The Centers for Disease Control and Prevention (CDC) has issued an alert to consumers about a widespread bacterial outbreak in the US and Canada linked to consumption of cantaloupes. The bacteria in question is called “salmonella.” So far, about 120 cases have been identified, hospitalizing 60 and killing two in Minnesota. More cases are expected to be documented in the coming days and weeks.
Contaminated whole and pre-cut products were apparently distributed to chains like Kroger, Trader Joe’s, Walmart, Aldi, and others in states including Arizona, California, Connecticut, Maryland, Missouri, Montana, Nevada, New Jersey, New York, Oregon, Pennsylvania, Tennessee, Utah, Illinois, Michigan, Wisconsin, Texas and Florida, as well as Canada. Brands include Trufresh, Crown Jewels Produce, Vinyard Fruit and Vegetable, CF Dallas, ALDI, and Pacific Trellis Fruit. These have all been recalled.
Look for whole fresh cantaloupes with Malichita, Rudy, “4050” and “Product of Mexico/produit du Mexique” labels. These, along with pre-cut versions, are unsafe and should be thrown away.
These are serious recommendations, as the CDC states that all forms of salmonella poisoning cause, annually, 1.35 million infections, 26,500 hospitalizations, and 420 deaths in the United States. This may seem like a lot to you, but worldwide, typhoid fever, one of the illnesses caused by salmonella, infects 21 million people a year and kills 200,000 (the U.S., however, only sees about 400 cases of typhoid fever yearly).
In survival settings, food contamination will be a common problem confronting the family or group medic. They must be aware of the signs and symptoms and intervene early in the infection to prevent a tragic outcome.
SALMONELLA
Salmonella is a group of rod-shaped bacteria of the family Enterobacteriaceae. It was named after a famous veterinary surgeon, Daniel Salmon, in the 1880s but the genome has been found in human remains 6,500 years old.
Salmonella is a common cause of “enteric fevers,” including the very dangerous “typhoid fever.” Enteric fevers are acquired by the ingestion of water, food, or dirty hands contaminated with the feces of those infected.
Typhoidal salmonella strains (Salmonella e. typhi) can only be transferred between humans. In these cases, salmonella invades the bloodstream and invades organs by secreting toxins that lead to shock.
Nontyphoidal Salmonella strains (Salmonella enterica) can be transferred from animals as well as between humans. These are known as “paratyphoid fever” and stay in the intestinal tract and are usually less lethal.
SYMPTOMS OF SALMONELLA INFECTION
Most people who get ill from Salmonella have diarrhea (sometimes bloody), fever, and stomach cramps. Some experience nausea, vomiting, headache, muscle ache. A rash may develop but doesn’t affect everyone infected. It consists of rose-colored spots on the neck and abdomen.
Symptoms usually begin 6 hours to 6 days after infection and last 4 to 7 days. A few have a delayed response which may occur weeks after consuming contaminated food.
TREATMENT OF SALMONELLA INFECTION
Thankfully, most people with salmonella-associated enteric fever recover in a few days with rest, electrolyte rehydration, and fever meds.
Antibiotics are typically used only to treat people who have severe illness (unrelenting fever and diarrhea), such as may be seen with typhoid fever or those at high risk. These are mostly the elderly, infants, and those with compromised immune systems or significant heart and joint disease. Fatalities can occur when they invade urine, blood, bones, joints, or the brain.
In severe cases, antibiotics that may be effective include:
- Azithromycin 500mg PO for 7 days for adults (1000mg may be given on the first day as a “loading dose.” Children get 10-20mg/kg body weight once daily.
- Cefixime 200mg twice a day for 10 to 14 days for adults. Childen get 10mg/kg body weight twice a day.
- Amoxicillin 500mg three times a day for 14 days for adults. Children get 30mg/kg body weight three times a day.
- Sulfamethoxazole 800mg/trimethoprim 160mg twice a day for 14 days. Children get 20mg SMX/4mg TMP/kg body weight twice a day.
Ciprofloxacin (Cipro) also works and is the drug of choice in some areas, but may cause significant damage to muscle/nerve tissue.
In all cases, antibiotic-resistant salmonella can affect results of treatment. If no success, switch to another (a good reason why I recommend having a variety in your storage).
PREVENTION
Salmonella isn’t killed by freezing, but heating food to 167 degrees Fahrenheit internal temperature and UV sterilization are effective methods of decontamination.
Those who are ill and normally responsible for food preparation in a family or group must be relieved of those duties for the duration of the illness. As there is a “carrier” status, it may be wise to delegate food preparation to others for several weeks.
In the case of the recalled cantaloupes, if you can’t tell if yours were impacted by the current recalls, throw it away. The CDC has advised people to wash utensils, plates, or surfaces that may have come into contact with the fruit using hot soapy water or a dishwasher.
Joe Alton MD
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