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(USA TODAY) --An outbreak of a diarrheal disease that has sickened 372 people in 15 states since June may be linked to a bagged salad mix.

"The evidence points to a salad mix containing iceberg and romaine lettuce, as well as carrots and red cabbage, as the source of the outbreak reported in Iowa and Nebraska," Steven Mandernach, chief of the Food and Consumer Safety Bureau of the Iowa Department of Inspections and Appeals, said in a release Tuesday.

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The investigation by Iowa and Nebraska health officials found that at least 80% of people in those states infected in the cyclospora outbreak had eaten a prepackaged salad mix.

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A seven-person Food and Drug Administration team has begun a trace-back investigation to identify where the ingredients in the salad mix came from.

Cyclospora is an intestinal illnesses caused by the microscopic parasite Cyclospora cayetanensis. It is transmitted when feces enter the food or water supply and are consumed. The disease causes watery and sometimes explosive diarrhea and is treated with antibiotics. Symptoms can also include fatigue, anorexia, bloating, stomach cramps, vomiting, muscle aches and a low fever.

The illness is generally found in tropical or subtropical regions of the world. Foodborne outbreaks of cyclospora in the United States in the past have all been linked to imported fresh produce.

The first cases in the national outbreak were reported June 28. At least 21 people have been hospitalized in the outbreak, according to the Centers for Disease Control and Prevention

Iowa state officials are not naming the salad mix nor the company that produced it, but they say the salad mix is no longer being sold in the state. None of the ingredients was grown in Iowa.

Looking at the dates when people fell ill, it appears as if most people ate the contaminated food in mid-June, according to a news release posted Tuesday by the Iowa Department of Public Health.

Cases have been reported in Arkansas, Connecticut, Florida, Georgia, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, New Jersey, New York, Ohio, Texas and Wisconsin. Health officials do not know whether all the reported cases are part of the same outbreak.

FOOD SAFETY LINKS

CDC: Food Safety Basics for Fruits & Vegetables

Food Poisoning Bulletin

FDA: Ensuring Food Safety

FDA: Lettuce Safety Initiative

FDA: Raw Produce - Selecting and Serving it Safely

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