Commentary by Rebecca Hall MD, PGY-1
Growing concerns over Salmonella contamination of pistachio products sold by Setton Pistachio of Terra Bella Inc in California have lead the manufacturer to voluntarily recall about a million pounds of its pistachio containing products. 1 The recall involves bulk lots o f roasted shelled pistachios and roasted inshell pistachios shipped on or after September 1st 2008. 2 Because pistachios are a component of numerous other products including many baked goods and nut mixes, many additional products may be affected and could be recalled in the near future.1 Already, nut containing products from Kroger, the “Georgia Nut Company” and “Back to Nature Foods Company” have been recalled.1
Multiple strains of Salmonella have been implicated. Thus far, several illnesses in consumers which may be related to pistachio consumption have been reported but it has not yet been verified whether these illnesses have been caused by the Salmonella strains found on the implicated pistachio products. Salmonellosis most often occurs in those most susceptible to food borne illness including the elderly, infants, and those with compromised immune systems. Twelve to seventy two hours after exposure, persons infected with Salmonella may experience as diarrhea, fever, abdominal cramps. It occasionally causes life-threatening diarrhea.3
Diagnosis is based on isolation of Salmonellae from stool cultures which takes a minimum of 48-72 hours. 4 However, given the lack of a rapid diagnostic test, symptomatic patients should be treated empirically with fluids and electrolyte replacement. For mild to moderate illness, antibiotic treatment is not recommended for immunocompetent children over 12 months of age and adults.4 However, treatment with a fluroquinolone, TMP-SMX, or amoxicillin should be considered in immunocompetent patients with severe diarrhea (>9 stools/day), a high fever, or those patients requiring hospitalization.4
1.U.S. Food and Drug Administration, “Pistachio Product Recalls: Salmonella“. http://www.fda.gov/pistachios/ Updated 3/31/09.
2.U.S. Food and Drug Administration, “Recall- Firm Press Release, Setton Pistachio of Terra Bella” http://www.fda.gov/oc/po/firmrecalls/setton03_09.html
3. CDC, Division of Foodborne, Bacterial and Mycotic Diseases. “Salmonellosis.” http://www.cdc.gov/nczved/dfbmd/disease_listing/salmonellosis_gi.html
4. “Approach to the patient with nontyphoidal Salmonella in a stool culture” Uptodate.com, accessed 3/31/09.