Salmonella Update

March 21, 2009

salmonella_typhimurium.jpgCommentary by Sherley Abraham MD, PGY-3

The CDC reports there have been 666 cases and 9 deaths associated with Salmonella Typhimurium infections. The outbreak began September 1st, 2008 and has spread across 45 states, including 30 cases in New York. The source has been traced back to peanut butter and peanut paste made at the production company in Blakely, Georgia which is owned and operated by the Peanut Corporation of America. There is a nationwide product recall which can be found on the FDA website or by calling the CDC at 1-800-CDC-INFO. Of note, national brands of jarred peanut butter are not on this recall list. The list does include many snack items and prepackaged foods with peanut butter or peanut paste and includes some pet foods.

Investigations of the Georgia peanut company revealed that Salmonella had been isolated in the internal sampling program at least a dozen times but no actions were taken to remedy the problem. The New York Times reports that the company had health violations since 2006 with numerous citations for substandard cleanliness. In light of these investigations, the Peanut Corporation has voluntarily recalled all products processed since 2007. The Corporation states it cannot provide additional recall information to consumers as it is undergoing bankruptcy proceedings.

Consumers are urged to adhere to the recall list. Salmonella infection usually presents with fever and gastrointestinal symptoms within hours to days of exposure, and lasts days, and up to one week. The illness may be self-limiting or require supportive hydration. In certain populations, such as the very young or very old, or those who are immunocompromised, there is higher risk of systemic infection, which can be fatal if not treated promptly with antibiotics. There are also connections between Salmonella infection and development of reactive arthritis in Reiter’s syndrome and osteomyelitis in patients with sickle cell.

In a NEJM perspective article, Dr. Maki states that foodborne disease causes 350,000 hospitalizations and 5000 deaths per year. In addition, there is a large problem of underreporting due to lack of diagnosis. It is estimated that in large salmonella outbreaks, there are 38 additional cases for every detected case. Prevention of such outbreaks would require expansion of the surveillance programs of the USDA and FDA, as well as better methods to rapidly detect enteropathogens and trace foods to their origin. Dr. Maki goes on further to call for the discontinuation of antibiotics in animal feeds which leads to microbial resistance, more hygienic food preparation, as well as routine irradiation of high risk foods.

References
CDC. Investigation Update: Outbreak of Salmonella Typhimurium Infections, 2008–2009. http://www.cdc.gov/salmonella/typhimurium/update.html

FDA. Peanut Product Recalls: Salmonella Typhimurium.
http://www.fda.gov/oc/opacom/hottopics/salmonellatyph.html

Rabin, RC. Peanut Plant Had History of Health Lapses. New York Times. 2009 Jan 27.
http://www.nytimes.com/2009/01/27/health/27peanuts.html?scp=7&sq=rabin%20salmonella&st=cse

Maki DG. Coming to Grips with Foodborne Infection — Peanut Butter, Peppers, and Nationwide Salmonella Outbreaks. N Engl J Med. 2009 Feb 11. Epub.

http://content.nejm.org/cgi/content/extract/NEJMp0806575v1

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