Hello, folks. Dr. Maurice Selby here, medical director, producer, and co-host of Health in Harlem on WHCR 90.3 FM and the Health in Harlem podcast.
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Hello, ladies and gentlemen.
My name is Maurice Selby a.k.a. Dr. Mo Selb My name is Reed, And you're listening to the one and only Health in Harlem on WHCR 90.3 FM, New York, The Voice of Harlem and the Health in Harlem podcast.
And we are going to be discussing the outbreak. It is all over the news, but we figured we'd spend some time with it and maybe approach it from a different angle. But yeah, man, how have you been doing, Reed?
Yeah, I've been doing well. It's summer in the city. I just went camping, so that was really nice.
And now I'm back. How about you? I'm good, man.
Camping. Don't tell me you drink from like a contaminated water source. I brought a filter along.
All the water was pretty clean. A couple leeches, but otherwise, not too bad. Where did you go camping?
Up in the Adirondacks. Nice.
Yeah, stayed in New York, but rented a car and drove up to the Adirondacks and did a little camping. So nice to get away, but nice to be back. That's what's up, man.
And now that is that is something we aspire to myself and the girls. I think one day we can do it. But right now it'd be more like glamping and we got to bring like air mattresses and stuff.
I don't think we do well. We barely do well in our own beds as a family. Like they were both sleeping with us last night, man.
It was torture. But anyway, we got to talk about this, man, because I think there's already I can't say there's panic, but I've definitely seen the alarm and people like asking more questions about sort of what's going on. With more information popping up in like social media news feeds on my phone continuously, i can't even say that's a bad thing honestly i'm actually, kind of happy that this illness is getting the attention that it's getting but i definitely was hoping that we could put it into perspective amidst the many other public health challenges we have.
Like i want to make sure that this is at the appropriate level for folks so they understand but anyway yeah man let's let's tone it down a notch so for real for There's a lot of cases, more than 1,600 cases spanning 34 states since May 1st of this year, 5,100 in total that are sort of even under investigation at this point to see if they are connected to the outbreak. With that over 1,600 or more specifically, 1,645 cases that are known of those cases, 149 that have been hospitalized. It's about 9% of those cases.
But one thing, no deaths, no deaths up to this point. The thing to understand, too, though, folks, this is substantially higher than where we were last year, where by this time last year, there were 249 known cases around this time throughout the country last year. But another thing, too, that we have to think about is that this is I think this is the case with everything we talk about, Reed, whenever it is an outbreak of an infectious disease.
The one thing that always comes up, right, is that, hey, these cases are often underdiagnosed and or underreported. I think across the board, whenever we talk about an outbreak and in this case, we're not talking about a novel illness, not like novel or something new, like as in, you know, when COVID first hit the scene. But whenever there's an outbreak, there's always a lag.
Right. I think that's an important pattern to note that there's always a lag. Right.
The number of cases that are under investigation, and then the potential cases that nobody ever talked about. Either folks just didn't report them or talk about their illness, or they were just not diagnosed, meaning we missed them, right, as clinicians. And I even have examples of that, you know, as we go on in the program and talk more about this.
But yeah, some of the same patterns we see.
Another thing, the CDC, the FDA, Food and Drug Administration, and other state and local health agencies are collaborating to try to determine the source of this outbreak. They're actively working on it. But yeah, the bad news, that's it, y'all.
That's the bad news. We have another outbreak. All right.
There's another outbreak to deal with. And the headaches that come with that, the anxiety, infection control measures, the misinformation and disinformation, all of that is there. The political ramifications—Lord knows what the outcome of this will be.
And we don't talk that on this program, but for real, right? That's one thing that is, you know, I'm even anxious about. If there's anything I'm anxious about, it's like, man, what are we going to gain from this outbreak?
Not only in getting a handle on it, but what we learn from it. That's the bad news.
No, for sure. But there is plenty of good news. Like I said, I went away for five days and before I left, I heard nothing about it.
And now that I'm back, Like almost everybody I know and I've talked to has mentioned it. So I think, you know, the information is out there and it's spreading really rapidly. It's not as dangerous or deadly as other pathogens, at least from a morbidity mortality standpoint.
It could certainly be a lot worse. A 9% hospitalization rate is concerning, but it is treatable. And once a diagnosis is made, we can treat it not only with supportive therapies, but with antibiotics.
So it's totally treatable as well. And so those are all the good things There's been no death so far It's treatable It's obviously going to suck It's going to put you out of work for a few days You're not going to feel very well You might even, you know, really have some energy drained And have, you know, maybe some negative health implications down the road But I think from a management standpoint This is definitely a manageable disease As long as we continue to stay on top of it We have the right resources to track the illness Yeah, we just attack it together as a community.
I guess that's part of the good news to read is because, you know, when I think about it, I'm like, man, this is not I'm so I'm surprised, actually, that it's getting this much coverage. You know, it's saturation almost as much as I've seen it pop up. I've seen it on like the broadcast news, like on television, as I said, in my like social media and news feeds, maybe myself, you know, sort of prime for this and some of like the algorithms and stuff and what they send to me as an individual.
