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Red Book Online Outbreaks: Salmonella Outbreak Linked to Small Turtles

August 3, 2022

Overview

As of July 21, 2022, a total of 15 people infected with the outbreak strain of Salmonella Stanley have been reported from 11 states (see map). Illnesses started on dates ranging from January 3, 2022, to June 24, 2022 (see timeline). Sick people range in age from less than one year to 59 years, with a median of 7 years, and 71% of ill people are female. Of the 12 people with information available, 5 (42%) have been hospitalized. No deaths have been reported.

Clinical Guidance

  • Presentation: Most people infected with Salmonella experience diarrhea, fever, and stomach cramps. Symptoms usually start 6 hours to 2 days after ingesting Salmonella, though incubation periods of a week or more have been reported. Most people recover without treatment after 4 to 7 days.
  • Who is at highest risk/complications: The incidence of non-typhoidal Salmonella (NTS) infection is highest in children younger than 4 years of age. In the United States, rates of invasive infections and mortality are higher in infants, elderly people, and people with hemoglobinopathies (including sickle cell disease) and immunocompromising conditions (eg, malignant neoplasms, HIV infection).
  • Patients should be seen by their pediatrician if they have any of these symptoms suggesting severe Salmonella infection:
    • Diarrhea and a fever higher than 102°F
    • Diarrhea for more than 3 days that is not improving
    • Bloody diarrhea
    • Not tolerating oral liquids
    • Signs of dehydration, such as:
      • Decreased urine output
      • Dry mucous membranes
      • Orthostatic hypotension
  • Diagnosis: Salmonella gastroenteritis is diagnosed by stool culture or molecular testing (including PCR); stool testing should be obtained in all children with bloody diarrhea or unexplained persistent or severe diarrhea. 
  • Risk Mitigation: Families who are thinking of getting a turtle should only buy ones with shells longer than 4 inches. Although federal law bans the sale and distribution of turtles with shells less than 4 inches long as pets, these animals are available for purchase from some vendors. Pet turtles are not recommended for children younger than 5, adults aged 65 and older, and people with weakened immune systems because these people are more likely to develop a severe Salmonella infection. Review the following strategies to reduce the risk of exposure to Salmonella: Stay Healthy Around Pet Reptiles and Amphibians | Healthy Pets, Healthy People | CDC
  • Treatment: Antimicrobial therapy usually is not indicated for patients with either asymptomatic infection or uncomplicated gastroenteritis caused by NTS, including Salmonella Stanley, because therapy does not shorten the duration of diarrheal disease, can prolong duration of fecal shedding, and increases symptomatic relapse rate. Antimicrobial therapy is recommended for gastroenteritis caused by NTS serovars in people at increased risk for invasive disease, including infants younger than 3 months and people with chronic gastrointestinal tract disease, malignant neoplasms, hemoglobinopathies, HIV infection, or other immunosuppressive illnesses or therapies. It should also be considered for those experiencing severe symptoms such as severe diarrhea or prolonged or high fever. If antimicrobial therapy is initiated in patients in the United States with presumed or proven NTS gastroenteritis, a blood and a stool culture should be obtained prior to antibiotic administration and an initial dose of ceftriaxone should be given. The patient who does not appear ill or have evidence of disseminated infection can be discharged with oral azithromycin pending blood culture results. Once susceptibilities are available, ampicillin or trimethoprim-sulfamethoxazole may be considered for susceptible strains. A fluoroquinolone is an alternative option. For those who appear ill or have evidence of disseminated infection, hospitalization is required.
  • Reporting: Suspected cases should be reported to the local department of public health.

Resources

Pediatric Practice Tools and Information

Salmonella Homepage | CDC

Public Health Resources

CDC case count map

Investigation Details | Salmonella Outbreak Linked to Small Turtles | CDC

Where Sick People Lived | Salmonella Outbreak Linked to Small Turtles | CDC

When People Got Sick | Salmonella Outbreak Linked to Small Turtles | CDC

Infection Prevention and Control Resources

Project Firstline (aap.org)

Information for Patients and Caregivers

AAP HealthyChildren.org: Salmonella Infections in Children | Spanish: Infecciones por Salmonela

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