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Mandy Adams, 70, of Los Angeles, holds a U.S. flag in support of the immigration rules implemented by U.S. President Donald Trump's administration, at Los Angeles international airport in Los Angeles, California. Image Credit: REUTERS

Guangzhou - A crisis over a mysterious ailment sickening U.S. diplomats and their families - which began in Cuba and recently appeared in China - widened on Wednesday. The State Department evacuated at least two more Americans who fell ill in China after hearing strange noises, officials said.

Many other employees at the U.S. Consulate in the southern Chinese city of Guangzhou and their family members are also being tested by a State Department medical team that has been flown in, officials said. It is unclear how many of them are exhibiting symptoms, but officials expect more U.S. personnel to be evacuated.

For months, U.S. officials have been worried that their diplomats have been subjected to targeted attacks involving odd sounds, leading to symptoms similar to those "following concussion or minor traumatic brain injury," the State Department says.

The new illnesses in China come just weeks after U.S. officials reported finding their first case in Guangzhou, where a consulate employee got sick after reporting disturbing noises.

The illnesses in China have broadened a medical mystery that started in 2016, when U.S. Embassy employees and their family members began falling ill in Havana. In all, 24 of them were stricken with headaches, nausea, hearing loss, cognitive issues and other symptoms after saying they heard odd sounds. The issue has roiled relations with Cuba, which immediately fell under suspicion, and led the United States to expel Cuban diplomats.

But with Americans now exhibiting similar symptoms in Guangzhou, U.S. officials have raised suspicions about whether other countries, perhaps China or Russia, might be to blame.

That is sure to complicate already strained relations with both countries over a variety of economic, political and security issues. Russia has been accused of meddling in the 2016 American presidential election, trade disputes have erupted with China and U.S. officials fear that the Chinese are undermining relations with North Korea before a summit meeting with President Donald Trump planned for next week.

But it remains unclear whether the illnesses are the result of attacks at all. Other theories have included toxins, listening devices that accidentally emitted harmful sounds or even mass hysteria.

On Tuesday, Pompeo said in a statement that the symptoms in the first case discovered in Guangzhou were similar to the ones experienced by the 24 Americans who became ill in Havana. He said that the cause had not yet been established.

The injuries in Cuba, like those in China, followed disturbing sensations of sounds and vibrations that have been described variously as the sounds made by cicadas, static, metal sheets waving or, in Lenzi's case, marbles rolling around a metal funnel.

After the injuries were diagnosed in Cuba, the Trump administration expelled 15 Cuban diplomats, saying Cuban officials had failed to adequately to protect American diplomats. The Cuban government denied any involvement and questioned whether any "attacks" had taken place. U.S. officials suggested it was too soon to consider such a response in China, though they have raised it with the Chinese government.