But like you said, man, there's people coming up and asking me that I was like, oh, wow, you oh, you know what is going on. That's what's up. You know, it's reaching everyone.
And if anything, I'll say that's part of the good news. Right. We still have some aspects of our public health system that are functioning, folks.
If anything, that's what I'm like, considering all of the challenges, everything that's happened over the last few years since COVID, you know, loss of funding, many health departments. And I'm talking about even from the top, the tippity top, the CDC, FDA, the Department of Health and Human Services, just as a whole. We talk about funding cuts across the board at the federal state level, even at some local levels.
And guess what is still functioning?
Now, not optimally. That's one thing I'll talk about, I think. Right.
Not optimally, not at the highest levels, because I would argue that something like this probably would have been prevented from the get go. 249 cases last year, and we're up to 1600 this year. I think that might be evidence of our systems struggling a little bit or having being more challenged, right?
More taxed because they're less resourced. But in the end, I'm like, man, somewhat it's functioning because we know it's out there and folks are investigating it. And I think we're getting more information coming in that might point to, you know, the source where we can really get a handle on this.
And then with that said, I want to just shout out, right, take this opportunity to celebrate the public health community, the heroes and sheroes that are still doing this work despite the public backlash since COVID, the epidemiologists, the microbiologists that are appearing through microscopes right now to learn more about this. The people that are performing the critically important detective work, looking for the sources of this outbreak, the systems engineers, the food inspectors, testers, physicians, advanced practice providers that are out there trying to make the diagnoses.
Right. The nurses out there collecting the specimens to send stool specimens. I shout all of those folks out, man.
And then as wounded as our public health system is in recent years. Right. I think we still benefit from it.
That's the thing that I'm hoping folks, can really take that away. And we find ways to invest in this infrastructure because this is important. And we got lucky with this one.
I mean, there's more stuff out there, ladies and gentlemen. Right. More emerging threats.
But the system is designed to keep us all safe. And I'm hoping we can start to build that back up before we do get something with a higher mortality rate or that is more virulent. Right causes more severe disease something that spreads like wildfire like some of those COVID variants that we saw or even the initial sort of outbreak of COVID man that was scary bro and i don't know if we learned a lot from that unfortunately.
Yeah, I feel like one somewhat functioning system. I feel like one thing that I've been picking up on lately, and I know this is just sort of like a my own kind of case study, but I feel like there's not as much disinformation out about cyclospora yet. I feel like a lot of the information, I mean, again, like you said, it could just be how my algorithm is primed as somebody who's curious about medicine and that kind of stuff.
Maybe I am just kind of feeding myself accurate information, but I don't know. I feel like it's easy to find good information about cyclospora. It came up really quick.
So I feel like one thing that we might have learned from the pandemic is there's so many micro-influencers who have YouTube channels, doctors who have, you know, Instagram pages who are out there disseminating good and accurate health information to combat the disinformation out there. And I feel like that's something we've learned from the pandemic, because it's like it wasn't it's not just, you know, CDC newsletter anymore, because these are sort of government entities that we don't necessarily trust that much anymore. But it's it's now like this dermatologist that you follow who does like cool skincare videos is now putting out a video about cyclospora and, you know, providing accurate health information.
So I think that's something that we've learned from the pandemic. And I think we're better equipped to combat misinformation. Obviously, this is a fairly straightforward illness.
It's caused by a parasite. We know roughly where it comes from. We're trying to pinpoint it down.
There's no vaccines involved that rules out a whole, you know, sort of source of misinformation. But I think we're doing a good job so far. And I want to caution all those listening out there that with new information that comes out to, you know, take it with a grain of salt, look at the source, look at who it's from, do a little bit more digging to verify if you can find the same claims in other sources.
And yeah, just sort of research things and, you know, ask questions as you hear new things.
Yeah. And that's one thing I'm hoping to read in this program. We can point to people to those more reliable sources of information.
And I, too, now I'm waiting for it, man. I'm like, I got to sit down and get on social media, which is, I hate to say it, one of the banes of my existence. I have to be on these platforms now to try to like find not only the good information to point people towards, but also the misinformation so that we can challenge that and call it out for what it is and the disinformation.
Information but yeah man I agree like I have not seen you know in all of the reels that I see playing on like my family and friends phones or like at work as I'm just running around and stuff I haven't really seen a lot of stuff crop up, pertaining specifically to this outbreak and cyclospora but if anything I'm worried that is on the horizon and so I think if anything we can take this opportunity to kind of have a lead right before all of that stuff, sort of saturates things, you know, behind the waves of media coverage that we see already. But let's talk about Mike Cyclospora because I'm actually fascinated by sort of where this came into existence and not that.
It existed when we identify it has been around for, you know, millennia. But we sort of first picked it up as human beings and understand natural history, sort of where it comes from and how it causes disease. I think that is fascinating.
So in May 1993: Souls of Mischief’s “93 ’til Infinity” was a hip hop hit on the radio. The 274th and final episode of Cheers aired, drawing millions of viewers. There was Cliffhanger was a blockbuster movie to be released in the summer.
