Taylor Farms has recalled iceberg lettuce distributed in 27 states, sharply expanding the scope of a cyclospora outbreak initially linked to shredded lettuce served at Taco Bell restaurants in five Midwestern states.

The Salinas company said the recalled lettuce was sourced from central Mexico and distributed from June 29 through Thursday. Products have “best if used by” dates extending through Aug. 3.

Consumers who have the recalled lettuce should not eat it and should throw it away or return it for a refund, Taylor Farms said late Friday.

The recall covers shredded and chopped iceberg lettuce, salad mixes and blends of iceberg and romaine sold under several abbreviated brand codes. It also includes Marketside iceberg salad and shredded lettuce sold by Walmart.

Walmart said it removed four private-label lettuce products from stores in the affected states as a precaution and advised customers to discard them or return them for a refund.

The recalled products were distributed in Alabama, Arkansas, Connecticut, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Missouri, Mississippi, North Carolina, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and Wisconsin.

California and New York were not listed. It remains unclear whether distributors or other customers moved the lettuce beyond the states identified by Taylor Farms.

Taylor Farms has not released a full list of restaurants, grocery stores and other businesses that received the products.

That leaves consumers dependent on retailers, restaurants and food distributors to identify products sold under private labels or used in prepared foods.

Sysco, the country’s largest food service distributor, said it stopped distributing the affected Taylor Farms products Thursday and was removing all iceberg lettuce from Mexico from its supply chain. US Foods said it also notified affected customers.

Taylor Farms said it had stopped receiving lettuce from the implicated lot, suspended distribution of iceberg lettuce from central Mexico and notified its customers.

The company previously said an FDA traceback investigation had focused on an independent farm that accounts for less than 1% of the U.S. iceberg lettuce supply. Taylor Farms has not identified the farm.

No Taylor Farms-branded salad kits are included in the recall, the company said. It has emphasized that those kits do not contain iceberg lettuce.

Federal authorities initially linked the outbreak to shredded iceberg lettuce supplied to Taco Bell restaurants in Indiana, Kentucky, Michigan, Ohio and West Virginia. 

Taco Bell said Friday that it had removed all affected Taylor Farms lettuce from its restaurants.

At least 1,644 people in those five states have been infected, including 94 who were hospitalized. No deaths have been reported. 

The CDC cautioned that other cyclospora illnesses being investigated around the country are not necessarily connected to the Taco Bell outbreak.

Nationwide, the CDC has confirmed 1,645 domestically acquired cases and is reviewing more than 5,100 additional illnesses. The number could rise as investigators determine whether illnesses outside the original five-state outbreak are connected to the recalled lettuce.

California health officials previously said the state was not part of the multistate outbreak and had not been notified of any lettuce distribution or traceback findings affecting California.

Cyclospora is a microscopic parasite that can contaminate food or water. Infection can cause watery diarrhea, stomach cramps, bloating, nausea, fatigue, loss of appetite and weight loss. Bowel movements can be frequent and sometimes “explosive.”

Symptoms generally begin about a week after exposure but may take two weeks or longer to appear. Without treatment, they can last a month or more and may disappear before returning.

People who develop symptoms after eating recalled lettuce should contact a health care provider and ask whether cyclospora testing is appropriate. Routine stool tests do not always screen for the parasite.

Taylor Farms said consumers with questions can call its customer service line at 855-455-0098 from 8 a.m. to 5 p.m. Pacific time Monday through Friday.

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This article originally published at California company recalls lettuce shipped to 27 states as ‘explosive diarrhea’ outbreak grows.