Red Book Online Outbreaks: Salmonella Outbreak Linked to Geckos

Overview

CDC and public health officials in several states are investigating a multistate outbreak of Salmonella infections linked to pet geckos. 

As of March 10, a total of 8 people infected with the outbreak strain of Salmonella Muenchen have been reported from 8 states. Illnesses started on dates ranging from December 16, 2024, to February 1, 2025.

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 Infections Diagnostic Tests.
• Risk Mitigation: CDC provides the following guidance on how to stay healthy with a pet gecko:
  • People should wash their hands with soap and water after handling a gecko, feeding a gecko or handling its food, handling a gecko’s droppings, handling a gecko’s cage equipment, or cleaning a gecko’s cage.
  • Children younger than 5 years old should not handle or touch reptiles, amphibians, or their environments because they are at a higher risk for serious illness and hospitalization caused by Salmonella infection.
  • Geckos and their equipment should be kept out of the kitchen or anywhere that food is prepared, stored, served or eaten. Geckos should not roam freely in a home.
  • Gecko supplies should be cleaned outside of the house, if possible. These supplies include feeders, toys, and food and water containers. If they must be cleaned indoors, then a laundry sink or bathtub should be used rather than a kitchen sink. The sink or bathtub should be thoroughly cleaned and disinfected immediately after and water from the gecko’s enclosure should be poured down the toilet instead of sinks or drains.
• 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 Salmonella Infections.