One person has died and scores more remain hospitalized in Russia in an outbreak of botulism that spans several Russian regions, the authorities have reported.

Foodborne botulism is a rare illness caused by a toxin produced by a type of bacteria called Clostridium botulinum. Eating foods contaminated with the toxin can cause paralysis, breathing difficulties and sometimes death. Improperly canned, preserved or fermented foods are common sources.

Symptoms typical of botulism can include severe abdominal pain, vomiting, diarrhea, blurred vision, a dry mouth, difficulty in swallowing or speaking, and neurological symptoms.

More than 300 people have been hospitalized with botulism in Russia in a fairly big outbreak. The U.S. on average records 110 cases of botulism a year, according to the Centers for Disease Control and Prevention, and only 82 cases were recorded in the European Union in 2021, a 2023 report by the European Center for Disease Prevention and Control says.

Russian authorities blame the outbreak on ready-to-eat salads that contained canned beans and were made by a popular delivery service. Since mid-June, officials in Moscow, the outlying Moscow region, Nizhny Novgorod and Kazan have been reporting cases of botulism.

On Monday, an aide to Russia’s Health Minister Alexei Kuznetsov reported that a total of 369 people have been hospitalized with symptoms of botulism. Kuznetsov told Russian state news agency RIA Novosti that 218 people remained in the hospital as of Monday, including 38 people on ventilators, while 151 people have been discharged.

A 21-year-old man died in a hospital in the city of Kostroma, local officials reported Monday. According to the authorities, the man had traveled to Nizhny Novgorod, roughly 250 kilometers (155 miles) southeast of Kostroma, to visit relatives and ordered the salad with beans there.

Health officials initially linked at least some of the cases in Moscow to two brands of ready-made salads. Rospotrebnadzor, Russia’s public health agency, halted the sale of the salads pending investigation after the first cases of poisoning were reported.

Within days, the authorities named one of the two salads as the culprit — the one made and sold by popular delivery service Kukhnya Na Rayone, which operates in Moscow, Kazan, Nizhny Novgorod and several other cities. Kukhnya Na Rayone has suspended operations, saying in an online statement that it no longer offered the salad with canned beans in it, and would check its other products as well.

A criminal investigation has been launched on the charges of making and distributing products in violation of safety standards. The authorities detained two top managers of Kukhnya Na Rayone, as well as the head of a company that makes canned beans and a man who worked as a cook there. The cook was placed in custody pending investigation and trial, while the three others were put under house arrest.