On Monday, Michigan health officials confirmed the first two deaths linked to the largest U.S. cyclosporiasis outbreak. According to medical records, both individuals had significant underlying health conditions that may have been impacted by diarrheal illness and dehydration. Michigan health officials stressed cyclosporiasis generally isn’t life-threatening and that deaths from it are uncommon in the U.S.

Meanwhile, cyclosporiasis cases in Michigan grew to 12,218 as of Wednesday. As of July 30, 193 reported cases indicated they had been hospitalized.

The two Michigan cases became ill prior to the voluntary recall of iceberg lettuce announced by  Food and Drug Administration on July 17. While the investigation is ongoing, available information indicates that lettuce or salad greens may be a potential source of this outbreak. However, other food items cannot be completely ruled out. No specific type of produce, grower, or supplier has been identified as the source. 

The Michigan cases are tied to the largest known cyclosporiasis outbreak, which expanded to 15 states, including Missouri, which has confirmed 1,095 cases as of Aug 2. The other states joining the outbreak tied to lettuce from Mexico are Arkansas, Iowa, Nebraska, New Hampshire, ​and North Carolina, ​the Washington Post ⁠said, citing a person familiar with the investigation. AS CMM previously reported, the Centers for Disease Control and Prevention expanded the outbreak last week to Illinois, Indiana, Kansas, Kentucky, Michigan, Ohio, Oklahoma, Pennsylvania, and West Virginia. Cases have now reached 45 states as infections climb, USA TODAY reports.

As of July 30, the Ohio Department of Health confirmed 4,013 cases of cyclosporiasis across the state. Ohio has seen 172 cyclosporiasis hospitalizations this year. As of Aug. 4, the Indiana Department of Health confirmed 1,524 cases and the Illinois Department of Public Health reported 995 confirmed and probable cases.

Cyclosporiasis is an illness caused by a microscopic parasite, Cyclospora cayetanensis. Food or water can become contaminated with feces that contain the parasite. People can then become sick by consuming contaminated food or water. Symptoms generally begin around seven days after exposure but that time range can range from two to14 days. Symptoms can last for a few days to more than a month if left untreated. Individuals who do not receive treatment can cycle through symptoms, feeling sick, appearing to get better, then feeling sick again.

The Suffolk County Department of Health (SCDHS) in New York said Monday that there’s been three probable cases of tularemia, a rare but serious infection that’s also known as rabbit fever, on Long Island. It can occur after a bite from a tick or a fly that has previously bitten a sick mammal, typically a rabbit, Axios reported.

The rare illness can be caught while lawnmowing and comes at a time when tick-borne illnesses are sharply rising in the United States. As CMM previously reported, emergency department visits for tick bites have reached their highest levels for this time of year since 2017.

SCDHS currently has three probable cases of tularemia this year. Confirmation of a tularemia diagnosis requires a combination of laboratory testing and fulfillment of specific clinical or epidemiologic criteria. The laboratory testing to confirm a tularemia diagnosis may take several weeks. Suffolk County has reported multiple cases of rabbit fever over the years, with four in 2024 and three in 2023, per the county’s health data.

Tularemia has been reported from all states except Hawaii but is most common in the south-central United States, the Pacific Northwest, and parts of Massachusetts, including Martha’s Vineyard, the Centers for Disease Control and Prevention said. Tularemia occurs in people of all ages but is most common in children. From 2015 to 2023, the CDC has confirmed between 315 and 150 cases per year.