Hawaii's health department has confirmed a fifth case of the stomach parasite cyclosporiasis, a sign the outbreak is still spreading.

• The newest case is another military member who had traveled overseas and to a mainland state that also has cases.
• Traces of the parasite showed up at the Hilo wastewater plant, hinting someone in that area is also carrying it.
• The wider outbreak has been tied to iceberg lettuce from Mexico.
• That lettuce-linked outbreak has now grown to 47 cases.

Outlook: Expect more cases to surface as testing continues and health officials trace the tainted lettuce.