Red Book Online Outbreaks: Salmonella Outbreak Linked to Pet Bearded Dragons

Overview 

As of June 14, a total of 15 people infected with the outbreak strain of Salmonella Cotham have been reported from 9 states (see map). Illnesses started on dates ranging from January 8, 2024, to May 16, 2024 (see timeline). Of 15 people with information available, 4 have been hospitalized and 0 deaths have been reported. 60% of the cases are in children under 5 years. 

Bearded dragons can carry Salmonella in their droppings even if they look healthy and clean. These bacteria can easily spread to their bodies and anything in the area where they live and roam. People can get sick from touching a bearded dragon or anything in its environment and then touching their mouth or food and swallowing Salmonella. Bearded dragons and other reptiles are not recommended for children younger than 5, adults aged 65 and older, and people with weakened immune systems. 

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: CDC advised people should always take the following steps to stay healthy around bearded dragons: 
  • Wash hands after handling bearded dragons, their food, or items in their environment.
  • Don’t kiss or snuggle bearded dragons.
  • Keep bearded dragons out of the kitchen or anywhere that food is prepared, stored, served, or eaten and away from areas where young children play.
  • Keep its supplies and habitat clean.
  • Limit young children’s contact with bearded dragons.
• 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