MONTREAL -

Quebec health authorities say one person has died in the province after being stricken with an E. coli infection apparently linked to walnuts.

Besides the fatality, 13 other people have fallen sick from the same infection, including nine in Quebec.

There are also two each in Ontario and New Brunswick. One case has also been reported in the United States, where the walnuts originated.

Nathalie Levesque, a spokeswoman with the Quebec Health Department, said Thursday a Quebecer died between Jan. 31 and April 5.

She would not divulge any other details about the person other than to say he or she suffered from pre-existing health problems.

Charlene Wiles, a spokeswoman with the Public Health Agency of Canada, said 10 people had been hospitalized, including three who suffered from hemolytic uremic syndrome.

Levesque said two of the syndrome cases are Quebecers, including the one who died. She said the syndrome, commonly called hamburger disease, "affects the kidneys and other organs."

Wiles said the federal agency's "epidemiological evidence suggests raw shelled walnuts as the most likely source for these E. coli infections."

She said the agency is encouraging consumers to be careful because the source of the outbreak has not been absolutely confirmed and other walnut products may pose a risk.

"Food-borne illness outbreaks are complicated," Wiles said in an email. "Only about one-third of all investigations lead to a definitive source being found.

"It can sometimes be difficult for individuals to remember all the foods they ate, especially if symptoms occur up to 10 days after consuming the bacteria. In situations such as these, laboratory analysis of the suspect foods can be very helpful."

However, she said it can be difficult to test dried products, such as nuts, for E. coli.

The Canadian Food Inspection Agency issued a warning a few days ago about the nuts, which are generally sold from bulk food bins.

The walnuts were prepackaged as walnut halves, crumbs and in mixes and all were distributed by Montreal-based Amira Enterprises Inc.

Adel Boulos, the company's vice-president, says Amira ordered a voluntary recall of the product but so far no contaminated walnuts have been found.

He said the company was contacted by the Canadian Food Inspection Agency on April 1 and the agency took samples during the weekend.

Boulos said the company decided to do the recall early Sunday.

"We did this recall even though all the walnuts tested negative," he said. "That means there's no E. coli in it. We did it just to protect the consumer and we didn't want anyone to get sick."

All the company's walnuts were removed from store shelves across Canada.

Boulos said some of the people who fell ill had apparently not eaten walnuts but the company is co-operating fully with the federal investigation.

"We've been in business 30 years now and we've never seen anything like this before."

Montreal-based Amira says the walnuts were imported from the United States and have been available since Jan. 1.

The products -- which may not all be marked with the brand name -- have been distributed in Atlantic Canada, Quebec, and Ontario, but may have also been sold in other provinces.

Until further notice, the public health agency says consumers who have raw shelled walnuts in their home can reduce the risk of E. coli infection by roasting the walnuts prior to eating them.

Consumers should place the nuts on a cooking sheet and bake them in a 180 C (350 F) oven for 10 minutes, turning the nuts over once after five minutes.

Infection from E. coli may cause serious and potentially life-threatening illness. Symptoms include severe abdominal pain and bloody diarrhea.