State health officials warned residents Thursday night about a multistate outbreak of listeriosis linked to eating caramel apples that has led to the deaths of two people in Minnesota.

Four people in the state have become ill and had to be hospitalized as part of the outbreak, according to a release by the Minnesota Department of Health. All victims were adults ages 59 to 90 years and had gotten sick in late October and November.

Consumers who may have purchased prepackaged, commercially produced caramel apples, including caramel apples with other toppings such as nuts, chocolate and sprinkles, are warned not to eat them until more information becomes available.

In the Minnesota cases, caramel apples were purchased from Cub Foods, Kwik Trip and Mike's Discount Foods, which carried Carnival brand and Kitchen Cravings brand caramel apples.

These two brands are no longer available for purchase, but health officials are concerned that people may still have them at home. Other caramel apple brands and locations may also be affected. At this time, no illnesses have been linked to apples that are not caramel-coated and not prepackaged.

Listeriosis is a serious infection caused by eating food contaminated with the bacterium Listeria monocytogenes. The disease affects mostly older adults, pregnant women, newborns and persons with weakened immune systems.

Minnesota averages seven reported cases each year. Listeriosis symptoms, which begin anywhere from three to 70 days after consuming the bacteria, include fever, muscle aches, headache, stiff neck, confusion, loss of balance and convulsions.

The state Departments of Health and Agriculture are working with the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration to investigate the outbreak. Anyone who believes they may have become ill with listeriosis should contact their health care provider.

Nicole Norfleet • 612-673-4495

Twitter: @stribnorfleet