The rare parasite cyclospora has caused at least 235 illnesses in six midwestern states since mid-June, according to state health department reports Friday. On Thursday, that number stood at 206, including case counts in Iowa, Texas and Nebraska. Illnesses were known to have occurred in Wisconsin, but the number of cases there had not yet been reported. Now, the Wisconsin Department of Health Services is reporting at least four illnesses among residents of Milwaukee, Brown and Grant Counties. In Nebraska, the number of reported illnesses has risen from 53 — reported Thursday — to 63. Cases in that state are largely concentrated in the East. Iowa reported 109 cyclospora illnesses Friday, up seven from the 102 it reported Thursday. And in Texas, the case count stood at 56 Friday, according to a CIDRAP. That same report cited two illnesses in Illinois and one in Kansas. While the Nebraska and Iowa cases have been established to be part of the same outbreak, suggesting that they arose from a common source, a connection between the outbreak and the illnesses in Wisconsin and Texas has yet to be officially established; however evidence is suggesting that the 52 cyclospora cases in these two states are probably part of the outbreak as well. “These cases are presumed to be part of a multi-state outbreak of the disease affecting approximately 200 people, mostly in Iowa, Nebraska, and Texas,” said Wisconsin’s health department in its announcement of the four WI cases Friday. “DCHHS is continuing to investigate the possible food sources of contamination and who may have been exposed to them,” said the director of the Texas Department of State Health Services, Zachary Thompson, in a statement Thursday. Cyclospora outbreaks are rare in the United States. When they do occur, the source is most commonly either a fresh fruit or vegetable. An outbreak of cyclospora that sickened at least 1,465 people in the U.S. and Canada in 1996 was later traced to raspberries imported from Guatemala. The source of the ongoing cyclospora outbreak in the Midwest is thought to be a fresh vegetable. Because fresh produce has a relatively short shelf life, the contaminated product is no longer thought to be on the market, according to Iowa health officials. Investigators continue to try to determine the exact source of the parasite.