Cyclosporiasis has been linked to fresh produce, including bagged lettuce, herbs and berries. DAN TUOHY / NHPR

Nine cases of cyclosporiasis, the intestinal illness associated with a national lettuce recall, have been confirmed in New Hampshire, the state Department of Health and Human Services said Thursday.

Cyclospora spreads to humans through food and water contaminated with feces, and infection isn’t unheard of among travelers returning from international trips. Six previous cases had been identified in New Hampshire this year, but until now, none were linked to the national outbreak.

The new cluster of cases involves people who consumed lettuce products served at the Cheshire Medical Center cafeteria in Keene. The cafeteria had been serving iceberg lettuce that, on July 17, was voluntarily recalled by Taylor Farms; the lettuce had been distributed to 27 states prior to the recall.

Cyclospora symptoms include stomach cramps, nausea, fatigue, low-grade fever and, notably, “watery diarrhea,” according to DHHS. “If untreated, symptoms can last for weeks and may relapse after a period of improvement,” the department said. “Anyone experiencing symptoms with potential exposure to recalled lettuce should contact their healthcare provider.”

Although Taylor Farms lettuce has not been sold directly to consumers in New Hampshire, other food service businesses across the state received the recalled product, according to health authorities.

The recalled lettuce originates from Mexico; the parasite thrives in tropical climates.

The Cheshire Medical Center is no longer serving the recalled lettuce. The center is a nonprofit community hospital that belongs to the Dartmouth Health system.

Rebeca Pereira is the news editor at the Concord Monitor. She reports on farming, food insecurity, animal welfare and the towns of Canterbury, Tilton and Northfield. Reach her at rpereira@cmonitor.com