A growing number of cases of cyclosporiasis are being reported as a cyclospora outbreak continues to spread across North Texas.

As of noon Tuesday, more than two dozen cases of cyclosporiasis have been reported in DFW including 10 cases in Dallas County, nine in Tarrant County, four in Collin County and two in Denton County.

Past cyclospora outbreaks in the U.S. have been associated with the consumption of imported fresh produce, including fresh cilantro, prepackaged salad mix, raspberries, basil, snow peas and Mesclun, including an outbreak affecting Texas in 2013.

No common exposure source for the latest outbreak has been identified, though investigators are working to determine a common source among the afflicted.

Thorough washing of fresh produce is recommended as a precaution, though it may not eliminate the risk of transmission since cyclospora can be difficult to wash off all types of produce.

"I go back over again with a brush and brush it underneath the water so that way anything it's pulling off is immediately going off," said Andrew Metcalf, with the North Richland Hills Farmers Market.

Metcalf added that knives could carry bacteria between fruits and vegetables if they all aren't washed properly before being cut.

Increased numbers of cyclospora cases are also currently being noted elsewhere in Texas. Within the past month, 61 cases of cyclosporiasis have been reported statewide to the Texas Department of State Health Services.

By comparison, only 12 cases of cyclosporiasis were reported in Dallas County between 2008 and 2012, but 38 cases were reported in the county last summer. In 2013, the state reported 278 cases to The Centers for Disease Control and Prevention while nearly 130 cases were recorded in Dallas, Tarrant, Collin and Denton counties.

The CDC eventually traced most if not all of those cases to fresh cilantro from Mexico.

According to Dr. Seema Yasmin, medical expert for The Dallas Morning News, symptoms of cyclosporiasis usually begin two to 14 days after ingestion of contaminated food or water. Diarrhea can last weeks to months and may relapse. Symptoms may include weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting and low-grade fever.

Dr. Glenn Hardesty, with Texas Health Resources Arlington, said that's what can make this so tricky.

"It's not at the top of our list. There are many other causes of nausea, vomiting, diarrhea that can range anything from food poisoning to other infectious agents," he said.



Infection is generally not transmitted directly from person to person and can be treated with Bactrim, an antibiotic. But even if you've had those symptoms and you never go to the doctor, they will go away eventually.

NBC 5's Kevin Cokely and Ben Russell contributed to this report.