Like one of Sylvester Stallone's classics after Rambo and Rocky in the 80s. That was like his 90s, I guess, one of his 90s hits. And, you know, believe it or not, I never saw that movie, Reed.
I was like, damn, y'all need to go back and watch it.
No, me neither. Cliffhanger, bro. All this was before my time.
I was born in 98, so before my time. Okay, okay. I was nine.
I remember when Cliffhanger came out, but I never saw the whole thing. I'm embarrassed to say. Anyway, OK, I move on.
And then there was a New England Journal of Medicine article that appeared describing cyanobacterium-like bodies recovered from immunocompetent and immunocompromised people in Peru. They noted this spherical cyst-like organism that was found in the feces of an 85-year-old Peruvian woman that presented with severe chronic diarrhea. Chronic as in diarrhea that had been going on for multiple weeks.
Usually about two weeks is where we kind of make that determination. And in 1987, there were two additional patients, a 33-year-old American missionary and a 50-year-old wholesale meat vendor that were evaluated in Peru for cases of diarrhea. Some of it had been chronic as well going on for weeks.
They were found to have similar organisms, this cyanobacterium-like or organism that contained cyanobacterium-like bodies. Basically, these were dark spots within these sort of membrane-walled organisms, that, you know, following acid-fast staining or when you do certain staining techniques to look at organisms or microscopic organisms under a microscope, they take up the stain and they cause these various colors and they had sort of this, cyan, or bluish, color or really a dark color stained with them. The individuals had endoscopies.
So they had basically cameras that went down their esophagus to look at their esophagus and their stomach to see if there were any lesions and they were negative. Right. But then one of the things that came up was that they kept on getting these from the stool of these individuals, kept on getting these organisms.
And then after a few weeks, they just sort of went away. Right after multiple weeks of having this diarrheal illness and them shedding, these cyanobacterium-like organisms, they ultimately were no longer had detectable organisms. And at first it was some confusion because the organisms looked like some other protozoa.
One thing, right, that. We understood pretty early is that these were protozoal organisms. Protozoa basically are organisms that can often function as parasites in mammals, including humans, and they resembled some cyclospora or some organisms from the genus Cyclospora, and look similar to them, including organisms like cyclospora muris, which typically infects like rodents, and even Cryptosporidium parvum, which can infect young children and cause severe diarrheal illness.
So that was one thing that these researchers were picking up right away is that, hey, man, this is not only something different, but it looks similar to things that we already sort of know about and even know sort of the pathophysiology of, right, how it causes diseases and maybe even how to treat it. Problem is when they did try to treat these organisms, despite their morphological or their similar appearance to these other infections, right, these patients were not responding to treatment appropriately, right? They were not improving as expected.
And from 1988 through 1991, there was this prospective study of two cohorts of infants and children that were experiencing diarrheal illness, and they were found to have these organisms present in their stool samples. It was found that these organisms were similar, as we said, to the coccidian genus Cyclospora, But on further study, they were really found to closely resemble Cryptosporidium in both their morphology and in the symptoms that they cause in these patients, especially when it came to the diarrhea. And from there, they noted even more specifics of this organism.
Now, the thing is, right, I want to really point this out, ladies and gentlemen, just because... I think it is important to, when we talk about information gathering and how the science is done, right, the work that goes into research like this, I want to highlight that because I think it'll and Reed, I don't know, you can challenge me on this, man, or weigh in.
But, you know, I think when folks look at the work that goes into an investigation like this, and we're talking about the outset of understanding this disease that we're dealing with today, right, back in the late 80s and early 90s, figuring out what cyclospora, what this was, right? I think it's important to think about the work that went into this, because then when we compare that with, again, I'm already waiting for the rush of misinformation that's coming to read and disinformation, because I feel like it's, I'm not going to sit here and be naive and say it's not going to happen, right?
There's going to be nonsense that creeps up talking about, you know, what this is and how to treat it. There's going to be maybe some conspiracy theories and all of that stuff. Like, I feel like it's coming and maybe we can get ahead of it right now.
But just look at like the science behind figuring out this organism, right? And I'm going to quote from this original paper from the New England Journal of Medicine. Quote, the organisms have been observed in fecal smears after the application of either phenol-safranin or modified acid-fast stains.
Although both are highly variable in their ability to stain the cyst. In addition, the organisms have been reported to show autofluorescence when examined by ultraviolet epifluorescence. On light microscopy, they are nonrefractile spheres, 8 to 10 micrometers in diameter, containing a cluster of refractile membrane-bound globules enclosed within a membrane, a.k.a.
A morula. A single division of the morula occurred after the organism was cultured in distilled water for seven days, but no further development followed prolonged cultivation. And this is greater than seven months.
Preliminary electron microscopic examination revealed a spherical object with an outer fibrillar coat and a thick cell wall. The internal cytoplasm, which contained light and dark granules, was bound by cell membrane. In addition, the presence of lamellar structures, suggestive of thylakoid membranes from chloroplasts, and the absence of a nucleus suggested that the organism might be prokaryotic, resembling cyanobacteria.
