text: Cyclospora, the identified parasite, is rarely seen in the United States. 
   
   A prepackaged lettuce mix. (Photo: Elizabeth Weise, USA TODAY) Story Highlights The national cyclospora outbreak linked to food has reached 397 victims 
   
   Iowa and Nebraska have fingered prepackaged salad 
   
   Others aren't so sure about culprit 
   
   Food safety experts are beginning to grumble that an investigation into the latest food-borne illness is taking too long to find the exact source of the outbreak. Two states, Iowa and Nebraska, have reported they believe the outbreak is linked to prepackaged, bagged salad mix, but others aren't so sure. 
   
   The number of victims in the national outbreak of the food-linked diarrheal disease cyclospora rose to 397, with illnesses reported in 16 states, the Centers for Disease Control and Prevention reported late Wednesday. 
   
   The CDC says it is working to determine whether the possible link to bagged salad mix applies to cases in other states as well. 
   
   The Food and Drug Administration "can't speak to an ongoing investigation," said FDA spokeswoman Theresa Eisenman. 
   
   "With 390-some people ill, you'd think it would be fairly easy to triangulate the trace back" to the food causing the illnesses, said Dave Gombas, senior vice president for food safety with United Fresh Produce Association, a produce trade group in Washington, D.C. "So the fact that FDA and CDC aren't going along with Iowa and Nebraska gives me pause." 
   
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   Cyclospora is an intestinal illnesses caused by the microscopic parasite Cyclospora cayetanensis. It is transmitted when feces enter the food or water supply and are consumed. The disease causes watery and sometimes explosive diarrhea and is treated with antibiotics. Symptoms can include fatigue, anorexia, bloating, stomach cramps, vomiting, muscle aches and a low fever. 
   
   Michael Last is a parasitologist at the Iowa State Hygienic Laboratory at the University of Iowa in Coralville who first recognized that an outbreak of diarrheal disease in Iowa in June was caused by the microscopic parasite Cyclospora cayetanensis. It is transmitted when feces enter the food or water supply and are consumed. (Photo: Mary DeMartino, Iowa State Hygienic Laboratory) 
   
   At least 22 people in five states have been hospitalized in the outbreak. 
   
   Iowa's public health system first caught the outbreak on June 25 when Michael Last, a parasitologist at the State Hygienic Laboratory at the University of Iowa in Coralville, recognized the parasite in a stool sample sent in by a physician for testing. 
   
   He is "a good, good, good microbiologist," said Patricia Quinlisk, Iowa's state epidemiologist. 
   
   The parasite is rarely seen in the United States. "We haven't had a major outbreak from cyclospora in almost a decade," said Caroline Smith DeWaal with the Center for Science in the Public Interest in Washington, D.C. Her database shows the most recent large outbreak was in Florida in 2005, where 592 people were sickened with contaminated basil. The nation's largest-known cyclospora outbreak was in 1996 when raspberries from Guatemala sickened 1,465 in multiple states, she said. 
   
   Using Twitter, Facebook and other media, Iowa officials made sure health workers across the state were looking for similar illnesses. Very quickly more cases came in, including from Nebraska next door. Most of the patients had gotten sick in mid-June. 
   
   "At the peak of this outbreak we were seeing anywhere from seven to 12 new cases a day," said Mary DeMartino, who runs Iowa's Disease Control Division of the State Hygienic Laboratory. 
   
   Iowa health workers established that about 80% of the people who had gotten sick had eaten the same brand of prepackaged salad mix containing iceberg and romaine lettuce, carrots and red cabbage. Packaged lettuce has a short shelf life, so by the time investigators began interviewing people "the bags were long gone," Quinlisk said. That means there wasn't anything for them to test to see which of the mix's four ingredients was responsible for the illnesses. 
   
   A photomicrograph of a fresh stool sample, which had been prepared using a 10% formalin solution and stained with modified acid-fast stain, reveals the presence of four Cyclospora cayetanensis oocysts. Iowa and Nebraska health officials said Tuesday that a prepackaged salad mix is the source of a cyclospora outbreak. (Photo: CDC via AP) 
   
   The last person Iowa tested got sick on June 28. State officials believe the tainted lot of salad mix is gone from store shelves and the outbreak is waning there. What's going on in other states is difficult to say because "their epidemiology looks a little different," Quinlisk said. 
   
   It wouldn't surprise her at all if there were more than one outbreak going on, Quinlisk said. "When we look at the data from other states, the people who are getting ill are not necessarily the same as we saw; they're not getting sick at the same time." Bagged salad may not explain all the illnesses in the nation. 
   
