The ongoing multistage outbreak of cyclosporiasis, caused by the cyclospora parasite, has risen significantly to 321 cases in 15 states, the Centers for Disease Control and Prevention said Friday.

According to the latest update, cases have been reported in Iowa, Texas, Florida, New York City, Wisconsin, Georgia, Missouri, Arkansas, Connecticut, Minnesota, New Jersey, and Ohio. Illinois and Kansas have also notified CDC of one case each that may have been acquired out of state but in the United States.

CDC said At least 18 persons reportedly have been hospitalized in three states.

“No food items have been implicated to date, but public health authorities are pursuing all leads,” read the update. “Previous outbreak investigations have implicated various types of fresh produce.”

Cyclospora infection causes a watery diarrhea that lasts an average of 57 days, if untreated, according to IDPH. Most of the illnesses in the current outbreak began in mid to late June. Many people report still being ill and some have had relapses, according to the update.

Anyone experiencing diarrhea, or have recently had a long bout with diarrhea, should contact their health care provider and see if they should be tested for Cyclospora infection.

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