The Food and Drug Administration said most people reported eating a salad at a restaurant, and romaine lettuce was the only common ingredient identified among the salads eaten. Federal health officials say California reported the death, but they did not provide other details.
Massachusetts, along with Utah and Kentucky have been added to the list of states that have reported cases of the virus.
As in previous updates, the CDC continues to warn consumers about consuming romaine lettuce that originates specifically from Yuma, Arizona.
Three more states have reported ill people - Kentucky, Massachusetts, and Utah - bringing the total number of affected states to 25.
"Don't eat or buy ANY romaine lettuce unless you can confirm it is not from the Yuma, Arizona growing region".
Laboratory testing in April determined that the strain of deadly E. coli behind the outbreak, known as O157:H7, produces a toxin known to cause more severe illness, which could explain the high hospitalization rate, the CDC said. Restaurants and retailers are told to ask their suppliers about the source of the lettuce.
Symptoms of E. coli begin on average three to four days after consuming the bacteria. Signs of HUS include fever, abdominal pain, pale skin tone, fatigue and irritability, unexplained bruises or bleeding from the nose and mouth, and decreased urination. Pennsylvania has 20. Idaho has 11. Since 14 people have developed hemolytic uremic syndrome, that rate is nearly 14%, which is higher than the typical rate of 5 to 10% for most E. coli O157:H7 outbreaks. Fourteen of those patients developed a type of kidney failure called hemolytic uremic syndrome.
The latest illness onset was April 21, and the CDC said infections occurring after April 11 might not be reported yet, due to the average 2- to 3-week interval between symptom onset and case reporting.
Photo The outbreak involves both whole-head and chopped, bagged romaine lettuce.