Red Book Online Outbreaks: Salmonella Outbreak Linked to Cucumbers - Outbreak Over

As of August 22, 2024, this outbreak is over.

Overview

As of August 22, 2024, a total of 551 people infected with one of the outbreak strains of Salmonella Africana and Salmonella Braenderup have been reported from 34 states and the District of Columbia (see map). Of these illnesses, 269 people were infected with the Salmonella Braenderup strain and 282 people were infected with the Salmonella Africana strain. Illnesses started on dates ranging from March 11, 2024, to July 26, 2024 (see timeline). Of 456 people with information available, 155 have been hospitalized and no deaths have been reported.

FDA’s traceback investigation identified Bedner Growers, Inc., in Florida as a supplier of cucumbers in this outbreak. This one grower does not account for all illnesses in this outbreak. Bedner Growers, Inc. in Florida, where the positive sample was collected, is no longer growing and harvesting cucumbers for the season. There is no product from this farm on the market and likely no ongoing risk to the public.

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

• For more information see the Red Book chapter on Salmonella Infections