Now, I'm not going to burden y'all no more with that, all right? I'm going to stop. I'm going to stop right there.
It's not dramatic reading. It's not dramatic reading. I'll admit that, right?
I don't know, but thinking of it from the vantage point of an investigator, right? A researcher looking at this, looking at the detail of what they were doing to try to figure this out. I mean, it's more.
This is only a paragraph of their methods. Reading through the rest of the methods, including the sample collection, the identification of isolates, the sporulation of these organisms and the excystation, basically when they sort of break out of these cysts, sort of the more mature form of the organism. Like to me, I don't know, y'all can argue with me, maybe because I'm a geek.
I'm a geek. I'll put it out there. But this paper is fascinating.
It's fascinating because to me, it shows how painstakingly the researchers work to differentiate this from other parasitic infections, right? And essentially to confirm that this was something brand new, right? That we just, we just, it wasn't on our radar before.
Previously sort of unknown infectious organism. It looked just like some other things, but it was slightly different, even in how it responded to treatment. And we learned all of that from this painstaking work where we have the tools to deal with this illness today.
Yeah. And I want to add to COVID was a similar deal. We learned about coronaviruses a while ago.
There was SARS. And yeah, it was a lot of like research about these viruses that because science realized how dangerous it could be and how likely a pandemic or epidemic or whatever it is could have been. They'd done a lot of research so that when the pandemic came around, there was a lot of preliminary research.
And obviously they had to really, you know, put their heads down and grind and figure out ways to apply all of these things to the current problem at hand. But I think without all of that preliminary research in advance before the breakout, then it would have, you know, been almost impossible to combat this. No.
And that's the thing, man. It's like there are people that are working on this stuff, right, that devote their lives to this type of work. And I think it's really important not only to highlight it for what it is, right, the amount of work that goes into it.
But when we talk about the result, right, the result, nearly 40 years later, right, from when they first identified this back, when was it, 1985? Those sort of first cases that came on the radar where they said, hey, we need to investigate this in Peru, 1987, right? So we're already at 20, 39 years.
But today, right, we know Cyclospora cayetanensis, right?
Now, we know it mainly causes diarrhea. We know its life cycle and a good amount about how it, right, the pathophysiology, how it causes disease in humans. And then fortunately, with all of that, we know what to do about it, right?
We know how it spreads. We know that it's largely spread through ingestion of contaminated water and or fresh produce. Human to human spread of this illness is very unlikely.
I'm not going to say impossible. Even researchers say they'll say it's impossible, but it is, you know, not highly transmissible like some other diarrheal illnesses or even parasitic infections. Right.
And that is but that is from the science, ladies and gentlemen. Right. That's not something that happened overnight.
That's not something that somebody just sort of developed from blog posts, or just you know sort of their own “do your own research” on the internet type stuff this is like, real deal detective work going into the field collecting specimens doing studies i think right at one point they were talking about sort of cultivation of these organisms for seven months read this is like, in peru that's heavy man, And so, yes, we know a lot more today and we're able to deal with this illness.
Yeah, absolutely. Briefly, I just want to talk a little bit more about the mode of transmission because we haven't touched on it yet. But how is it transmitted?
Like you said, human to human is extremely unlikely. It's only really known to infect humans as well. So it's not like your dog can get it or you can get it from other dogs.
Just being out and about walking your dog, stuff like that. And yeah, what is it most likely found? And it's usually found on fresh, raw produce that is difficult to wash.
So historically the most likely, and these are from former cases and former studies, they found that it's bagged salad mixes, leafy greens, fresh herbs like cilantro, parsley, basil, and delicate berries like raspberries that are fairly difficult to wash. Cooking kills it, so it's not found in canned vegetables, and if you roast any of your vegetables you are extremely unlikely to get it as well because sufficient heating for a certain amount of time kills it. And you're roasting your vegetables way hotter than that for significantly longer.
So that's the way you're going to avoid it. My friend, Eric, I had a really great question. Is it better to buy fruits and vegetables from a farmers' market?
I would say it may reduce risk in some circumstances, but it does not eliminate risk. I don't want to say that there's no risk of getting it. But usually these outbreaks are typically traced back to centralized industrial supply chains and imported produce so huge operations that if they get contaminated it's going to cause something like this across the u.s and many cities.
So, yes, we're talking 34 states at this point. So that makes sense. Exactly.
So shopping locally may reduce your risk of getting it. There's way fewer steps involved as well, like industrial washing that could go wrong. It's still important that you wash your vegetables as best as you can.
Washing thoroughly is not guaranteed to get rid of Cyclospora. It is fairly sticky and is difficult to get off of vegetables. But yeah, it's not bad advice to go to a local farmer's market that has local produce.
I again will not say that there's a 0% chance of getting cyclospora, but it may reduce your likelihood.
Hmm. And right now, I would say just keeping an eye on what we are seeing as far as the reports from the Centers for Disease Control and Prevention from the FDA, right? Notices that they put out on potential sources for this outbreak.
