A massive cyclosporiasis outbreak linked to shredded iceberg lettuce has expanded to an additional six states, according to a source familiar with the matter. The outbreak, caused by a microscopic parasite found in human feces, is responsible for hundreds of hospitalizations and two deaths since early May. The additional states, however, do not necessarily mean the outbreak is continuing to spread, said Dr. Stephen Ostroff, a former acting FDA commissioner. On Monday, health officials in Michigan — which has the most cyclosporiasis cases — confirmed the first deaths linked to this outbreak in the United States. Ostroff said the key question about the newly added states is when their patients became sick.