Michigan health officials have confirmed the first two deaths linked to the ongoing cyclospora outbreak, a parasitic infection that can cause severe diarrhoea.

The two individuals had significant underlying health conditions that may have been impacted by cyclospora and dehydration, state health authorities said.

The outbreak has spread to 45 states, with nearly 7,000 laboratory‑confirmed cases reported nationwide, according to the US Centers for Disease Control and Prevention (CDC).

While the outbreak has infected thousands of people, the CDC says deaths from cyclospora are far from common, as it is usually not life‑threatening.

Michigan’s health department did not provide further details about those who have died, but the state is the epicentre of the current outbreak, with more than 11,000 cases and 193 hospitalisations, although many have not been laboratory‑confirmed.

The heat‑loving parasite infects the intestines and is transmitted through faecal contamination. Past outbreaks have occurred when people consumed fruits or vegetables irrigated with water contaminated by faeces.

The CDC recommends washing all produce under running water, including those that are labelled as pre‑washed.

Washing alone might not be enough to rid produce of the parasite. Cooking produce to a temperature of at least 70 °C (158 °F) can kill the parasite, the agency recommends.

Officials have linked this year’s widespread outbreak to lettuce imported from Taylor Farms in Mexico, a key supplier for many food establishments in the US. Fast‑food chain Taco Bell said it has removed lettuce from the supplier from its menu, and Taylor Farms itself announced a voluntary recall of lettuce sourced from central Mexico.

UK health officials have warned about the outbreak following recent cases contracted by returning travellers.