Just be mindful recalls of produce and stuff. Just be on the lookout for those things being reported in the news media or through those agencies. And I would even say down to your state and local agencies.
Be on the lookout if you can sort of subscribe to any newsletters or publications offered by those organizations. Again, those agencies, not just your some good Substacks, too, that we'll recommend in this program.
But, you know, I would start for those if you want the reliable information on what's happening around you in your community, your state. I would start with those governing bodies. But this is this is heavy stuff.
So as far as like we can even talk about symptoms, you know, we're just going to jump into the cyclospora right now. Some things up now, diarrhea. Right.
And this is always maybe it's the ER doc in me. Read. I'm so morbid, man.
But it's something about the phrase “explosive diarrhea” kind of cracks me up as unpleasant as it is. But I've witnessed it, too.
Yeah, I'm sure. So it's not funny when it's happening. Both as an ER doctor and as a dad.
Yeah. There we go. I'm like explosive diarrhea, like diarrhea in and of itself is bad.
But adding that adjective to it, explosive is. But I mean, that's what it is. The you know, that burst is kind of like the fart that you have where it just bursts out and then you got a bunch of liquid stool or loose stool.
Well, that's it. That is graphic.
Now, there are some naysayers, though, before I go on, we talk about other symptoms associated with this, because you got folks out there that's like, yo, man, well, they didn't kill nobody yet. And it's just diarrhea. Well, let me tell you about diarrhea.
This is before that stupid song, Jeffy and SML on YouTube. I don't know, man. I heard, I hope you don't get sued for this.
But I definitely heard this song before in like elementary school, before YouTube even existed. I didn't even know who Jeffy was actually before preparing for this show. So kind of embarrassed to say that because he seemed like it was a big deal.
Did you know about this?
No, I don't know anything about this. Jeffy and SML, I don't know. Apparently it's like a YouTube, they have a following somehow, even as early as like 2004 but i remember hearing this song in school and it was like when you're sitting in the bush and you feel something mush diarrhea diarrhea when you're basking in the sun and you feel something run diarrhea, diarrhea so kids aren't right it's easy to trivialize this because you made kid songs about it and, you know it's like probably movies and shows in which it happens to a character or something it's embarrassing like the punchline of a comedy thing but diarrhea is real talk, though, because we're talking about one of the leading causes of mortality worldwide.
As much fun as we want to make of it, we're talking about serious illness, ladies and gentlemen. 1.6 million deaths worldwide. This is according to World Health Organization's.
The majority of these deaths are reported in South Asia and sub-Saharan Africa. Diarrhea is believed by many to be the second-leading cause of death of children in the world. Right.
Under five years of age, killing approximately five hundred twenty five thousand children annually. I'll repeat that number again. More than five hundred thousand children annually losing their lives to diarrhea.
This is another reason why I write is sort of a big deal. People are like, oh, well, measles, it's not that bad. It's like, no, actually, it's pretty bad.
And one of the main reasons that it's pretty bad is that it, right, one of the complications of measles infection is diarrhea leading to dehydration and hospitalization of children. Aside from the myriad of other complications, pneumonia, subacute sclerosing panencephalitis, all those things that can come with a measles infection. Just throwing that in there, right, since we're talking real talk right now.
But anyway, another thing, enteric protozoan parasites, such as Cyclospora cayetanensis, are a leading cause of human diarrheal illness worldwide, right? And it's just one of those things that I think we really need to just... Understand is that this is a serious illness and leads to serious morbidity and mortality.
And that is why this particular illness that is going around is such a problem. It is such a problem and we need to pay attention to it.
Yeah, absolutely. Like you said, diarrhea is something that everybody's experienced in their lives, but it's a serious thing and you can get very dehydrated very quickly. So if you are experiencing it, it's really important to stay on top of your hydration.
Obviously, this is an illness where you're not going to feel very good. And so you might not want to eat or intake nutrients or intake water, but it's important that you do and you really try to so that you are bringing in as much as you're losing. I think it's pretty easy to imagine how much water you're losing during something like this.
So make sure that you are restoring that water. Like you said, in places all across the world, diarrhea is the leading causes of mortality. And so this is not something to laugh at at all.
But it's essentially an imbalance in the water content of our stools and is the result of abnormal physiologic function or dysfunction of the normal physiologic process of the small and large intestines that are responsible for the absorption of various ions, substrates, and water. So like you said before, chronic diarrhea is more than 14 days, so two weeks. Acute diarrhea is three or more loose or watery stools, lasting 14 days or less.
But we're talking about chronic diarrhea, and this is also more likely to be caused by something other than an infection. So typically, it could be, you know, an issue with your intestines, something a little bit more serious. So this time frame is really important because treatment is largely dependent on duration and etiology.
So acute diarrhea is typically infectious, mostly viral. Chronic diarrhea is often non-infectious. It comes from malabsorption, IBS, inflammatory bowel disease, effects from certain medications.
