The U.S. Centers for Disease Control and Prevention (CDC) is warning people not to eat shredded iceberg lettuce served at Taco Bell locations in Indiana, Kentucky, Michigan, Ohio and West Virginia due to the spread of Cyclospora.
The warning, posted Thursday night, follows an outbreak of cyclosporiasis that has sickened more than 1,644 people who reported eating at the chain’s restaurants in those five states, according to the CDC.
Of those, 94 have been hospitalized. No deaths have been reported. No recall has been issued, and the investigation remains open, The New York Times reported.
The lettuce was grown by a single supplier in Mexico, the U.S. Food and Drug Administration (FDA) said. The agency has increased screening of that company’s lettuce at the border and warned that other restaurants and stores could be implicated as the investigation continues.
Not every Taco Bell in the five states received the affected lettuce.
It was supplied by Taylor Farms, two federal officials who were not authorized to speak publicly told The Times. The Salinas, California-based company is one of the country’s largest producers of fresh lettuce and vegetables, with roughly $7 billion in annual revenue.
A Taylor Farms spokeswoman did not respond to requests for comment, according to The Times.
The CDC has not publicly named the supplier.
Taco Bell said Thursday it was voluntarily pulling potentially affected lettuce from select states and would “indefinitely” remove that supplier’s lettuce from its nationwide supply chain, The Times reported.
Taylor Farms has been tied to earlier outbreaks, including a 2013 cyclosporiasis outbreak linked to salad mix and a 2024 E. coli outbreak linked to onions served at McDonald’s that caused 104 illnesses, 34 hospitalizations and one death, The Times reported.
Nationally, the United States is on track for its highest number of Cyclospora cases on record. As of Monday, the CDC had confirmed 1,645 cases and 141 hospitalizations across 34 states and was investigating more than 5,100 additional suspected illnesses, according to The Times.
State tallies run higher because they count probable cases alongside lab-confirmed ones.
The Michigan Department of Health and Human Services reported 4,312 cases as of July 16, including 102 hospitalizations.
Dr. Natasha Bagdasarian, Michigan’s chief medical executive, told The Times that not everyone sickened in the state reported eating at a single restaurant. A supplier that sells to restaurants may also stock grocery stores, she said.
The CDC is also investigating other cyclosporiasis illnesses and outbreaks nationally that are unrelated to the Taco Bell cases.
Symptoms usually start about a week after infection, though onset can range from two days to two weeks or more, the CDC said. They include watery diarrhea, loss of appetite, fatigue, weight loss, cramping, bloating, gas and nausea. If left untreated, symptoms can last a month or longer. Antibiotics are the main treatment.
Routine stool tests don’t always screen for the parasite, so patients may need to specifically request testing for Cyclospora, the CDC said.
Because routine gastrointestinal panels do not always include testing for Cyclospora cayetanensis, clinicians should maintain a high index of suspicion in patients presenting with prolonged watery diarrhea, especially if symptoms persist beyond several days or standard stool studies are negative.
Patients may not immediately connect their illness to a restaurant meal eaten one or two weeks earlier, making a detailed food history important. Asking about recent consumption of fresh produce, restaurant meals, or travel can help identify potential exposures and guide diagnostic testing.
Unlike many common causes of infectious diarrhea, Cyclospora is not routinely detected on standard stool examinations. If cyclosporiasis is suspected, clinicians should specifically request testing for Cyclospora or order a multiplex gastrointestinal pathogen panel that includes the parasite.
Early diagnosis can reduce unnecessary testing and allow for prompt treatment with trimethoprim-sulfamethoxazole (TMP-SMX), the recommended first-line therapy for most patients.
Although many healthy adults recover with appropriate treatment, prolonged illness can be particularly concerning for older adults, young children, and people with weakened immune systems. Persistent diarrhea can lead to dehydration, electrolyte imbalances, and weight loss, making early recognition especially important in these populations.
While the Taco Bell investigation remains ongoing, the broader rise in Cyclospora cases serves as a reminder that foodborne parasitic infections should remain on clinicians’ differential diagnosis for patients with persistent diarrhea. Because routine stool testing may miss the parasite, targeted testing and a thorough dietary history can help shorten time to diagnosis and treatment.
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