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Publisher’s Platform: Basil Salmonella Outbreak Likely 38.6 Times Larger Than Reported

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Publisher's Platform: Basil Salmonella Outbreak Likely 38.6 Times Larger Than Reported

Just a small part of everything Salmonella infections are diagnosed and reported to health departments. It is estimated that for every reported case there are approximately 38.6 undiagnosed infections. The CDC estimates that 1.4 million cases, 15,000 hospitalizations, and 400 deaths are caused by Salmonella infections in the US every year. Overall, the incidence of Salmonella in the United States has not changed significantly since 1996.[1]

As of April 17, 2024, a total of 12 people had been infected by the outbreak of Salmonella Reports have been made from seven states: Florida, Georgia, Minnesota, Missouri, New Jersey, Rhode Island and Wisconsin. Illnesses began on dates ranging from February 11, 2024 to April 2, 2024. Of the 11 people for whom information was available, 1 person was hospitalized. No deaths have been reported.

Of the twelve people surveyed, ten (83%) reported shopping at Trader Joe’s. Seven sick people reported purchasing or likely purchasing organic basil in 2.5 oz clamshell-style containers from Trader Joe’s. In addition, traceback data collected by the FDA revealed that Infinite Herbs, LLC, in Miami, Florida, was the supplier of the 2.5 oz packages of organic basil sold in Trader Joe’s stores.

While this investigation is ongoing, you should not eat Infinite Herbs organic basil sold in Trader Joe’s stores in those 29 states and Washington DC. The basil was sold in clamshell-style packages of 2.5 oz. Researchers are investigating whether more products may be contaminated.

Salmonella is a bacterium that causes one of the most common intestinal infections in the United States: salmonellosis. Salmonella are found in the intestinal tract of wild and domesticated animals and humans.[2] The condition Salmonella refers to a group or family of bacteria that cause disease in humans in various ways. Salmonella serotype typhimurium and Salmonella serotype enteritidis are most common in the United States.[3] Most Salmonella infections are caused by eating contaminated food, especially food of animal origin. One study found that 87% of all confirmed cases of Salmonella were foodborne, with 10 percent of infection caused from person to person and 3% caused by pets.[4]

Salmonella Bacteria can be detected in the feces. In cases of bacteremia or invasive disease, the bacteria can also be detected in the blood, urine or, rarely, in tissues. The test consists of growing the bacteria in culture. A fecal, blood or other sample is placed in nutrient broth or on agar and incubated for 2-3 days. After that time, a trained microbiologist can identify the bacteria, if present, and confirm its identity by looking at biochemical reactions. Treatment with antibiotics before collecting a sample for testing can affect bacterial growth in the culture and lead to a negative test result, even if Salmonella is causing the infection.[5]

Salmonella infections can have a wide range of illnesses, from no symptoms to severe illness. The most common clinical presentation is acute gastroenteritis. Symptoms include diarrhea and abdominal cramps, often accompanied by a fever of 38°C to 39°C.[6] Other symptoms may include bloody diarrhea, vomiting, headache, and body aches. The incubation period, or the time from ingestion of the bacteria to the onset of symptoms, is typically 6 to 72 hours; However, there is evidence that in some situations incubation can last longer than 10 days.[7] People with salmonellosis usually recover within 3 to 7 days without treatment. Nevertheless, after recovery from symptoms, the bacteria will remain in the intestinal tract and feces for weeks – on average one month in adults and longer in children.[8]

In approximately 5% of non-typhoidal infections, patients develop bacteremia. In a small proportion of these cases, the bacterium can cause a focal infection, where the bacterium burrows into a tissue and causes an abscess, arthritis, endocarditis or other serious disease. Infants, the elderly, and individuals with weakened immune systems are at greater risk for bacteremia or invasive disease. In addition, infection is caused by antimicrobial resistant non-typhoid fever Salmonella Serotypes seem more likely to cause bloodstream infections.[9] Overall, about 20% of cases require hospitalization each year, 5% of cases have an invasive infection, and half of 1% die. Infections in infants and in people aged 65 or older are much more likely to require hospitalization or result in death.

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[1] Voetsch, Andreas, et al., “FoodNet estimation of the burden of disease caused by non-typhoid fever Salmonella Infections in the United States”, CLINICAL INFECTIOUS DSEASES, Vol. 15, no. 38, supplement 3, pp. S127-34 (April 15, 2004) available online at http://cid.oxfordjournals.org/content/38/Supplement_3/S127.long

[2] Miller, S. and Pegues, D., “Salmonella Species, including Salmonella Typhi,” in Mandell, Douglas and Bennett’s PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES, Sixth Edition, Chapter. 220, pp. 2636-650 (2005).

[3] Tauxe, R, “Emerging Foodborne Diseases: An Evolving Public Health Challenge.” EMERGING INFECTIOUS DISEASES, Vol. 3, no. 4, pp. 425-34 (1997) op http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640074/pdf/9366593.pdf

[4] Buzby, Jean and Roberts, Tonya, “The economics of enteric infections: foodborne illness, GASTROENTEROLOGY, Vol. 136, No. 6, pp. 1851-1862 (May 2009).

[5] Tauxe, R, “Emerging Foodborne Diseases: An Evolving Public Health Challenge.” EMERGING INFECTIOUS DISEASES, Vol. 3, no. 4, pp. 425-34 (1997) op http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640074/pdf/9366593.pdf

[6] American Academy of Pediatrics,”Salmonella infections”, RED BOOK: 2006 Report of the Committee on Infectious Diseases, edited by LK Pickering, pp. 581–584 (27e ed. 2006).

[7] Medus, C, et al., “Salmonella Outbreaks in Minnesota Restaurants, 1995 through 2003 – Evaluating the Role of Infected Food Workers”, JOURNAL OF FOOD PROTECTION, Vol. 69, no. 8, pp. 1870-78 (August 2006), article summary and paid access to the full text available online at http://www.ncbi.nlm.nih.gov/pubmed/16924912

[8] Behravesh, C.B. et al., “Salmonellosis”, in CONTROL OF COMMUNICABLE DSEASES MANUAL, 19th edition, published by American Public Health Association, pp. 535-540. (Heymann, D, editor 2008).

[9] Varma, Jay K., et al., “Antimicrobial resistant, non-typhoid Salmonella is associated with excessive bloodstream infections and hospitalizations, JOURNAL OF INFECTIOUS DISEASES, Vol. 191, no. 4, pp. 554-61 (February 15, 2005) available online at http://jid.oxfordjournals.org/content/191/4/554.long