Cyclosporiasis is an intestinal illness caused by food or water contaminated with the parasite Cyclospora.

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Two people have died as part of the cyclosporiasis outbreak in Michigan, according to the state’s Department of Health and Human Services. These are the first reported deaths associated with cyclosporiasis since the outbreak began in May.

The department said in an update on its website Monday that “both individuals had significant underlying health conditions that may have been impacted by cyclosporiasis and dehydration.” No other information will be provided on those two cases, according to the department.

Cyclosporiasis usually isn’t fatal. The illness can last weeks and pass on its own. Symptoms include watery diarrhea, nausea and fatigue. Antibiotic treatment can help speed recovery.

The parasite Cyclospora makes its way into the human digestive system in food or water contaminated with human waste.

In Michigan and eight other states, contaminated iceberg lettuce from Taylor Farms in central Mexico has been linked as a source of the outbreak. That lettuce was recalled July 17.

Michigan’s case count of cyclosporiasis is up to 11,234 cases. As of July 30, there have been 193 reported hospitalizations there.

Nationally, the Centers for Disease Control and Prevention counts 6,707 confirmed cases as of July. The number is lower than what states collectively are reporting because of the time it takes for local health authorities to pass information to the federal level, and for federal officials to investigate and confirm.

The CDC and the Food and Drug Administration are investigating cases in 45 states. It’s the largest cyclosporiasis outbreak on record in the U.S.

Health officials recommend people follow standard food safety handling protocols to protect yourself from the parasite. Cooking fruits and vegetables to 158 F will also kill the parasite.