Nearly 400 People in 42 States Affected in Salmonella typhimurium Outbreak

Neil Osterweil

January 08, 2009

January 8, 2008 — At least 388 people in 42 states have been sickened in an outbreak of Salmonella typhimurium, resulting in at least 70 hospitalizations, the Centers for Disease Control and Prevention (CDC) reports. The source of the outbreak is unknown.

The CDC has not specified which states have been affected in the current outbreak, but the Ohio Department of Health issued a press release on January 6 stating that 50 cases, confirmed by DNA fingerprinting, have been reported, dating back to October 2008. The incidence rate is the second-highest in the nation, the Ohio Department of Health says.

“We’re not contradicting what Ohio is saying,” CDC spokeswoman Lola Russell told Medscape Medical News.

Salmonellosis cases traced to the current outbreak have also been reported in California, Michigan, Arizona, and Texas, according to news agencies.

The typhimurium serotype of Salmonella, the most common cause of salmonellosis in the United States, is commonly found in poultry, raw (unpasteurized) dairy products, produce, and small animals such as reptiles often kept as household pets.

In 2007, Salmonella typhimurium was responsible for 401 cases of salmonellosis in 41 states, in an outbreak traced to consumption of frozen pot pies that had not been fully cooked by consumers, and smaller outbreaks were reported among people who consumed raw milk.

Symptoms and Treatment

Salmonellosis can affect patients of all ages, although the elderly, infants, and those with compromised immunity are at highest risk for severe illness.

Most people infected with enteric Salmonella strains will develop diarrhea, fever, and abdominal cramping within 12 to 72 hours. Salmonellosis is generally self-limiting, lasting 4 to 7 days, and most people who are infected will recover without treatment, although fluid support/replacement may be necessary for cases of severe diarrhea. Some patients may require hospitalization.

The CDC notes that the primary goal of treating Salmonella gastroenteritis is fluid and electrolyte replenishment to counteract depletion and possible imbalance. Antimotility therapies (eg, loperamide, diphenoxylate, paregoric) should not be given if the patient has bloody or mucous stools, and they should not be given to elderly patients at risk for ileus, toxic megacolon, or perforation.

Although uncommon, Salmonella bacteremia can be a serious (although rarely fatal) complication of infection. It requires treatment with intravenous antibiotics, said David R. Syndman, MD, chief of the Division of Geographic Medicine and Infectious Diseases and hospital epidemiologist at Tufts Medical Center in Boston, Massachusetts, in an interview with Medscape Medical News in June 2008.

"The lab would test for susceptibility [of the isolate], but generally you would treat people who have it with intravenous antibiotics, either ceftriaxone, or ciprofloxacin, or levofloxacin," and if the cephalosporins fail, a quinolone category antibiotic would be the next agent of choice, Dr. Syndman said.

"The debate is whether you should treat people who just have diarrhea with fever — if it's GI disease only, a lot of patients don't need to be treated; it's only if they're immunocompromised or are over the age of 50, have known prosthetic material or an aortic aneurysm that could be seeded, then you would treat those people as well," he added.

In recent years, several multidrug resistant variants of Salmonella typhimurium have developed, due to selection pressures from widespread use of antibiotics in veterinary clinics and in animals raised for food, the CDC reports.

Incidence and Prevention

About 40,000 cases of salmonellosis are reported in the United States annually, and it is estimated that the actual number of cases may be up to 30-fold higher, because infections are often not reported and because the symptoms are nonspecific and may be mistaken for other bacterial or viral infections.

In a joint briefing with the Food and Drug Administration in June 2008, Ian Williams, PhD, chief of the CDC's OutbreakNet Team, advised clinicians to watch for cases of foodborne illness and to report any suspected cases of Salmonella infection to local and/or state health authorities, who will then culture samples and report positive results to the CDC.

With this outbreak, the CDC reminded clinicians of advice to give patients about avoiding salmonellosis:

  • Cook poultry, ground beef, and eggs thoroughly. Do not eat or drink foods containing raw eggs or raw (unpasteurized) milk.

  • If you are served undercooked meat, poultry, or eggs in a restaurant, send it back to the kitchen for further cooking.

  • Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with raw meat or poultry.

  • Be particularly careful with foods prepared for infants, the elderly, and the immunocompromised.

  • Wash hands with soap after handling reptiles, birds, or baby chicks, and after contact with pet feces.

  • Avoid direct or even indirect contact between reptiles (turtles, iguanas, other lizards, snakes) and infants or immunocompromised people.

  • Do not work with raw poultry or meat and an infant (eg, feed, change diaper) at the same time.

  • Mother's milk is the safest food for young infants. Breast-feeding prevents salmonellosis and many other health problems.



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