What Clinicians Need to Know About the Outbreak of Salmonella Infections Linked to Cucumbers

What Clinicians Need to Know For Treatment of Salmonellosis

Signs and symptoms

Those exposed to Salmonella typically become symptomatic within 12 to 72 hours with diarrhea, fever, and abdominal cramps.¹

Duration

The illness typically lasts 4 to 7 days, and most people recover without treatment. In some people, the diarrhea may be so severe that the patient needs to be hospitalized.Salmonellainfection may spread from the intestines to the bloodstream and then to other places in the body. In rare cases,Salmonellainfection can cause death unless the person is treated promptly with antibiotics.¹

Who is more likely to be at risk with this illness?

Children younger than 5 years, adults older than 65 years, and those with weakened immune systems are at greatest risk.¹

What to Look for During the Physical Exam

• Get vital signsBacterial infection temperatures are typically between 101°F and102°FBe sure to note any hypotension and/or tachycardia
• Check for signs of dehydrationDry buccal mucosa, increased thirst, decreased urine output, rapid thready pulse, tachypnea, lethargy, or postural hypotension
• Auscultate the abdomen for bowel soundsHyperactive, absent, or hypoactive
• Palpate the abdomen for diffuse tenderness, slight distention, masses, rebound tenderness, or spasm
• Obtain stool cultures.²

Interventions

• Rest, with slow progression to normal activity
• Withhold oral foods and fluids, with slow addition of clear liquids to maintain hydration
• Slowly progress with a BRAT diet (bananas, rice, applesauce, and toast) until the patient is able to tolerate other solid foods
• Antimicrobial therapy is not indicated for uncomplicated cases because it does not shorten the duration of the disease, and can prolong the duration of excretion of salmonella organisms.²

Are there any long term consequences?

People with diarrhea due to aSalmonellainfection usually recover completely, although it may be several months before their bowel habits are entirely normal.¹

A small number of people withSalmonelladevelop pain in their joints, called reactive arthritis. Reactive arthritis can last for months or years, although antibiotic treatment of theSalmonellainfection does not make a difference in whether or not arthritis develops.¹

As of September 21, 2015, a reported 558 people from 33 states have been infected withSalmonellaPoona, according to Centers for Disease Control and Prevention (CDC) data. The number of ill people reported from each state are as follows: Alaska; 12; Arizona, 95; Arkansas, 8; California, 120; Colorado, 17; Hawaii, 1; Idaho, 20; Illinois, 8; Indiana, 2; Iowa, 1; Kansas, 2; Kentucky, 1; Louisiana, 4; Minnesota, 29; Missouri, 9; Montana, 14; Nebraska, 5; Nevada, 11; New Mexico, 27; New York, 5; North Dakota, 3; Ohio, 2; Oklahoma, 12; Oregon, 17; Pennsylvania, 2; South Carolina, 8; South Dakota, 1; Texas, 24; Utah, 46; Virginia, 1; Washington, 18; Wisconsin, 29; and Wyoming, 4.³

Of those infected, 112 people have been hospitalized, and 3 people have died. Fifty-two percent of those infected are children younger than 18 years.³

The likely source of the infections is cucumbers imported from Mexico and distributed by Andrew & Williamson Fresh Produce. The CDC'sNational Antimicrobial Resistance Monitoring System(NARMS) laboratory conducted antibiotic resistance testing on clinical isolates collected from 6 people infected with the outbreak strains and all were susceptible to all antibiotics tested on the NARMS panel. The laboratory will continue to conduct antibiotic resistance testing on additional isolates, and results will be reported when they are available.³

References:

1. Centers for Disease Control and Prevention. What is Salmonellosis? Centers for Disease Control and Prevention website.www.cdc.gov/salmonella/general/index.html. Published March 9, 2015. Accessed September 22, 2015.
2. Cash JC, Glass CA.Family Practice Guidelines. 2nd ed. New York, NY: Springer Publishing Company, NY; 2011.
3. Centers for Disease Control and Prevention. Multistate outbreak of Salmonella Poona infections linked to imported cucumbers. Centers for Disease Control and Prevention website.www.cdc.gov/salmonella/poona-09-15/index.html. Published September 22, 2015. Accessed September 22, 2015.