The Centers for Disease Control and Prevention in Atlanta said the vast majority of cases were in Iowa with 127 cases, Nebraska with 68 cases and Texas with 65 cases. Other states reporting cases include: Wisconsin with four cases, Georgia with two cases, and one case each in Connecticut, Illinois, Kansas and New Jersey.
CDC officials said it is not yet clear if the cases are part of the same outbreak, if there is a common source or if the infections are due to international travel.
Most past infections were associated with international travel or contaminated basil, mesclun lettuce, raspberries and snow peas.
Cyclospora cayetanensis is a parasite of one cell, too small to be seen without a microscope, that causes the intestinal infection cyclosporiasis. It is spread by people ingesting something that was contaminated with the parasite. It is unlikely that Cyclospora is passed directly from one person to another, health officials said.
The time between becoming infected and becoming sick is usually about a week and while some people have no symptoms, others might have diarrhea, loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea and fatigue.
The CDC said most of the illness onset dates ranged from mid-June through early July and at least 10 people were hospitalized in three states.
No common events such as social gatherings were identified among the cases, the CDC said.
Since no source has been identified, health officials recommend consumers should always practice safe food handling and wash hands, utensils and surfaces with hot, soapy water before and after handling food. Fresh produce should be thoroughly washed before it is eaten, officials said.