The Centers for Disease Control, or CDC, released its latest update on the status of their cyclospora outbreak investigation on Friday, August 2. According to its latest tally, more than 400 cases of cyclospora infections have been reported in 16 states and one city, including Iowa, Texas, Nebraska, Florida, Wisconsin, Georgia, Illinois, Arkansas, Kansas, Louisiana, Missouri, Connecticut, Minnesota, New Jersey, New York, Ohio and New York City. Illinois, Missouri, New York and Louisiana are reporting one case each that was likely acquired out of state, with Kansas reporting two cases that were possibly acquired out of state.

According to the report, Iowa has the most reported cyclospora infections with 146 cases, followed by Texas with 113 cases and Nebraska with 81 cases.

Cyclospora, a single-celled parasite, causes an intestinal infection called cyclosporiasis, marked by symptoms such as diarrhea, stomach cramps, nausea and fatigue, weight loss, loss of appetite, fever and other flu-like symptoms.

Cyclospora infections tend to occur in people living in or traveling to the tropics and subtropic regions, where the parasite is endemic. It is usually spread when people ingest food or water contaminated with feces.

Twenty-two people have been reportedly hospitalized in five states as a result of the outbreak.

The CDC continues to cooperate with FDA and public health officials across multiple states to aid in the investigation of the source of the outbreak in those states as well. Officials in Nebraska and Iowa pointed to prepackaged mixed bagged salad as the source of the outbreak on July 30. However no specific brand was named, possibly due to “laws prohibiting investigators from naming brands or companies if it's believed the contaminated product is no longer a public health threat,” according to a CBS News report.

Investigators in Nebraska and Iowa are still working to find where the contamination happened within the production and distribution chain. Other states have not ruled whether or not this unnamed bagged salad is the source of their cyclospora outbreaks.

The CDC defines outbreak cases as “laboratory-confirmed Cyclospora [infections] in [people] who became ill in June or July, 2013, and had no history of travel outside of the United States or Canada during the 14 days prior to onset of illness.”

The CDC continues to post updates on their website about their investigation and confirmed cases. Out of all of the cases, 41 have been confirmed in CDC laboratories.

The CDC and FDA advise the practice safe food handling, including the thorough washing of produce and hands to reduce the chance of a cyclospora infection.