Infected people shed unsporulated (non-infective; immature) Cyclospora cayetanensis oocysts in their stool; immature oocysts usually require at least 1-2 weeks under favorable laboratory conditions to sporulate and become infective. Symptoms of the illness include diarrhea, vomiting, fever and body aches.
According to that report, there have been 395 lab-confirmed illnesses from an outbreak of the cyclospora parasite, which causes intestinal illness.
The states that are impacted are Iowa, Illinois, Indiana, Kentucky, Michigan, Minnesota, Missouri, Nebraska, Ohio, South Dakota, and Wisconsin. The company supplied McDonald's in the Midwest with bags of mixed lettuce that had been tainted with cyclospora. However, the patients in Connecticut, Michigan, Tennessee and Virginia bought their salads in IL while traveling, and the Florida patient bought the salad in Kentucky.
"Fresh Express products subject to recall had already passed the "use-thru" date of July 24 and were not marked or labeled for retail sale", a spokesperson emailed, adding the company is working with health officials and hopes "a definitive source is found soon".
In the alert, the USDA said the issue was discovered when Indianapolis-based food distributor Caito Foods "received notification from their lettuce supplier, Fresh Express, that the chopped romaine that is used to manufacture some of their salads and wraps was being recalled".