Florida (1), Texas (1), North Dakota (2), and Minnesota (see below) have joined 25 other states reporting sick people in the multistate E. coli O157:H7 outbreak linked to tainted romaine lettuce, according to a Centers for Disease Control and Prevention (CDC) update.

In Minnesota, ten cases of E. coli O157 infection in residents have recently been identified and linked to the multi-state outbreak. Illness onset dates range from April 20 through May 2. The cases are from both metro and greater Minnesota counties

E. coli mapAs of Tuesday,  149 people infected with the outbreak strain of E. coli O157:H7 have been reported from 29 states. Sixty-four people required hospitalization including 17 people who developed hemolytic uremic syndrome, a type of kidney failure. One death was reported from California.

State and local health officials continue to interview ill people to ask about the foods they ate and other exposures they had before they became ill. Of the 112 people interviewed, 102 (91%) reported eating romaine lettuce in the week before their illness started.

According to an FDA update Wednesday:

The FDA is continuing to investigate illnesses related to romaine lettuce from the Yuma growing region. We are working to identify multiple distribution channels that can explain the entirety of the nation-wide outbreak and are tracing back from multiple groupings of ill people located in diverse geographic areas.

The FDA has identified one farm as the source of the whole-head romaine lettuce that sickened several people at a correctional facility in Alaska. However, the agency has not determined where in the supply chain the contamination occurred. The agency is examining all possibilities, including that contamination may have occurred at any point along the growing, harvesting, packaging, and distribution chain before reaching the Alaska correctional facility where it was served.

All of the lettuce in question from this farm was harvested during March 5-16 and is past its 21-day shelf life. Because the growing season in the Yuma region is at its end, the farm is not growing any lettuce at this time.

Most of the illnesses in this outbreak are not linked to romaine lettuce from this farm, and are associated with chopped romaine lettuce. The agency is investigating dozens of other fields as potential sources of the chopped romaine lettuce and will share information as it becomes available.

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To date, the FDA also has no evidence that other types of lettuce, or romaine lettuce grown outside of the Yuma growing region, are involved in this outbreak.

Symptoms of illness caused by E. coli O157 typically include stomach cramps and diarrhea, often with bloody stools, but only a low-grade or no fever. People typically become ill two to five days after exposure, but this period can range from one to eight days. Most people recover in five to 10 days. However, E. coliO157 infections sometimes lead to HUS. Those most at risk of developing complications from E. coli O157 include children younger than 10, the elderly, and those with weakened immune systems.

Diarrhea associated with E. coli O157 infections should not be treated with antibiotics, as this practice might promote the development of HUS.