Michigan's cyclosporiasis outbreak grew by about 208 cases in one week, pushing the statewide total to 14,718 as of Thursday, Sept. 3, the Michigan Department of Health and Human Services reported.

Ingham County's count held steady at 925 confirmed cases, unchanged from the previous week's update. The county ranks behind Wayne County (2,616 total, including 458 in Detroit), Oakland County (1,692) and Washtenaw County (1,115) in total cases, according to WLNS.

Two people have died in connection with the outbreak. Both had significant underlying health conditions that may have been worsened by cyclosporiasis and dehydration, according to MDHHS. Their ages and hometowns have not been released. Statewide, 366 people reported being hospitalized as of Sept. 3.

The weekly increase of roughly 208 cases marks a continued slowdown from earlier in the summer. On June 30, the state had just 174 confirmed cases. Michigan typically sees about 50 cyclosporiasis cases per year.

A day before the latest case update, the New England Journal of Medicine published an interim report on the outbreak. The study examined the early phase, from May 10 through July 18, using food history data from 3,114 patients, Lansing City Pulse reported.

The report found that iceberg lettuce and one restaurant chain were potential exposure sources. Seventy percent of interviewed patients had eaten at the implicated chain, and 90% of those had consumed iceberg lettuce. The report does not name the chain, but a supporting link in the study points to a July FDA alert identifying Taco Bell as having stopped its supply from Taylor Farms, according to City Pulse.

The U.S. Centers for Disease Control and Prevention (CDC) previously linked the outbreak to iceberg lettuce, and Taylor Farms has recalled all of its iceberg lettuce sourced from central Mexico.

New cases slowing

MDHHS said on Aug. 6 that most exposures likely occurred in late June and early July, and that the contaminated produce was probably no longer available. Laina Stebbins, an MDHHS associate public information officer, said in an Aug. 14 Lansing State Journal report that "the data also suggests that most exposures occurred in late June to early July."

Cyclosporiasis is caused by the parasite Cyclospora cayetanensis, typically spread through contaminated food or water. It does not usually pass from person to person. Symptoms include watery diarrhea, abdominal cramps, bloating and nausea. Diagnosis requires a stool sample, and the infection can be treated with antibiotics.

In the mid-Michigan region, several neighboring counties also have significant case counts: Shiawassee (503), Livingston (493), Jackson (440), Eaton (430) and Calhoun (409).

MDHHS has been releasing weekly case updates on Thursdays. Residents who suspect they have cyclosporiasis should contact their health care provider for testing.