A massive cyclosporiasis outbreak linked to shredded iceberg lettuce has expanded to an additional six states in the United States. The newly linked states — Arkansas, Iowa, Missouri, Nebraska, New Hampshire and North Carolina — join Illinois, Indiana, Kansas, Kentucky, Michigan, Ohio, Oklahoma, Pennsylvania and West Virginia. The agency’s update marks a significant expansion in the outbreak of cyclosporiasis, a foodborne illness that often leads to watery and sometimes explosive diarrhoea. A massive cyclosporiasis outbreak linked to shredded iceberg lettuce has expanded to an additional six states in the US. On Monday, health officials in Michigan — which has the most cyclosporiasis cases — confirmed the first deaths linked to this outbreak in the US.