The state's top health official confirmed Monday that the sudden death of a Pasco County (search) girl is being investigated as possibly linked to an outbreak of kidney disease caused by E. coli bacteria believed to have been contracted at a fair.

Florida Health Secretary John Agwunobi (search) said there are 14 confirmed cases of people who attended the Strawberry Festival (search) in Plant City or the Central Florida Fair (search) in Orlando in early March and who have since been sick, and either tested positive for E. coli, or a kidney disease that sometimes results from E. coli infection.

Of those 14, the majority by far are in Orange County, which includes Orlando. Agwunobi said that nine of the victims remain hospitalized. He declined to say what their conditions were, but said none had died.

Along with those 14 cases, state health officials are also investigating seven suspect cases around the state, in which victims may have been sickened by the E. coli (search) strain, or contracted the potentially fatal kidney disease, including the death of the Pasco County girl.

He said state officials were awaiting reports from the medical examiner to help make a determination whether she was infected with the particular bacterium, E. coli O157:H7, or the kidney disease that sometimes results from it, known as hemolytic uremic syndrome, or HUS.

Health officials declined to identify the girl, but local media reports said 12-year-old Kayla Nicole Sutter of Wesley Chapel had a high fever and collapsed and died Wednesday. Her family told medical investigators that she had visited the Strawberry Festival, the St. Petersburg Times reported.

Officials have said that contact with animals in petting zoos that were at both fairs is one possible way victims could have contracted the bacteria. But Agwunobi cautioned Monday that officials don't know the definitive source.

"We're not sure that the petting zoos have anything to do with this outbreak," Agwunobi said. "They are one possible source that we are investigating."

Others include the possibility that tainted food was served at the fairs, or that contact with other animals, animal waste, or even hay might have caused the sickness.

About 8 percent of people who are infected with E. coli O157:H7 go on to get the kidney disease HUS. The mortality rate ranges from 2 to 8 percent, officials said.

If someone develops HUS, it might be two or three weeks after having diarrhea; symptoms would likely include lethargy, puffiness and vomiting.