NEW YORK (AP) — U.S. health officials say a food-poisoning outbreak tied to alfalfa sprouts and involving multiple germs has sickened people in 15 states.

State officials announced the outbreak earlier this week, saying they documented more than three dozen cases in Minnesota and Wisconsin. On Friday, the U.S. Centers for Disease Control and Prevention said the agency is aware of 55 cases nationally, including four people who have been hospitalized.

The CDC said cases are also reported in Florida, Indiana, Iowa, Kansas, Michigan, New Hampshire, New York, Pennsylvania, North Carolina, South Carolina, North Dakota, South Dakota and Washington.

Of 34 sick people interviewed, 26 reported eating alfalfa sprouts, according to the U.S. Food and Drug Administration.

Food poisoning outbreaks tend to be defined by one type of germ, but this outbreak involves people with salmonella and different strains of E. coli.

Shiga toxin-producing E. coli — or STEC — can cause stomach cramps and bloody diarrhea. Infections can lead to a severe complication that involves acute kidney failure.

Salmonella poisoning can cause diarrhea, fever, severe vomiting, dehydration and stomach cramps.

Officials are linking cases to alfalfa sprouts produced by Everything Sprouts, a Minnesota grower, and sold under the Calco and Everything Sprouts brands to restaurants and grocery stores. The company has yet to issue a recall, the FDA said.

Last year, the FDA sent a warning letter to Everything Sprouts, saying inspections the year before identified several points of concern, including a leaking roof that was dropping water onto bean sprouts and workers' smocks.

The Associated Press left messages for Everything Sprouts seeking comment.

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