The U.S. Centers for Disease Control and Prevention said 31 more people have fallen ill in an E. coli outbreak tied to romaine lettuce.
The total number of cases now stands at 84 and the outbreak has spread to 19 states, the CDC said Wednesday afternoon. Forty-two patients were hospitalized and nine developed a form of kidney failure. No deaths have been reported.
Investigators have not yet identified a grower, supplier, distributor or brand responsible for the outbreak, the CDC said, although it has been traced to the Yuma, Arizona, region.
The CDC warns people not to eat any form of romaine lettuce from Yuma area. Romaine confirmed not to be from the Yuma area is OK to eat.
The E. coli spreading through the states is "toxin-producing," the CDC states — specifically a toxin known as Shiga. People get sick within two to eight days of swallowing the germ, which causes diarrhea, stomach cramps and vomiting. Although most recover in one week, it could lead to kidney failure.
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To avoid E. coli, wash your hands regularly and thoroughly, cook meat completely, wash fruits and vegetables, avoid raw milk and don't prepare food when you're sick. If you find yourself sick, write down what you've eaten, contact your doctor and report your illness to your local health department.
The CDC, the U.S. Food and Drug Administration and states are investigating the outbreak, which began March 13.
The Wednesday update adds Colorado, Georgia and South Dakota to the list of affected states. Pennsylvania has the most number of cases with 18, followed by California with 13 and Idaho with 10. Those affected are 65% female and range in age between 1 and 88 years old.