Cucumbers in connection with the ongoing Salmonella Africana outbreak

The Centers for Disease Control and Prevention, along with public health and regulatory officials in several states and the U.S. FDA, are investigating an outbreak of Salmonella Africana infections in multiple states that may be linked to cucumbers. Epidemiological data indicate that cucumbers can be a source of contamination, causing consumers to become ill.

As of June 4, 162 cases of Salmonella Africana infection have been reported in 25 states and the District of Columbia. The onset of the diseases varies from March 11 to May 16. Of the 127 people with available information, 54 have required hospitalization. At the time of posting this update, no deaths have been reported.

The actual number of infected individuals is likely higher than reported, as many people recover without seeking medical attention or being tested for Salmonella. Additionally, recent cases may not yet be documented due to the time it takes to determine if a patient is part of the outbreak.

Public health officials have collected various demographic data from the infected individuals to help determine the source of the outbreak. The data reveals:

• Age: Ranges from less than 1 year to 92 years old, with an average age of 40 years
• Gender: 64 percent female and 36 percent male

Of the 65 patients interviewed, 47 reported consuming cucumbers in the week before becoming ill.

The CDC’s PulseNet system, which maintains a national database of DNA fingerprints of bacteria that cause foodborne illness, played a major role in this research. Whole genome sequencing (WGS) of the bacteria from infected individuals shows that they are genetically related, indicating a common source of infection.

Further analysis showed that bacteria from 162 samples showed resistance to fosfomycin, and in five cases resistance was also found to other antibiotics, including amoxicillin-clavulanic acid, ampicillin, azithromycin, cefoxitin, ceftiofur, ceftriaxone, ciprofloxacin and tetracycline. This antibiotic resistance complicates treatment for those who require antibiotics, although most Salmonella infections resolve without such interventions.

The Pennsylvania Department of Agriculture collected cucumber samples from retail locations and identified Salmonella in a sample. Further testing is being conducted to confirm if this strain matches the outbreak strain.

CDC does not recommend eating, selling or serving recalled cucumbers while the investigation continues. Fresh Start Produce Sales, Inc. has recalled whole cucumbers distributed in bulk to several states from May 17 to 21. The recall affects 14 states: Alabama, Florida, Georgia, Illinois, Maryland, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia and West Virginia.

Consumers are advised to:

• Avoid eating recalled cucumbers. If in doubt, please contact the store of purchase.
• Wash items and surfaces that may have come into contact with the recalled cucumbers with hot soapy water or a dishwasher.
• Seek medical attention for severe symptoms, such as high fever, prolonged diarrhea, bloody stools, or dehydration.

Companies must:

• Stop selling or serving the recalled cucumbers.
• Clean and disinfect surfaces and objects that may have come into contact with the cucumbers.
• Inform customers of the recall through signage or direct communication.

Anyone who has eaten cucumbers and developed symptoms of Salmonella infection should seek medical attention. Sick people should tell their doctor about possible exposure to Salmonella bacteria, because special tests are needed to diagnose salmonellosis. Symptoms of Salmonella infection can mimic other diseases, often leading to misdiagnosis.

Symptoms of a Salmonella infection may include diarrhea, abdominal cramps, and fever within 12 to 72 hours of eating contaminated food. Otherwise, healthy adults are usually sick for four to seven days. However, in some cases, the diarrhea can be so severe that patients require hospitalization.

Older adults, children, pregnant women, and people with weakened immune systems, such as cancer patients, are more likely to develop serious illness and serious, sometimes life-threatening conditions.

Some people become infected without becoming ill or showing symptoms. However, they can still spread the infections to others.

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