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Red Book Online Outbreaks: Salmonella Outbreak Linked to Cucumbers

June 13, 2024

Overview

As of June 12, a total of 196 people infected with the outbreak strain of Salmonella Africana have been reported from 28 states and the District of Columbia (see map). Illnesses started on dates ranging from March 11, 2024, to May 23, 2024 (see timeline). Of 164 people with information available, 68 have been hospitalized and 0 deaths have been reported.

The Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) are also investigating an outbreak of Salmonella Braenderup infections, with 185 illnesses in 24 states. The two outbreaks share several similarities, including where and when illnesses occurred and the demographics of ill people. Investigators are working to determine whether the two outbreaks could be linked to the same food. Information will be provided on the source of the Salmonella Braenderup outbreak as it becomes available.

Fresh Start Produce Sales Inc. recalled whole cucumbers. This recall does not include English cucumbers or mini cucumbers. Recalled cucumbers should no longer be in stores.  The cucumbers were grown in Florida and sold in bulk to retail distribution centers, wholesalers, and food service distributors in 14 states, but these sellers may have shipped to additional states or re-packaged them for stores.

Clinical Guidance

  • Presentation: Most people infected with Salmonella experience diarrhea, fever, and stomach cramps. Symptoms typically start 6 hours to 6 days after swallowing the bacteria. Most people recover without treatment after 4 to 7 days.
  • Who is at highest risk/complications: The incidence of Salmonella 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 present with the following symptoms of 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: Isolation of Salmonella organisms from cultures of stool, blood, urine, bile (including duodenal fluid containing bile), and material from foci of infection is diagnostic. 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. See Red Book Salmonella diagnostic tests.
  • Risk Mitigation:
    • Adults and children should not eat any recalled cucumbers. If families recently purchased cucumbers and have them at home, they can check with the store where they purchased them to see if they were part of the recall. If they are not sure, they should not eat them.
    • Items and surfaces that may have touched the recalled cucumbers should be washed using hot soapy water or a dishwasher.
  • Treatment: Antimicrobial therapy usually is not indicated for patients with either asymptomatic infection or uncomplicated gastroenteritis caused by Salmonella, 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 Salmonella 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. Antibiotics 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 Salmonella gastroenteritis, a blood and a stool culture should be obtained prior to antibiotic administration. Most cases of Salmonella gastroenteritis are treated empirically. If the person appears ill or has evidence of disseminated infection, hospitalization along with initiation of a broad spectrum parenteral cephalosporin often is prescribed. Oral antimicrobials, such as azithromycin may be considered for patients who do not appear ill or have evidence of disseminated infection. If cultures are obtained, definitive therapy should be based on the susceptibility of the organism isolated.
  • Reporting: Suspected cases should be reported to the local department of public health.

Resources

Pediatric Practice Tools and Information

Salmonella | CDC

 

Public Health Resources

Salmonella Outbreaks Linked to Cucumbers| CDC

Outbreak Investigation of Salmonella: Cucumbers | FDA

 

Infection Prevention and Control Resources

Project Firstline (aap.org)

 

Information for Patients and Caregivers

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

AAP HealthyChildren.org: Food Poisoning & Contamination | In Spanish: Intoxicación y contaminación alimentaria

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