Missouri health officials say they have been notified of a third confirmed case of cyclospora infection.

The state Department of Health and Senior Services said Friday the latest report of the stomach bug came from a health provider in the Kansas City metro area. The others were reported earlier this week from Jackson County and Taney County.

The state health department said the sources of the Missouri cases have not been confirmed.

It’s not clear if they’re linked to cyclospora infections in more than a dozen other states.

Officials in Iowa and Nebraska have said they believe cases those two states are linked to bagged salad mix.

“The evidence points to a salad mix containing iceberg and romaine lettuce, as well as carrots and red cabbage as the source of the outbreak reported in Iowa and Nebraska,” said Steven Mandernach, Chief of the Food and Consumer Safety Bureau of the Iowa Department of Inspections and Appeals.

Mandernach said residents could continue eating salads, because the prepackaged mix is no longer in the food supply chain.

“Iowans should continue eating salads as the implicated prepackaged mix is no longer in the state’s food supply chain.”

At least 78 people have been sickened by this parasite in Nebraska.   By the end of July, 146 cases had been confirmed in Iowa.  At least two cases have been reported in Kansas.  Most illnesses began in mid to late June.

The last multistate cyclospora outbreak in the United States was in 1997, linked to raspberries imported from Guatemala. An outbreak in Pennsylvania in 2000 sickened 54 people who were guests at a wedding, also associated with Guatemalan raspberries. Other outbreaks were associated with mesclun lettuce and basil.

Cyclospora infections are mostly found in tropical or subtropical countries. Symptoms include diarrhea, severe stomach cramps or nausea.

(The Associated Press contributed to this report)