OMAHA ? Health officials have confirmed at least 54 cases of salmonella in four states as part of an outbreak linked to alfalfa sprouts recalled by an Omaha company.

Cases of salmonella in Nebraska, Iowa, Kansas and South Dakota have been tied to SunSprout Enterprises’ sprouts that were distributed to grocery stores and restaurants.

SunSprout has defended its products.

Nebraska health officials said Monday at least 25 cases of salmonella St. Paul have been confirmed near Omaha, Lincoln and Kearney.

Iowa officials confirmed 19 cases as of Monday.

South Dakota and Kansas officials have both confirmed at least five cases in their states.

Salmonella poisoning can cause diarrhea, fever, dehydration, abdominal pain and vomiting.