   Some of the food safety world feels the investigation has not moved as quickly as it should have. "This thing should have been solved a month ago," said Michael Osterholm, Minnesota's former state epidemiologist who now directs the Center for Infectious Disease Research and Policy at the University of Minnesota. 
   
   The fact that patrons of a large number of restaurants became ill, including several national chains, "should have helped them," he said. "They were national chain restaurants all owned by one company, which in turn got its ingredients from a single source." 
   
   Finding the culprit isn't easy and takes time, Quinlisk said. "Most people's idea of an outbreak is everybody went to the same grocery store and bought the same item. It's not like that. It wasn't one brand name, it was a salad mixture that came into Iowa in a variety of ways in different packaging." 
   
   Cyclospora is a protozoan that can cause severe diarrhea if left untreated. (Photo: The Des Moines Register) 
   
   Another issue is that Iowa, like at least 30 other states, has laws on the books protecting agricultural producers. These laws encourage states not to make public information about possible contamination of food that might harm sales unless there is an ongoing outbreak that puts people at risk. 
   
   "They don't say 'Thou shall not tell who the business is,'" said Bill Marler, a lawyer in Seattle who has been involved in food-borne illness outbreaks for decades. Instead it's a discretionary decision that has led to a "culture of non-disclosure" that he and others believe is hampering the investigation. 
   
   "This ain't done yet. I think the investigation has a long way to go," Gombas said. 
   
   Read or Share this story: http://usat.ly/1ctlKuv ||||| Laws may stop identification of cyclospora source 
   
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   (CBS News) NEW YORK -- The mystery over the cyclospora outbreak has deepened. Cyclospora is a dangerous parasite that causes stomach illness. The Centers for Disease Control and Prevention said Thursday there are now 397 cases in 16 states, but no one has yet identified the source. 
   
   In early July, days after eating salads at home and at restaurants in Texas, Suzie Matteis developed diarrhea that persisted for weeks before a test found cyclospora. 
   
   The CDC said Thursday there are now 397 cases of cyclospora in 16 states. / CBS News 
   
   "I had Montezuma's revenge, dysentery, something was going on," Matteis said. "Weight loss - I still don't have a normal appetite. I just want to get better because I'm used to being in good shape." 
   
   Matteis still doesn't know what food made her sick. Investigators in Texas have not named a source. 
   
   But this week, health investigators in Nebraska said the outbreak there originated from prepackaged salad mix that came through "national distribution channels." Now, the CDC and the FDA are looking for the exact source of that contamination. 
   
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   Iowa officials also said a prepackaged salad mix is to blame, but neither state is naming the company or companies involved. Both states cite laws prohibiting investigators from naming brands or companies if it's believed the contaminated product is no longer a public health threat. Officials believe the contaminated food is likely out of the food supply. 
   
   Matteis was given antibiotics and is slowly improving. 
   
   "I think that we should know where the food came from," she said. "I'm skittish. I don't know where to go to eat. I'm not out of the woods yet. I'm still feeling poorly." 
   
   We've been pushing the FDA and CDC for days on identifying the source. The CDC told us that just because a certain brand of salad is infected, it doesn't mean that brand is the ultimate source of the infection. For example, it could come from a common distributor or a common processing plant which involves a lot of other brands. 
   
   For now they're saying they're getting closer, they're eliminating certain things and they're probably going to give us more information soon. Right now, they're not ready to say anything more.
target: – The cyclospora outbreak, believe to be linked to prepackaged salad in Iowa and Nebraska, just got a little ickier: Experts say that salad may not be the sole source of the stomach bug, which causes "sometimes explosive diarrhea"and has now sickened a confirmed 397 people across 16 states as of Wednesday, according to the Centers for Disease Control and Prevention. Indeed, Iowa's state epidemiologist tells USA Today that the "epidemiology looks a bit different" in other affected states. "The people who are getting ill are not necessarily the same as we saw; they're not getting sick at the same time." The FDA says it "can't speak to an ongoing investigation," though CBS News reports the FDA and CDC are "getting closer" to IDing the source. (CBS points out that even if the salad is to blame, the true root of the illness could be the plant that processed the lettuce, for instance.) Says the VP of a produce trade group, "I think the investigation has a long way to go." If you want a first-hand account of what cyclospora is like, CBS talks to a Texas woman who had diarrhea "for weeks."