So it's different to tease these two apart. And we're always hoping that it's acute as opposed to chronic diarrhea because that's a sign of a much, well, significantly more serious illness. Whereas if it's acute, it's definitely treatable.
Or if it's viral, you kind of just let it run its course and it'll end soon as an unpleasant as it is. It will be over pretty soon.
Yeah, most cases are self-limited, meaning your body deals with it, even in those infectious cases, those viral illnesses that sort of run through, you know, they run their course over a couple of days and they're gone. That's what's unusual about cyclospora in that it's typically prolonged illness, right? We hit that two-week mark and we're like, wait, this is still going?
Another characteristic thing is that it's often relapsing, remitting, meaning that one minute, you know, you're having a diarrhea for a day or two, maybe even three. Then things seem to be getting better. It goes away.
You get some, you know, normal function back or normal stools. And then guess what? You're back to loose and or watery stools or the explosive diarrhea.
I got to throw a sound effect in there for that. Explosive diarrhea. But anyway, there are other symptoms that come with it or can come with it, including, things like flu-like symptoms, muscle aches, headache, low-grade fever, other systemic symptoms of fatigue, you know, malaise, tiredness, nausea.
Some individuals do go on to ultimately have vomiting, loss of appetite. And because this kind of hits that point of a chronic diarrheal illness, individuals can even have significant weight loss, dehydration, and even to the extent of requiring hospitalization, right? Because of things like electrolyte dysfunction, they lose a lot of sodium, potassium, chloride, and cause many other problems throughout the body and complications.
And then the just the GI distress of the frequent bowel movements, severe stomach cramps, bloating, excessive gas. It is just if it's not life threatening for an individual, it's just very unpleasant. To say the least.
So we're talking about a serious disease.
Yeah, absolutely. And like you said, there's probably going to be more and more kind of silly things that come out about this disease might be called the poop disease. They'll come up with silly things, but I encourage everybody to take it seriously.
There have been some jokes. That's true. I have, there have been some memes and stuff that I've come across that have people making fun of it already.
And it's like, I get it, man. It's diarrhea. Come on.
No, but seriously, in all seriousness, yes, while on the spectrum of illnesses that we've covered on this program or that you see, you know, in the news media that people are worried about or even. Public health professionals are concerned about, infectious disease specialists, the things like COVID and avian flu, just as those are serious from the standpoint of, serious morbidity and mortality, we're talking about something that, while it's not killing a ton of people, can be, if not really, really unpleasant, it could still be bad for some individuals. And especially when we talk about more vulnerable populations, more vulnerable groups, individuals that have immune compromise.
So those are either the very, very old, right? Elderly in our population, our society, especially if they have other medical problems. And then the very, very young, young children can be significantly impacted, by this disease.
As we said, right, the second leading cause of death in the world, especially in children under five, being diarrhea. Right. And we're talking about an illness that primarily causes diarrhea.
We're talking about a lot of children being potentially seriously impacted by this illness. So it is something that I'm glad that it's being covered the way it's being covered. Folks are talking about it.
And I think not only that we stand a lot to learn about this illness in particular. We can also learn, right, why the stuff that is being done at that public health level, why it's so valuable, right? Because this is something that could have just continued to be off of our radar, honestly, Reid, would be knowing, you know, a lot of chronic diarrhea being classified as other diseases.
Causes or other etiologies for that. This is something that could have just been under the radar for a couple more weeks, months. So I'm glad that we were kind of on it as a society, I'm saying.
Yeah. And so other things to understand about this illness, there is an incubation period or a period when an individual could have acquired the infection but not show symptoms between two to 14 days after the infection. If anything, that's what makes this to a degree more concerning, right?
Because with such a wide and potentially long incubation period, right? Symptoms appearing to two weeks after the initial exposure or infection, right? Or after drinking or eating, you know, some contaminated water or food, that is what is concerning because we might not really know where we are with this outbreak for the next couple of weeks, right?
As people sort of develop more symptoms and going to be, you know, treated. So that's one thing that we really need to be mindful of. And I'll tell you, in my practice, I think working in the ER, in the last couple of weeks, there was a patient, at least one person I can think of where I was like, wow, that's unusual.
They were telling me about their illness, you know, the nausea, vomiting for, it was, I know it was definitely past 10 days, you know, approaching two weeks. And I was like, wow, that's very unusual. You know, talking to this individual was like, wow, You know, I think it's probably a viral cause, which typically it is.
Right. And they had nausea, vomiting, and diarrhea, was having some abdominal cramping. And we're talking about getting more history from this person, examining them.
And it was difficult to put my finger on what it was because of the unusual thing. And I was like, yeah, you know, it's probably sounds like it could be a viral infection, gastroenteritis, very common, even at this time of year in the summer. So some of the viral things going around, people on vacation with family and stuff, these things circulate.
But I was like, it is unusual that this is going on this long, right? And so that is a case. And this was not on my radar at that time.
And so this might be a case that I miss, man.
Yeah. And the thing is, you know, this individual could have benefited from possibly from antibiotic therapy, which we know that this organism is sensitive to, a very common antibiotic that we treat, you know, many patients with safely for other infections.
