The Iowa and Illinois health departments are investigating cyclospora infections they say could be linked to McDonald’s salads.

“We are closely monitoring this situation and cooperating with state and federal public health authorities as they further investigate,” the fast-food chain said in a statement to Reuters.

In an email sent to CNN, McDonald’s said July 12 that it has stopped selling salads at impacted restaurants “until we can switch to another lettuce blend supplier.”

“We are in the process of removing existing salad blend from identified restaurants and distribution centers—which includes approximately 3,000 of our U.S. restaurants primarily located in the Midwest,” McDonald’s wrote. The company is also re-supplying restaurants with salads from other suppliers.

The departments said McDonald’s is investigating as well, and has fully cooperated with state health officials, Centers for Disease Control and Prevention, and the Food and Drug Administration.

The Illinois Department of Public Health noted about 90 cases. The Iowa Department of Public Health recorded 15. In about a fourth of the Illinois cases people reported eating salads from McDonald’s leading up to their illness.

“Although a link has been made to salads sold in McDonald’s restaurants in some Illinois cases, public health officials continue to investigate other sources,” Illinois Department of Public Health director Nirav D. Shah, M.D., J.D., said in a statement. “If you ate a salad from McDonald’s since mid-May and developed diarrhea and fatigue, contact a health care provider about testing and treatment.”

Several outbreaks of cyclospora have occurred in the U.S. in the past several years. It typically hits during summer months, since it’s often linked to imported fresh produce, including raspberries, basil, snow peas, and lettuce. The parasite, cyclospora cayetanensis, infects the small intestine and is spread by ingesting food or water contaminated with feces, and not directly from one person to another.

“This summer there have been several clusters of Cyclospora illness associated with various foods that are commercially available. This week IDPH has identified 15 Iowans who ate McDonald’s salads in late June to early July prior to getting ill,” added Dr. Patricia Quinlisk in a statement posted on the Iowa Department of Public Health’s website. “Anyone who ate these salads since the middle of June and who developed diarrhea, especially watery diarrhea and fatigue, should see their health care provider and get tested for Cyclospora to ensure an accurate diagnosis and appropriate treatment.”

The Illinois cases date back to mid-May, and the Iowa ones were recorded late June.

Symptoms include:

  • Frequent bouts of watery diarrhea (the most common symptom)
  • Loss of appetite and weight
  • Cramping, bloating, and/or increased gas
  • Nausea (vomiting is less common)
  • Fatigue
  • Low-grade fever

Cyclospora infection can be treated with specific antibiotics, the IDPH said. If not treated, the illness may last for a few days to a month or longer.

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