An E. coli outbreak that has sickened dozens of people in multiple states might be linked to an ingredient used at fast-food chain Wendy's.
Specifically, federal health officials are investigating whether romaine lettuce is the culprit.
An exact food has not yet been confirmed as the source of this outbreak, but many people reported eating burgers and sandwiches with romaine lettuce at Wendy's restaurants before getting sick, according to the Centers for Disease Control and Prevention.
"Romaine lettuce served on burgers and sandwiches at Wendy's was one of the most common ingredients eaten among the menu items," the CDC said in a statement Friday. "Investigators continue to analyze data at the ingredient level to determine if there are any other possible foods that could be the source of the outbreak."
Following the announcement, Wendy's pulled lettuce from its sandwiches at restaurants in certain locations.
"We have taken the precaution of discarding and replacing the sandwich lettuce at some restaurants in that region," the company said in a statement. "The lettuce that we use in our salads is different, and is not affected by this action."
According to the CDC, a total of 37 people infected with the outbreak strain of E. coli O157:H7 have been reported from four states -- Michigan, Ohio, Pennsylvania and Indiana. Ten of those cases required hospitalization, the CDC said.
The Michigan Department of Health and Human Services, however, claims that it has identified at least 43 confirmed E. coli O157 cases matched with the outbreak strain from its state alone. More than half of the cases required hospitalization, including four people who developed a type of kidney failure called hemolytic uremic syndrome, the health department said.
Ohio has identified 19 cases, Pennsylvania has identified two cases, and Indiana has identified one case, according to the CDC.
The CDC noted that the true number of sick people in the outbreak is likely higher than the number reported, and the outbreak may not be limited to the states with known illnesses.
"Some of the recent illnesses have not yet been reported to PulseNet as it usually takes three to four weeks to determine if a sick person is part of an outbreak. In addition, some people recover without medical care and are not tested for E. coli," the agency said.
Sick people range in age from 6 to 91 years, according to the CDC. Illnesses started on dates ranging from July 26 to August 8.
At this time, there is no evidence to indicate that romaine lettuce sold in grocery stores, served in other restaurants, or in people's homes is linked to this outbreak.
"CDC is not advising that people avoid eating at Wendy's restaurants or that people stop eating romaine lettuce," the agency said. "Investigators are working to confirm whether romaine lettuce is the source of this outbreak, and whether romaine lettuce used in Wendy's sandwiches was served or sold at other businesses."
The company said it is cooperating with the CDC and the ongoing investigation.
"We are committed to upholding our high standards of food safety and quality," Wendy's said in a statement.
Symptoms of E. coli infection usually appear three to four days after the exposure but may appear in as short as one day or as long as 10 days. Symptoms often include severe stomach cramps, diarrhea (often bloody), vomiting and fever. Symptoms often improve within five to seven days. Some infections are very mild, but others can be severe or even life-threatening.
Anyone experiencing symptoms should contact a health care provider.
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