State health officials say a fifth case of cyclospora infection has been confirmed in Missouri.
The Missouri Department of Health and Senior Services said Tuesday that the latest case was reported by a health care provider in the Kansas City area.
Previous cases were reported in the Kansas City, Lake of the Ozarks and Branson areas.
Cyclospora is a rare parasite that causes a lengthy gastrointestinal illness with diarrhea and other flu-like symptoms.
It is spread when people ingest food or water contaminated with feces. The illnesses are most often found in tropical or subtropical countries and have been linked to imported fresh fruits and vegetables in the past.
So far, 593 outbreaks of the illness have been reported in 20 states. The U.S. Centers for Disease Control said the outbreak has sickened at least 247 people in Texas, 155 in Iowa and 86 in Nebraska.
The Missouri health department said it is working with the U.S. Centers for Disease Control and other agencies to investigate whether or not the Missouri cases are linked to cases in other states.
In July, health officials in Iowa and Nebraska identified prepackaged salad mix as the source of cyclospora in those states, but it isn't known if outbreaks elsewhere were linked to that produce.
State health officials urge those experiencing diarrhea, especially for a prolonged period, or with severe stomach cramps or nausea to seek medical attention.