CHICAGO — It’s been more than a week since Jackie Gonzalez ate the bag of prepackaged salad mix she suspects left her tied to the bathroom and doubled over with debilitating stomach pain.

As the infection leaves her system, the physical symptoms of the illness her doctor told her to assume was cyclosporiasis are fading. What’s left is a growing anxiety that follows her to the grocery store and the dinner table.

“It’s changed the way I’m eating and it’s created fear,” said Gonzalez, 25, who lives in Rogers Park. “I honestly didn’t think it was going to happen to me, and when it did, it was such a painful experience to go through.”

As cases of cyclosporiasis continue to climb across the country, Gonzalez is among hundreds of Illinoisans who have reported severe gastrointestinal illness since early May, when the Centers for Disease Control and Prevention first detected an increase in infections. While cases typically rise during the summer months, experts say this year’s outbreak is unusually large.

Illinois reported 309 confirmed cases as of Friday morning, more than doubling its count from a week earlier, according to the Illinois Department of Public Health. In Indiana, there were 366 confirmed cases, according to the Indiana Department of Health.

Infectious disease specialists say that figure doesn’t represent the true scope of the outbreak, as many people — including Gonzalez, who spoke with her doctor from home via telehealth — are never tested.

“We probably either underreport or overreport and we don’t have a true number,” said Graeme Forrest, an infectious diseases specialist at Rush University Medical Center. “But it’s been the biggest (outbreak) we’ve seen in a long time.”

The intestinal illness has sickened countless nationwide, with the CDC most recently reporting 1,644 confirmed cases across 34 states and more than 5,000 additional reports awaiting further testing. Cyclosporiasis is spread through human fecal matter and commonly linked to contaminated fresh produce, with past outbreaks stemming from vegetables like cabbage, snow peas and broccoli.

On Thursday, the CDC said public health officials had traced infections in Indiana, Kentucky, Michigan, Ohio and West Virginia to shredded iceberg lettuce from Mexico served at Taco Bell locations in those states. But investigators are still working to determine the product or supplier behind illnesses elsewhere in the country.

That uncertainty has left shoppers struggling to decide what belongs in their grocery carts. With no product recall and no clear guidance on which foods to avoid, some customers say they’re growing frustrated by the lack of answers.

“I think they should probably be posting information so people can at least make a choice,” said shopper Marty Stewart, 70, who said he saw no informational signs about the outbreak during a recent afternoon trip to a Jewel-Osco in North Center.

Another shopper, Jane Mecklenburg, 58, of Lincoln Square, wishes grocery stores would do more to help customers understand which foods, if any, pose the greatest risk.

“I’m worried, but I don’t really know what not to buy,” Mecklenburg said.

Representatives from Jewel-Osco, Mariano’s and Aldi did not respond to requests for comment regarding changes to sourcing, vetting and stocking of products amid the cyclosporiasis outbreak.

Meanwhile, Mecklenburg swapped her usual bagged salads for containers of cubed watermelon and pineapple, hoping the fruit’s protective rind made it a safer choice, even if she wasn’t sure it actually reduced the risk. It’s a tradeoff many shoppers are making this summer: trying to eat healthy while wondering which foods are safe to eat.

Many fresh fruits and vegetables are in season during the summer, making produce even harder to avoid. Santina Wheat, a family physician, encourages patients to cook food when possible but said thoroughly washing produce is still a good first step.

“So many of the patients I’m having this conversation with are also ones that are really trying to lead healthy lives,” said Wheat, program director for the McGaw Northwestern Family Medicine Residency at Delnor Hospital. “This is the time of year when you get to enjoy those foods.”

It’s a calculation Stefanie Alvarez made before reaching for the bagged greens at her local grocery store earlier this week. After a brief hesitation, she dropped them into her cart, saying she’ll reconsider if local cases continue to climb.

“The kids like lettuce, otherwise they wouldn’t eat their sandwiches,” said Alvarez, 41, gesturing toward the bag of greens as she left an Aldi in Avondale. “We’re thinking about not buying vegetables, it’s just going to be very hard.”

Kate Pacholek, 43, of Palatine, said she largely skipped produce and avoided prepackaged foods altogether during a trip to Mariano’s in Roscoe Village.

“I’ve been spending extra time washing stuff like cilantro, tomatoes, even cherries,” Pacholek said, adding that she sprinkles produce with baking soda before rinsing it up to five times.

Others, like Kelly Cormack, said the headlines aren’t keeping her out of the produce section.

“If I poop a bunch and then I lose a bunch of weight, it’s not a huge concern,” Cormack, 41, said with a laugh.

Indeed, medical experts warn that the parasite causes watery diarrhea, persistent nausea and fatigue. Wheat said the illness can also lead to dehydration, prompting dizziness, headaches or a racing heart.

“It started off as a regular stomachache until it wasn’t,” said Gonzalez. “My symptoms weren’t normal, and when they say explosive, it really is.”

A relapse of the illness, which Gonzalez experienced when one meal brought back the same agonizing stomach cramps she hadn’t felt in days, is a classic sign of the parasite, according to Wheat. She said that’s where it most differs from other gastrointestinal illnesses that can present similarly at first.

“This one is different because it potentially lasts a week, maybe symptoms get better and then come back again,” said Wheat. “Somebody (can have) explosive diarrhea for a few days, potentially get better without any sort of treatment, and then it comes back.”

During a virtual appointment, a doctor told Gonzalez she likely had cyclosporiasis and prescribed anti-nausea medication. Though Gonzalez never underwent the specialized stool test used to confirm the parasite, Wheat said it’s not unusual for doctors to treat patients based on symptoms rather than waiting weeks for test results that aren’t always accurate.

“A negative test doesn’t mean that somebody doesn’t have the disease,” she said. “While I would still send the test, I would offer the treatment at the same time because it’s still possible that they have it.”

Antibiotics are the standard treatment for cyclosporiasis, though doctors may also prescribe medication to ease nausea. Forrest cautioned that antibiotics can themselves cause diarrhea if given to patients who don’t actually have the parasite, though they can be essential for people with weakened immune systems, including pregnant women and recent transplant recipients.

Cyclosporiasis is not fatal, and most patients recover at home. Although 24 people in Illinois had been hospitalized as of Friday, Wheat said even those patients can recover with supportive care alone.

“It’s the folks who are unable to stay hydrated or weren’t super hydrated before they got the illness that are more likely to be hospitalized,” she said. “This is a frustrating illness, but not always a dangerous illness.”

As doctors continue fielding questions from concerned patients, they’re reassuring them that most people will recover. Wheat said much of the anxiety stems from unanswered questions, and she expects it to ease once investigators identify the source of the outbreak.

Gonzalez, however, isn’t sure answers are enough to restore her trust in food.

“It was honestly such a painful experience to go through,” she said. “I love going out and eating, and that’s just something I can’t really enjoy right now.”

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