing, a tremendous amount of interest come in. I think the increased awareness has helped to drive diagnosis and testing because there are probably a lot more people that, you know, wouldn’t have gone to the doctor, but because this has been in the news have sought out care, have sought out testing specifically cyclospora, which isn’t necessarily a common condition to be tested for,” he told reporters in a briefing.
He said Missouri is part of a nationwide effort to track and test cases:
” So when it comes to a large national outbreak like this, what we’re really trying to do is participate in the whole. So there’s a lot of national calls coordination between states coordinated coordination with CDC and FDA. So we’re really participating in that and trying to assist.”
He said cyclospora are “hard to kill and they’re resistant to most, even like industrial disinfectants that get used on food that are safe to eat. So, soaking alone, something like that, the best hope is really to rinse them off so that you don’t consume them when you eat them. But again, barring that, cooking the items so that you kill it, that would probably be the safest thing, or just avoiding it until you’re confident that this has passed and those items are safe to eat.”
Koffarnus added that a voluntary recall of iceberg lettuce continues.
‘We always would love to find the smoking gun with one of these investigations and I think that’s still possible that that’ll happen especially because this is still pretty early on. And there’s probably a lot of tests still pending.”
Doctors treat the infection with antibiotics and in some cases the symptoms can last for weeks. Those include watery diarrhea, nausea, abdominal cramps, and fatigue.