Red Book Online Outbreaks: Listeria Outbreak Linked to Chicken Fettuccine Alfredo Meals Free

Overview

CDC and public health officials in several states are investigating a multistate outbreak of Listeria infections linked to chicken fettuccine alfredo meals made by FreshRealm. As of June 18, 2025, a total of 17 people infected with the outbreak strain of Listeria have been reported from 13 states. Sick people's samples were collected on dates ranging from August 1, 2024, to May 27, 2025. Illnesses started on dates ranging from July 24, 2024, to May 10, 2025. Of 17 people with information available, 16 have been hospitalized and 3 deaths have been reported from Illinois, Michigan, and Texas. One pregnancy associated illness resulted in a fetal loss.

Recalled Food

On June 17, 2025, FreshRealm recalled chicken fettuccine alfredo meals that were distributed to retail locations nationwide. Recalled foods are no longer available for sale.

• Sold nationwide at Kroger and Walmart under the Marketside brand and the Home Chef brand.

• Establishment number "EST. P-50784," "EST. P-47770," or "EST. P-47718" appears on the label in the USDA mark of inspection.

• Best by dates: 06/27/25, 06/26/25 and 06/19/25 or prior

• Sold in the refrigerated section; does not include frozen meals

• Assembled and ready for microwaving

See the recall for additional information.

Clinical Guidance

Presentation

• Listeria usually causes common food poisoning signs and symptoms, like fever and diarrhea. People who experience these symptoms usually recover without treatment. Symptoms of self-limited febrile gastroenteritis usually start within 24 hours of ingesting contaminated food and last 2-3 days.
• Less commonly, Listeria can cause severe illness (known as invasive listeriosis) when the bacteria spread beyond the gut to other parts of the body. Symptoms of invasive listeriosis usually start 1 to 4 weeks after eating contaminated food but may occasionally start even later.

• Pregnant people with invasive listeriosis usually experience only fever, fatigue, muscle aches, and occasionally gastrointestinal tract infections.
• Non-pregnant people with invasive listeriosis may experience headaches, stiff neck, confusion, loss of balance, and convulsions, in addition to fever and muscle aches.

• Patients should be seen by their pediatrician right away if they exhibit any signs or symptoms of Listeria infection.

Who is at the highest risk/complications?

• People who are 65 years or older, are pregnant, or are immunocompromised.
• Listeria can cause pregnancy loss or premature birth.
• Listeria can also cause serious illness or death in newborns.

Diagnosis

• L monocytogenescan be recovered readily on blood agar from cultures of blood, cerebrospinal fluid (CSF), meconium, placental or fetal tissue specimens, amniotic fluid, and other infected tissue specimens, including joint, pleural, or peritoneal fluid. 
• Polymerase chain reaction (PCR) assays can be used to detect L monocytogenesin blood and CSF. 
• Stool cultures are generally not useful for the diagnosis of Listeria infection.

Precautions

• People should not eat or drink recalled products.  Advise them to throw away or return them to the place of purchase.
• Advise people to clean their refrigerator, containers, and surfaces that may have touched the recalled foods. Listeria can survive in the refrigerator and can easily spread to other foods and surfaces.

Risk Mitigation

• Antimicrobial therapy for infection diagnosed during pregnancy may prevent fetal or perinatal infection and its consequences.

Treatment

• Combination therapy using ampicillin and a second agent in doses appropriate for meningitis is recommended for severe infections. An aminoglycoside, typically gentamicin, usually is used as the second agent in combination therapy. Use of an alternative second agent that is active intracellularly (eg, trimethoprim-sulfamethoxazole [contraindicated in infants younger than 2 months], fluoroquinolones, linezolid, or rifampin) is supported by case reports in adults. If alternatives to gentamicin are used, susceptibility should be confirmed because resistance to trimethoprim-sulfamethoxazole, fluoroquinolones, linezolid, or rifampin occasionally has been reported. In the penicillin-allergic patient, options include either penicillin desensitization or use of either trimethoprim-sulfamethoxazole or a fluoroquinolone, both of which have been used successfully as monotherapy for Listeria meningitis and in the setting of brain abscess. Treatment failures with vancomycin have been reported. Cephalosporins are not active against monocytogenes.
• For bacteremia without associated central nervous system infection, 14 days of treatment is recommended. For L monocytogenes meningitis, most experts recommend 3 to 4 weeks of treatment. Longer courses are necessary for patients with endocarditis or parenchymal brain infection (cerebritis, rhombencephalitis, brain abscess). Iron may enhance the pathogenicity of L monocytogenes; iron supplements should be withheld until treatment for listeriosis is complete. Diagnostic imaging of the brain near the end of the anticipated duration of therapy allows determination of parenchymal involvement of the brain and the need for prolonged therapy in neonates with complicated courses and in immunocompromised patients.

Reporting

• Listeriosis is a nationally notifiable disease in the United States.
• Cases should be reported promptly to the state or local health department to facilitate early recognition and control of common-source outbreaks.
• Clinical isolates should be forwarded to a public health laboratory for genetic sequencing.

Resources

•  For more information see the Red Book chapters on:
• Listeria monocytogenes Infections (Listeriosis)
• Prevention of Infectious Disease From Contaminated Food Products