LANSING (WWJ) – State health officials say four cases of illness connected to a massive flour recall have been reported in Michigan, two of which required hospitalization.

The Michigan Department of Health and Human Services said Thursday that at least four adults in the state have  been infected with the outbreak strain of E. coli connected to three brands of flour recalled by General Mills.

READ MORE: The Detroit Zoo To Host Its Final Weekend Of Family-Friendly Halloween Event 'Zoo Boo' Oct. 22-24

Those sickened live in Ingham, Kent, Oakland, and Ottawa counties. Officials say two of the cases were so severe, the residents had to be hospitalized.

Nationally, 38 people in 20 states have been sickened; These illnesses occurred between late December 2015 and early May 2016. Preliminary results of the national investigation indicate an association between the outbreak strain and someone baking with Gold Medal flour or exposed to raw dough in restaurants. Traceback investigations show the flour was produced at the General Mills facility in Kansas City, Missouri.

General Mills announced a voluntary nationwide recall due to possible E. coli contamination of the three products on May 31.

READ MORE: Tillson Street's Halloween Displays Draws Thousands

[Click here to see the complete list of recalled products]

Symptoms of an E. coli infection include diarrhea (often bloody) and abdominal cramps. Recovery for most people occurs within one week. However, some illnesses last longer and can be more severe, resulting in a type of kidney failure called hemolytic uremic syndrome (HUS). HUS is more commonly seen in young children (less than 5 years), older adults, and people who are immune compromised. HUS symptoms can include fever, abdominal pain, pale skin tone, fatigue, bruising, bleeding from nose and mouth, and decreased urination. People who experience these symptoms should seek emergency medical care immediately.

Consumers should throw the recalled products away. Consumers with additional questions or requesting a replacement should contact General Mills at 800-230-8103. Additional recall information can also be found at

MORE NEWS: Kalamazoo Tests For Lead Exposure Following High-Lead Level Reports In Other Michigan Cities