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One of the notable developments for 2018 was a spike in Cyclospora cases, likely the result of multiple factors, the CDC said.
The outbreak has reached 156 cases, as 113,000 pounds of ground beef are recalled.
Case counts climb to 109, making it the 3rd-largest E coli outbeak in 20 years.
Patients range in age from 1 to 74 years, but at least half are children.
As the outbreak grows to 59 cases, officials puzzle over why romaine and not other lettuce was tainted.
The CDC notes 11 more illnesses, raising the outbreak total to 43 cases in 12 states.
So far 32 illnesses have been confirmed in 11 states, as well as 18 cases in Canada.
Investigators were't able to determine exactly how the water contaminated the lettuce, which may have occurred by irrigation or the dilution of chemical to protect crops.
Of 18 cases, 15 are in Florida; the meat producer has not been named.
The resistant E coli sublineage ST131-H22 has become established in poultry.
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