Michigan authorities on Aug. 3 said two deaths are linked to the cyclosporiasis outbreak in the state, the first time that cyclosporiasis-associated deaths have been reported since outbreaks began in the spring.

“Two deaths have been identified as part of the cyclosporiasis outbreak affecting Michigan,” the Michigan Department of Health and Human Services said in a statement.

“According to medical records, both individuals had significant underlying health conditions that may have been impacted by cyclosporiasis and dehydration. No additional information will be provided on these two cases.”

The Centers for Disease Control and Prevention said in a statement on Aug. 3 that it is aware of “two cyclosporiasis-related deaths in people with underlying health conditions from Michigan.”

In its latest update on cyclosporiasis, the CDC said on July 28 that it had received no reports of deaths from states.

The CDC said that 45 states have reported 6,707 laboratory-confirmed cases since May 1 that were acquired domestically, that patients ranged in age from 1 to 98, and that the median illness onset date was July 2.

More than 11,000 other cases are pending lab testing or further investigation. The CDC is not counting cases related to international travel.

The outbreak affecting Michigan has also affected eight other states, federal officials said in July. Iceberg lettuce from Mexico is believed to be a cause of the outbreak.

Taylor Farms, which sold the lettuce to Taco Bell and Walmart, among other outlets, on July 17 recalled lettuce sourced from central Mexico. Officials say people should not eat any of the recalled lettuce.

The Food and Drug Administration is still conducting testing and other measures to try to identify any additional sources.

Other states affected by the outbreak include Illinois, Indiana, Kansas, Kentucky, Ohio, Pennsylvania, Oklahoma, and West Virginia.

Michigan has recorded 11,234 cases in recent months, including 193 hospitalizations.

Indiana has recorded 1,285 cases. Kansas has reported 461 cases and 20 hospitalizations. Ohio has recorded about 20,000 cases. Oklahoma has reported 298 cases and 18 hospitalizations, and West Virginia has reported 268 cases and 19 hospitalizations.

Cyclosporiasis is caused by a parasite called Cyclospora that is present in produce contaminated with feces. Past outbreaks have been caused by produce such as salad greens, raspberries, and cilantro.

The disease’s main symptom is diarrhea. Other symptoms include abdominal pain and vomiting.