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Cyclospora, a rare parasite, has sickened at least 301 people in 11 states hospitalizing 18 of them, according to the latest information from the Centers for Disease Control and Prevention (CDC) and state health departments. Three new states, Minnesota, Ohio and New Jersey, have been added since yesterday.

Case counts by state are higher in some instances than those on the map in the link above. They are as follows: Iowa (138), Texas (80), Nebraska (70), Wisconsin (7), Georgia (2), Connecticut (1), Illinois (1), Kansas (1), Minnesota (1), New Jersey (1), Ohio (1). The cases in Illinois and Kansas may have been acquired out of state. “Additional cases are currently under investigation and will be included on this page as states confirm them,” the CDC update states. Those states may include New York, Arkansas and Florida which have all recently reported cases of Cyclospora infection to the CDC.

Health officials say they are uncertain if all the cases are related such as the case in Minnesota, for example. “This case was just reported to us very recently,” Doug Schultz, a spokesman for the Minnesota Department of Health told Food Poisoning Bulletin. “Our case is an adult male from the Twin Cities metro area who became ill early in July, was not hospitalized and is recovering.”

Cyclospora is rare, so a large spike in cases is unusual. Last year, for example, a total of 123 cases were reported nationwide. Reported cases are often associated with travel to tropical or subtropical regions, which is not the case with these recently reported illnesses.

Cyclospora when they ingest food or water containing microscopic amounts of fecal matter from an infected person. Case patients in this outbreak reported onset of illness dates range form mid-June to early July. Health officials have not pinpointed a specific food source, but fresh vegetables are a suspect.

Symptoms of a Cyclospora infection include: watery or explosive diarrhea, nausea, vomiting, bloating, gassiness, abdominal cramps, weight loss, loss of appetite, low-grade fever, fatigue and malaise. It can take two weeks after exposure for symptoms to develop and they can persist for up to two months. See your doctor if you have had these symptoms for more than a few days especially if your eyes look sunken or you have reduced urine output, reduced tear production or dry mouth or tongue, which are symptoms of dehydration.