Lee County now holds more cyclosporiasis cases than every Florida county except Miami-Dade, and the clinics closest to the uninsured say the test that would confirm it costs more than they can put in front of a patient

Florida's cyclosporiasis count reached 460 confirmed and probable cases among state residents in the update published Thursday, covering January 1 through August 15. Lee County holds 41 of them. Collier County has seven.

Only Miami-Dade, at 58, has more than Lee. The county has passed Bay at 36 and Broward at 35, both of which stood ahead of it a fortnight ago, which makes Lee the second highest county in the state. FOX 35 Orlando published the county by county table, naming the Department of Health's Reportable Diseases Frequency Report as its source.

This site has now moved Lee in that ranking twice in three weeks, and it has moved both ways. Lee was reported second on July 31, third on August 6 after Broward added twelve cases in a single week, and second again today. A ranking built on preliminary weekly data is a noisy thing. The steadier fact beneath it has not changed for a month: Lee County is the centre of this outbreak in Southwest Florida by a wide margin, with almost six times Collier's count.

The pace, though, is easing, and this is the third consecutive week it has done so. WGCU reports 43 new cases statewide in Thursday's release, against 66 a week earlier, 87 the week before that and 97 in the week to July 25. Lee added six, more new cases than any other county in Southwest Florida. Collier and Highlands added none, Sarasota added five, Charlotte added two, and Hardee County recorded its first two.

Two statewide figures are again in circulation and both are the state's own. The 460 is counted from January 1. WGCU's 450 is counted from May 1, the seasonal window the department uses because cases typically rise between May and August. Lee reads as 41 on the first basis and 39 on the second, and the two cases between them were recorded before May. Neither figure is wrong, but a reader who takes one week from one series and the next week from the other will invent an increase that did not occur.

What is new this week is a gap between the count and the illness behind it. The Centers for Disease Control and Prevention states on its outbreak page that routine stool tests do not always screen for this parasite and that a patient may need to request the test specifically.

Gulf Coast News, reporting Thursday evening, sets out what that means in Lee County. Susan Hook, a nurse practitioner at Samaritan Health and Wellness Center, told the station her clinic has seen several cases among both patients and staff, and that it does not test for the parasite at all.

"We are not testing anyone. We serve mainly people that are uninsured. And so from the testing that I understand is somewhat expensive for patients to access if they don't have insurance."

Hook said she is treating symptoms with antibiotics as the agency recommends. Lee Health hospitals do offer the specialised test, the station reports, with same day results available if needed.

The confirmation therefore exists in the county, but the route to it is narrower for someone without insurance, and the official count is assembled only from cases that complete that route. The 41 is a count of confirmed and probable cases that reached state surveillance, not a count of people in Lee County who have been ill.

The source has not been in doubt since July and has been off the shelves for weeks. The agency links the outbreak to iceberg lettuce from Taylor Farms de Mexico, grown in central Mexico and recalled by the company on July 17. Its August 20 update counts 10,930 cases, 454 hospitalizations and two deaths across 17 states, with no new states added since the previous update and the investigation still open. The Food and Drug Administration is running the traceback.

Because the best before dates have passed, this is no longer mainly a question of checking a refrigerator. It is a question of lag. Symptoms usually begin about a week after exposure and can take two weeks or more, untreated they can run for a month or longer, and the state's weekly counts sit behind that again, so cases reported in the coming weeks may still trace to exposure before the recall.

The advice for a household is unchanged and narrow. Cyclospora does not spread from person to person. Wash hands and fresh produce thoroughly under running water, and note that cooking produce to at least 158 degrees Fahrenheit kills the parasite while washing alone cannot guarantee removal. Anyone with watery diarrhoea lasting more than a few days should ask a doctor for a Cyclospora test by name.

The county figure is provisional by design. The department publishes these counts as preliminary, updates them each Thursday for the week ending the previous Saturday, and revises individual cases as laboratory and investigation results arrive. Lee County's 41 is a floor for that window, not a settled total.