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The Stockholm-based European Centre for Disease Prevention and Control (ECDC), which monitors diseases in the European Union, said it had reports of 214 cases of hemolytic-uremic syndrome (HUS), a serious complication of a type of E. coli.
"Of the 214 cases, 186 are 18 years of age or older and 146 are female," it said in a report in its online journal Eurosurveillance.
It said cases linked to this outbreak had been seen in Sweden, which reported nine instances of HUS, four in people who had recently travelled to northern Germany. Smaller numbers were also reported in Denmark, the Netherlands and Britain.
Britain's Health Protection Agency (HPA) said German authorities believed the source of the infection was likely to have been food. "Early studies implicate raw tomatoes, cucumbers and lettuce," it said.
Three of four contaminated cucumbers analysed by the Hamburg Institute for Hygiene and the Environment (HU) came from Spain, according to state health authorities in Hamburg. The country of origin of the other cucumber was not yet known.
"The HU has clearly identified a cucumber from Spain as a carrier of E. coli," the Health Ministry said in a statement.
"The suspicion concerning the cause of the illnesses now points to cucumbers," said Hamburg Health Minister Cornelia Pruefer-Storcks.
The European Comission's Rapid Alert System for Food and Feed said two companies from Andalucia may be implicated and that any product that may have been in contact with the infected batch had been removed, Spain's Health Ministry said.
"While the cucumbers were produced in Spain, an investigation must find out at what stage of the production chain the contamination occurred," the Ministry said.
Spanish consumers should not adjust eating habits as no case of the infection has been reported in Spain, it said.
Deaths in Germany
German officials said four people had died so far in the outbreak but the ECDC said its most recent information was that two people had died. Both were women, it said, one in her 80s and the other in her 20s.
HUS affects the blood, kidneys and, in severe cases, the central nervous system. It is a serious illness that requires hospital treatment.
The ECDC report said early investigations into the cause had found a "significant association between disease and the consumption of raw tomatoes, cucumbers and leafy salads".
"Nevertheless it is possible that another or an additional food item is the source of infection," it said, adding: "It has to be assumed that the source of infection is still active."
Health officials advised people in Germany to avoid eating cucumbers, tomatoes and lettuces and some of these products have been removed from the shelves of shops.
Germany imports about 182,000 tonnes of cucumbers a year from Spain, accounting for 40% of its total cucumber imports, according to German figures from 2008, the most recent available.
E. coli, bacteria are common and normally harmless, but a few strains can cause severe illness.
It was the second Food scare for German consumers this year. In January highly toxic dioxin was found in egg, poultry and pork products.
EurActiv with Reuters