McDonald's salads have left almost 400 people infected by a 'poo parasite' which causes vomiting and "explosive" bowel movements, according to reports.
A total of 395 cases of the Cyclospora infection by people who had eaten in the fast food restaurant across 15 different US states were recorded as of Thursday, according to the Food and Drug Administration.
It is usually caught from eating raw fruit and vegetables contaminated with human poo, the NHS says.
Sixteen of the 395 people who became ill in the US were hospitalised.
The FDA is currently reviewing the distribution and supplier information for romaine lettuce and carrots.
Most people infected with Cyclospora develop diarrhea, with frequent and sometimes explosive, bowel movements.
Other common symptoms include loss of appetite, weight loss, stomach cramps or pain, bloating, increased gas, nausea, and fatigue, the FDA says.
People infected by Cyclospora cayetanensis, a microscopic parasite of humans, may also suffer from vomiting, body aches, headache, fever, and other flu-like symptoms.
The FDA wrote in a statement : "As of August 2, 2018, a total of 395 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 15 states.
"Note, the Connecticut, Tennessee, and Virginia case-patients purchased salads while traveling in Illinois; the Florida case-patient purchased a salad while traveling in Kentucky."
The investigation is ongoing.
What causes cyclospora?
The NHS says: Cyclospora is caught by consuming food – especially raw berries, herbs and salad items – or water contaminated with human faeces (poo) carrying the parasite.
The parasite lives in the poo.
You can't catch cyclospora by coming into contact with an infected person, such as someone who hasn’t washed their hands after going to the toilet.
Once in the poo, the parasite takes about 10 days before becoming infectious.
If cyclospora isn't treated, the illness may last from a few days to a month or longer.
Symptoms may seem to go away and then return more than once. It's common to feel very tired.
If you think you have cyclospora, you're advised to see your GP to check your symptoms. Mention your recent travel history.
Cyclospora is treated with a course of antibiotics called co-trimoxazole.
A statement by McDonald's on July 20 said: "The health and safety of our customers and the people who work in McDonald’s restaurants is always our top priority.
"The additional states identified by the FDA and CDC are among the same states where a week ago we proactively decided to remove our lettuce blend in impacted restaurants and replace it through a different supplier.
"McDonald’s is committed to the highest standards of food safety and quality and we continue to cooperate and support regulatory and public health officials in their investigations."
Mirror Online has contacted McDonald's for further comment.