Red Book Online Outbreaks: Salmonella Outbreak Linked to Pistachio Cream Free

Overview

CDC and public health officials in several states are collecting different types of data to investigate a multistate outbreak of Salmonella Oranienburg infections. Epidemiologic and laboratory data show that Emek-brand pistachio cream is contaminated with Salmonella Oranienburg and is making people sick. The investigation is ongoing to determine if additional lots or products are affected.

As of June 13, 2025, four people infected with the outbreak strain of Salmonella Oranienburg have been reported from two states. Illnesses started on dates ranging from March 10, 2025, to May 19, 2025. Of four people with information available, one has been hospitalized and no deaths have been reported.

CDC is advising people not to eat, sell, or serve Emek-brand pistachio cream with a use by date of October 19, 2026.

• Production code (PNO): 241019
• Manufactured by Emek Dogal Saglik Urunleri Iklim Gida Insaat San Tic Ltd Sti in Turkey and imported into the United States.
• Shelf-stable nut butter cream sold online for wholesale distributors, restaurants, and food service locations nationwide.
• May be packaged in a 5-kilogram white tub.

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 Salmonellainfection:
  • 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 advises people should not eat Emek-brand pistachio cream; it should be thrown away or returned to the store where purchased.  People should wash items and surfaces that may have touched the recalled food 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