A total of 658 Cyclospora cases have been counted among residents of 23 states, according to case-count updates by the Centers for Disease Control and Prevention and the Texas Department of State Health Services on Friday. The CDC cautioned that although the investigation of cases continues, available evidence suggests that not all of the cases in the various states are directly related to each other. Taylor Farms de Mexico, the lettuce grower whose products were connected to Cyclospora cases in Iowa and Nebraska, resumed operations this week. The farm had suspended production at its processing facilities on August 9 after the epidemiologic investigation into the Cyclospora outbreak identified its products as the source of Cyclospora cases among customers of both Olive Garden and Red Lobster restaurants. The latest Cyclospora case count by state is as follows: Texas (304), Iowa (156), Nebraska (86), Florida (32), Wisconsin (16), Illinois (11), Arkansas (10), Georgia (5), Missouri (5), New York City (5), Kansas (4), Louisiana (3), Connecticut (2), Michigan (1), Minnesota (2), New Jersey (4), New York (2), Ohio (2), Virginia (3), California (1), New Hampshire (1), South Dakota (1), Tennessee (1), and Wyoming (1). Several states’ case-counts include cases that may have been acquired out of state. The CDC has received reports that 45 people were hospitalized due to their Cyclospora infections. No deaths have been reported. The median age of Cyclospora cases is 51 years, with case-patients ranging in age from less than one year to 92. Cyclospora is a single-celled parasite often associated with contaminated fresh produce. Symptoms can take several days or weeks to appear and include watery diarrhea, vomiting, fatigue, nausea and stomach cramps. It sometimes takes 5-6 weeks for confirmed illnesses to be reported to the CDC.