General Mills is expanding its national flour recall for the second time after more people were sickened due to E. coli in its products.

The Centers for Disease Control and Prevention says 46 people have become ill from E. coli contamination of its flour, with one person in Indiana having developed a type of kidney failure. The number of cases in Minnesota has risen from three to five — the most of any of the 21 states with cases.

General Mills in May recalled batches of its Gold Medal, Wondra and Signature Kitchens flour made during three weeks in November at a Kansas City plant. Earlier in July, it added another week of that plant's November production to the recall.

But the latest illnesses were traced to flour made outside of that one-month window, leading General Mills to significantly widen its recall time period by more than two months. Flour made at the facility between Nov. 4 and Feb. 10, totaling 45 million pounds, is now eligible for recall.

The CDC also revealed Monday the discovery of a second strain of the bacteria, E. coli O26, in flour from the same plant. E. coli 0121, the strain linked to 45 of the reported illnesses, is less common and likely less virulent than other strains that have wreaked havoc on public health in the past. The bacteria can cause bloody diarrhea, dehydration and possibly death. Elderly people, young children and those with a weakened immune system have a higher risk of foodborne illness.

All of the reported illnesses came from eating or handling raw products, including playdough, cookie batter or other uncooked items.

The CDC says the people who have gotten sick from handling or eating raw flour range from age 1 to 95. No deaths linked to this contamination have been reported; 13 people have been hospitalized.

A number of secondary product recalls have been issued in the wake of the flour recall, including another General Mills brand: Betty Crocker cake mixes. A few varieties of those mixes contained flavor pieces, purchased from a supplier, that used the recalled flour to make the bits.

General Mills produces 2.5 billion pounds of flour a year and, according to IRI, a market research firm in Chicago, is the nation's leading seller.

Gold Medal is the bestselling retail flour in the U.S., and General Mills also sells its flour to a plethora of food companies that use it in their products. A series of additional recalls from brands affected by General Mills' recall expansion will likely follow soon, said Bill Marler, a Seattle lawyer specializing in food poisoning lawsuits.

The CDC, the Food and Drug Administration and General Mills are still investigating the source of the outbreak.

"They clearly are seeing this as an ongoing problem in their flour supply," Marler said. "As [companies] start doing more testing for flour, you may see more recalls of flour."

General Mills isn't sure whether this uptick in detection is because of improved scientific tools, an unusually high E. coli level for a particular time period in the wheat, or whether people are just eating more raw batter, a company spokeswoman said. It could also be a combination of factors, she added.

Flour is a raw good and has always carried a risk — even if it's considered low by food safety experts — of transferring bacteria from grains in the field to the consumer. The FDA and General Mills implored the public to bake or cook flour-based foods before eating them.

"Flour is perfectly safe if you heat it by baking or cooking," a General Mills spokeswoman said.

Kristen Leigh Painter • 612-673-4767