Yeah, I have a question for you. So it's just something to think about. Yes, sir.
So you're a doctor, you're working in the ER, you're facing patients all day. How does that kind of information get spread? Like, hey, look out for this outbreak of cyclospora that's happening.
Keep it on your radar. Here are the symptoms. Like, is that something that you get from some sort of government agency?
Is that something that you get from doing your own research, from conversations with your colleagues about what's happening in health news? Is there some sort of centralized distribution to doctors about information for these kinds of things? Yes, sir.
And that's one thing that I'm proud of. Just as an emergency physician in general, and just some emergency departments, nationwide, we're talking about a tremendously valuable resource in our communities and in our nation as a whole, just because, these departments are on the front line, right? The providers there, the services that are provided in those departments, aside from taking care of patients that are presenting with acute medical complaints, acute trauma, even mental health, disorders and emergent presentations for mental health or even psychiatric emergencies.
One of the things that emergency departments as a whole provide is surveillance. Right. And so it's not uncommon that illnesses like this are discovered because emergency clinicians and I'll even say other, you know, it's multidisciplinary because sometimes patients are admitted like, hey, this person has had this longstanding diarrhea.
I don't know what's causing it. We need more time. Right.
We need to get more time to get them better, more time to investigate and figure out what this is. And so sometimes a patient is admitted to the hospital. So between that, the emergency department, the clinicians that are working, taking care of patients that are even admitted to the hospitals, a lot of times, right, that is part of the surveillance because when there is something unusual, think of what I got the hint if I started getting it because I had another patient that presented like this today with.
Similar symptoms and had been going on for two weeks and I was like, oh, this could be cyclospora, right? But we only get that antenna up when we... You'll encounter multiple patients with a particular pattern or constellation of symptoms that you're like, hey, this is something's going on here.
Right. I've had, you know, three or four people with some of the similar complaints, maybe even similar exposures. Maybe they were at a particular event or maybe they traveled from a particular place.
But it fits a pattern. And those things can be things that we report to local health departments or state health departments or depend. Right.
Cyclospora cayetanensis is a reportable illness to the CDC. Right. Meaning when you come across a case like this, you can say, hey, I need to.
Maybe talk to my infectious disease specialist in the hospital and figure out, you know, reporting this or getting this information to, an agency like the Centers for Disease Control, where they can send additional resources or you can even send things to them so that we can investigate this further. So that and that's typically how it works. That is it.
So ER is valuable. And there's other things that we might pick up to, you know, things like overdoses. And that's something that commonly comes up.
There's a new, you know, either a new drug on the street or a drug that everybody knows of, you know, things like fentanyls, but there's a, maybe a batch, an illicit drug being sold that is causing more harm. We see more overdose deaths, right? That is something that was reportable and we'll work with our poison control centers to sort of get a handle on where that's coming from and right.
Do a little detective work to try to stop that cycle. But yeah, thank you for that question, man.
Yeah, definitely. It's interesting to see how you're on like sort of both sides. You're on the detection and investigation side, but then you're also, once it's out and that information's out there, you have your antennas up.
You guys are the ones dealing with most of the outbreaks as well. And there are other resources, especially through the CDC, the National Institutes of Health. There's a traveler's resource, right?
So individuals like, let's say a patient, you know, told me a specific set of symptoms they're having fevers, chills, headaches, then maybe I can go to the traveler's resource. Oh my goodness. I'm trying to remember it off the top of my head, but anyway, you can go to this site that is.
Curated by the CDC to figure out, hey, this person is coming from this country. There are these endemic diseases to that country, right? This could be malaria or this could be maybe another zoonotic disease such as dengue fever, right?
Mosquito, you know, other mosquito-borne illnesses. But those things, that's how we really surveil and kind of pick those things up and get the help that those patients need, but also resources, again, to if there is an outbreak on a horizon, right? How do we marshal resources to deal with that and nip it in the bud?
So it's really, really important. And this is sort of a testament to all of that. And so moving on to treatment though, that's the thing, Reed.
I think there's anything I'm really grateful for is that this can be treated. Yes, absolutely. Not only from the standpoint of symptoms, a lot of times, especially when we talk about common diarrheal illnesses, like viral illnesses, virally mediated illnesses that are causing nausea, vomiting, diarrhea, gastroenteritis.
A lot of times, man, we're only limited to supportive therapies for patients. So meaning, you know, we're able to give medications that can help with the nausea, the vomiting, the abdominal cramps or pain. And really, you know, we're just relying on the body to sort of quell the infection to get rid of it.
But in this instance, with a lot of these protozoal illnesses, depending on the genus and species, we have specific agents that we can use to treat these infections. In this case, for a Cyclospora cayetanensis, we have Bactrim, or sulfamethoxazole-trimethoprim. It's a combination antibiotic in which this organism is sensitive to and we can treat patients with that.
