Two individuals in Michigan have died in connection with an outbreak of cyclosporiasis, an intestinal illness caused by the cyclospora parasite, state health officials announced Monday. Both individuals had significant underlying health conditions that may have been exacerbated by the infection and subsequent dehydration, according to the Michigan Department of Health and Human Services (MDHHS).

The MDHHS stated that no additional information would be released regarding these two cases. Cyclosporiasis typically causes diarrhea, severe cramping, nausea, vomiting, and fatigue.

The outbreak has affected 45 states nationwide, with Michigan identified as the epicenter. As of Monday, Michigan has reported 11,234 cases of cyclosporiasis. This number is nearly triple that of Ohio, the next most affected state, which has recorded 4,013 cases.