Cyclosporiasis outbreak in Germany associated with the consumption of salad

Abstract

This outbreak is the first foodborne cyclosporiasis outbreak reported from central Europe. The illness was reported in 34 persons who attended luncheons at a German restaurant. The overall attack rate was 85% (34/40). The only foods associated with significant disease risk were two salad side dishes prepared from lettuce imported from southern Europe and spiced with fresh green leafy herbs (p=0.0025).

Figure 1

Unsporulated oocyst of Cyclospora cayetanensis in an unstained stool preparation. A) Differential interference contrast. B) Same oocyst with typical blue autofluorescence (Filter sets: 365-nm excitation, 395-nm dichroic mirror, 420-nm suppression).

Figure 2

Epidemic curve of an outbreak of cyclosporiasis occurring in attendees of four holiday luncheons in a restaurant in Germany in December 2000. Results for the 26 cases in a retrospective cohort study. *Defined as having reported any of these symptoms: diarrhea (>3 bowel movements per day), loss of appetite, weight loss, flatulence, abdominal cramps, nausea, vomiting. †Laboratory confirmation by detection of Cyclospora oocysts in at least one stool sample by a modified Ziehl-Neelsen technique.