So it's really, if there's anything, man, that I'm really grateful for is that this is, you know, not only something that we can identify and that we know about, but that there's treatment, ladies and gentlemen, there is treatment for it. Yes, absolutely. And with cyclospora going around, do you recommend anybody who shows these symptoms of cyclospora infection go and receive the treatment, or is it more reserved for more serious cases?
Thank you. That's a great question, Reid.
Thank you for that, because... The fact of the matter is that most individuals, most people with this illness, it is going to be self-limited, meaning their bodies, right? Your sort of innate and adaptive immune system, your white blood cells, the miracle that is our bodies is going to be enough to take care of this infection, right?
To get rid of it. That's for most people, even as the studies that we read right from 1993, that paper published in the New England Journal of Medicine, right? Most of those people cleared it.
It took a number of weeks, but they ultimately stopped shedding those oocysts in their stool, the organisms in their stool.
Now, there are individuals, though, that might require antibiotic therapy. Typically, those are going to be individuals with more severe illness. So those are folks that have had protracted diarrhea, meaning they've had it for in excess of two weeks.
Maybe they're very symptomatic to the point where it's interfering with their daily functioning. You know, can you imagine having diarrhea? You're trying to get work done, take care of your family, enjoy your life period.
And when it interferes with someone's quality of life to a certain extent, right, you might be a candidate for therapy. So we're talking beyond loose stools, like you got explosive diarrhea every day, just watery diarrhea. Those are individuals that might be candidates for antibiotic therapy.
Individuals that are having such severe illness that they're having profound dehydration and.
And with that, things like electrolyte abnormalities, so they've lost sodium, potassium, chloride, other electrolytes because of the prolonged diarrhea and or vomiting. Those are individuals that would be candidates for antibiotic therapy to stop that infection, replenish their bodies with fluids and those electrolytes to get them back on track and make sure that they're safe. Those are individuals that will probably be treated with antibiotics.
And those are often individuals, right, that might even require hospitalization because they're so ill from this illness.
Another category where the bar might be a little bit lower to treat are individuals, as we said, that are more susceptible to more severe illness. So immunocompromised folks, those individuals with maybe cancer and they're on chemotherapy. As we said, extremes of age, either the elderly, especially with medical problems, the really, really young, like young children, and individuals with things like HIV or AIDS or severe immune compromise or that might just be more prone to more severe illness.
Those will probably be individuals that are candidates for antibiotic therapy. But again, most folks clear this infection, not only without complication, but they're, you know, just even supportive therapy or just riding it out. Most people are going to be OK.
I would say give it a little time. If your severe symptoms are severe and that's variable for everybody, right? It just might be severe cramping.
Intolerable abdominal pain. I would say, you know, if you're in doubt, go to your local emergency department to be evaluated. You could make an appointment with your primary care physician be evaluated by them but you know in a time of severe symptoms, you know you've had multiple runs of diarrhea you're feeling dehydrated not like yourself really tired and out of it which this illness can make you feel never hesitate to, be evaluated in your local emergency department or acute-care center or urgent-care clinic those places thank you for that i feel like my key takeaways from this episode are really It's great that we have the information out there.
It's great that people are hearing about it. Spread the message. Spread the word to those that you know that haven't heard about it.
You know, try and be a source of reliable and accurate health information for those in your community. It's definitely a treatable and preventable illness. Cook your vegetables.
Maybe try and avoid some of those most common sources of transmission. So like bagged salad, stuff that is difficult to wash.
Yeah, there's no reason to fear monger about this kind of stuff. We can definitely get through it if we act as community and take care of one another and look out for one another and learn from what we're hearing in the media as well. So yeah, I think this is definitely as much as the numbers sort of show dread compared to numbers of cyclospora infections from last year, this is definitely a significant outbreak, but hopefully we can deal with it quickly and efficiently.
Word. And the last thing I'll add, just a couple of, and we're going to put these links in the show notes for the podcast version of the show, some reliable sources that I would recommend. So outside of, yes, I know the political climate we're in, I'm still going to recommend the CDC, ladies and gentlemen.
They are putting out information daily information about the outbreak and really importantly about right where the source might be. Some important information might pop up there as far as where this is coming from and even right once that's established sort of what to avoid as far as produce and stuff, i do like reed's tip on maybe shopping more locally um if you're not in an outbreak area of course there are and the CDC has a nice map of some of the more hard hit areas which believe it or not new york state has a good number of cases as well as like michigan but just be on the lookout that.
Can help you guide your sort of decisions but Your Local Epidemiologist by dr Katelyn Jetelina they break down public health data but they've been putting out a lot of stuff about this outbreak um i would recommend, Unbiased Science there's a team of experts that talk about complex medical and health research and helps you avoid misinformation they've been putting out some good stuff Inside Medicine by Dr. Jeremy Faust another emergency physician doing some deep dives into public health data they have good information as well, but we're going to put like i said some of these resources, on our publications so that you guys can have access to that's it man, i want to thank you all for listening to Health in Harlem in advance we thank you for sharing what you learned with whomever will listen.
As always ladies and gentlemen this show is dedicated to the memory of miss gloria thomas harlem take care of yourself.
