At least 20 people across 17 states have been hospitalized due to severe gastrointestinal illness as more than 1,000 cases of the parasitic infection cyclosporiasis have been reported across the country, the U.S. Centers for Disease Control and Prevention (CDC) reports.

The CDC and the Food and Drug Administration (FDA) are investigating several clusters of the illness in Illinois, New York, Pennsylvania and Texas, according to CNN. However, the worst-hit state so far is Michigan, with 1,251 cases reported as of July 9, the Michigan Department of Health and Human Services (MDHHS) reported. According to the Associated Press (AP), this marks the biggest cyclosporiasis outbreak in the state’s history.

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