LANSING, MICHIGAN (VINnews)-Michigan health officials confirmed Monday that two people have died in connection with a large cyclosporiasis outbreak that has sickened more than 11,000 residents.

The Michigan Department of Health and Human Services reported 11,234 cases and 193 hospitalizations as of its latest update. Both people who died had significant underlying health conditions that may have been worsened by the infection and resulting dehydration, according to medical records. Officials said no further details on the deaths would be released.

Cyclosporiasis is generally not life-threatening, and deaths from the illness are uncommon in the United States, the department noted.

The illness is caused by the parasite Cyclospora cayetanensis, which is typically spread through contaminated food or water. Health officials said lettuce or salad greens may be a potential source in Michigan, though no single product, grower or supplier has been identified for all of the state’s cases. A related multistate cluster has been linked to iceberg lettuce from Mexico.

Symptoms include prolonged watery diarrhea, loss of appetite, weight loss, stomach cramps, nausea and fatigue. Treatment usually involves antibiotics and careful hydration.

Officials advised residents experiencing persistent gastrointestinal symptoms to contact a health care provider. They also recommended thoroughly washing produce and preferring whole heads of lettuce over pre-washed or bagged greens when possible.

The investigation remains ongoing.