More than 60 North Carolina cases tied to parasite behind ‘explosive diarrhea’

North Carolina is once again dealing with a rise in Cyclospora cases, a microscopic parasite known for unpleasant gastrointestinal symptoms, including “explosive diarrhea.” Cyclospora spreads when someone eats or drinks something contaminated with feces.

North Carolina Department of Health and Human Services officials confirm to WRAL there have been 69 reports of cyclosporiasis since early June, as of July 2, 2026. The majority of North Carolina’s reported cases have come from Wake County, the state’s most populous county.

The increase comes as the U.S. Centers for Disease Control and Prevention investigates more than 140 cyclosporiasis cases across 17 states, including at least 20 hospitalizations. The CDC’s investigation revolves around individuals who first got sick between May 1 to July 16, 2026. North Carolina is among the states reporting cases, though no hospitalizations have been reported. 

At this time, health officials are not sure what may be causing the current rise in cases nationwide, and if they are all being caused by the same product(s).

Dr. Carl Williams, State Public Health Veterinarian for NCDHHS, said North Carolina’s cases do not currently meet the criteria to be considered an outbreak.

“We’ve had cases among all age ranges, including children and people over 65,” Williams told WRAL. “It is something that we would expect to pick up in June and July. It’s very likely that we will have more reports in the coming weeks.”

Cyclospora cases typically rise during summer months largely due to the fact that the parasite is often found in fresh fruits and vegetables that are many times consumed raw. 

Williams explained that identifying the source of an outbreak can take weeks or even months because symptoms often don’t appear until 2-14 days after someone eats contaminated food. By then, many people struggle to remember exactly what they ate. “Foodborne disease investigations are complicated in general because you have to rely on interviews with the case patients to get their food history,” Williams said. “If you wait too long, you tend to get food preferences as opposed to the specific history.” 

The investigation is made even more difficult because cyclospora has historically been linked to ingredients like cilantro and parsley that are often mixed into meals and easily forgotten. 

That’s exactly what investigators faced during North Carolina’s largest recent cyclospora outbreak. WRAL investigated a 2024 outbreak of more than 130 cases tied to at least three Wake County restaurants. Health officials reported months later after speaking with several patients that the outbreak was due to a shrimp and parsley salad.

Following the 2024 outbreak, NCDHHS strengthened its investigation process by creating a working group with the Wake County Health Department, the CDC, the FDA and the North Carolina Department of Agriculture and Consumer Services. The agencies now coordinate food history interviews, ingredient tracebacks and genetic testing to better identify links between cases. 

“We’ve been working with them for the past two years now… to facilitate a coordinated investigation to do food history collection, food trace back, and submission of clinical specimens to the CDC for genetic typing,” Williams added.

Williams said investigators interview patients and work backward to identify common ingredients. 

“What all the states and local health departments try to do is, through that ingredient-level analysis, identify what is most commonly found in these cases’ food history,” Williams explained. “Where did they eat? If it was at a restaurant, where did they purchase the cilantro from? That’s the reason we do this surveillance: to try and find that contaminated food product and remove it from circulation if possible. It’s just more challenging to find it.”

Another challenge is the short shelf life of fresh produce. By the time investigators identify a common ingredient among patients with cyclospora, the contaminated product may have already been discarded from the food supply. 

As investigators continue searching for a common source, health officials say the best defense is washing fresh produce thoroughly and seeking medical care if severe symptoms develop.

“If you can remember one number, it’s 165 degrees Fahrenheit,” Williams advised. “If you cook your food, 165 Fahrenheit is enough to get rid of Shiga toxin, E. coli in ground beef, Trichinella in pork, salmonella in chicken; That’ll take care of everything.”

Williams also advised people preparing food over the Fourth of July weekend to avoid the “temperature danger zone” between 40°F and 140°F, where bacteria can multiply rapidly. According to the United States Department of Agriculture, some bacteria can double in number in as little as 20 minutes within that temperature range.

Anyone experiencing severe diarrhea or other gastrointestinal symptoms should contact a healthcare provider. Cyclospora is typically diagnosed through a stool sample, and Williams said testing helps public health officials identify infections and investigate potential outbreaks.