August 2012

It started out this week with produce distributor Splendid Products voluntarily recalling certain lots of Daniella brand mangoes because they may be contaminated with Salmonella braenderup. The recalled mangoes, a product of Mexico, were sold as individual fruit and can be identified by the Daniella brand sticker and one of the following PLU numbers: 3114, 4051, 4311, 4584 or 4959. The recalled mangoes were sold at various retail stores throughout the U.S. between July 12 and August 29, 2012. Mangoes have been linked to a number (21) of recent cases of salmonellosis in Canada, and will by week’s end be linked to cases in California and 16 other states.

Then Giant Food of Landover, Md., following a voluntary recall by Splendid Products, announced it removed from sale Daniella mangos due to possible Salmonella braenderup contamination.  The following product, purchased between July 12 and August 24, 2012 is included in this recall:  Daniella mangos, PLU 4959.

Then Stop & Shop Supermarket Company, LLC, following a voluntary recall by Splendid Products announced it removed from sale Daniella mangos due to possible Salmonella braenderup contamination.  The following product, purchased between July 12 and August 24, 2012 is included in this recall:  Daniella mangos, PLU 4959

Spokane Produce, Inc., then voluntarily recalled a small lot run of Pineapple/Mango Pico de Gallo because it has the potential to be contaminated with Salmonella braenderup. The recall only includes 128/16ounce plastic containers of the refrigerated Pineapple/Mango Pico de Gallo with the UPC code “8869483987” under the brand labels Garden Patch or Yoke’s. The product was distributed to 11 inland northwest supermarkets in Washington, Idaho and Montana. The Pineapple/Mango Pico de Gallo includes mangoes of the Daniella brand that is being recalled by the supplier due to the potential contamination with Salmonella braenderup.

Today World Foods, LLC initiated a voluntary, precautionary recall on various products (Tropical Salsa, Fresh Island Medley and Fresh Fruit Burst Bowl) it distributes to retail supermarkets that contain mangoes associated with the Splendid Products recall of Daniella Brand Mangoes with the potential to be contaminated with Salmonella braenderup.

Today BI-LO announced an immediate voluntary recall on whole Daniella brand mangoes sold with a universal product code (UPC) of 0-00000-04051 in stores between July 12 and Aug. 27, 2012. The recalled mangoes, a product of Mexico, were sold as individual fruit and can be identified by the Daniella brand sticker. The product is being recalled in the states of Georgia, North Carolina, South Carolina and Tennessee due to a potential health risk from possible contamination with Salmonella braenderup.

Today Winn-Dixie announced an immediate voluntary recall of select cut fruit produced by Renaissance Food Group. The products are being recalled as a precaution because they contain a mango ingredient that has the potential of being contaminated with Salmonella braenderup. This recall is associated with Daniella Brand Mangoes distributed by Splendid Products.

Today Garden Highway-brand Tropical Salsa, and Fruit Burst and Island Medley varieties of cut fruit sold under the Winn-Dixie name were recalled due to a potential health risk from possible contamination with Salmonella braenderup. The recalled products will have a plant number of P-009 on the product label that will be located to the left of the universal product code (UPC). The recall is not companywide, but only for product sold in central and south Florida stores from the following counties: Brevard, Broward, Charlotte, Collier, DeSoto, Flagler, Hardee, Hendry, Hernando, Highlands, Hillsborough, Indian River, Lake, Lee, Manatee, Marion, Martin, Miami-Dade, Monroe, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Saint Lucie, Sarasota, Seminole, Sumter and Volusia.

The week ended with a total of 105 persons infected with the outbreak strain of Salmonella Braenderup have been reported to PulseNet from 16 states since July 1, 2012.  The number of ill persons identified in each state is as follows: California (80), Delaware (1), Hawaii (3), Idaho (1), Illinois (1), Louisiana (1), Maine (1), Michigan (1), Montana (1), Nebraska (1), New Jersey (1), New York (3), Oregon (1), Texas (2), Washington (6), and Wisconsin (1).  25 ill persons have been hospitalized.

What will next week bring?

Over the last weeks the CDC and FDA have reported that a total of 204 persons infected with the outbreak strain of Salmonella Typhimurium have been reported from 22 states linked to cantaloupe grown in Indiana. The number of ill persons identified in each state is as follows: Alabama (13), Arkansas (5), California (2), Florida (1), Georgia (4), Illinois (24), Indiana (22), Iowa (8), Kentucky (63), Massachusetts (2), Michigan (6), Minnesota (5), Mississippi (5), Missouri (13), New Jersey (2), North Carolina (5), Ohio (5), Pennsylvania (2), South Carolina (3), Tennessee (8), Texas (2), and Wisconsin (4). 78 ill persons have been hospitalized. Two deaths have been reported in Kentucky.

This week the CDC and FDA have reported that a total of 105 persons infected with the outbreak strain of Salmonella Braenderup have been reported from 16 states since July 1, 2012 linked to mangoes grown in Mexico. The number of ill persons identified in each state is as follows: California (80), Delaware (1), Hawaii (3), Idaho (1), Illinois (1), Louisiana (1), Maine (1), Michigan (1), Montana (1), Nebraska (1), New Jersey (1), New York (3), Oregon (1), Texas (2), Washington (6), and Wisconsin (1). 25 ill persons have been hospitalized. No deaths have been reported.

The states with Salmonella illnesses caused by both cantaloupes and mangoes are in purple and are: Illinois (25), Wisconsin (5), New Jersey (3), Texas (4), California (82) and Michigan (7).

Not sure exactly what that means. Perhaps people in those states eat a lot of fruit? Perhaps people in those states are simply not very lucky? Or, perhaps the heath investigators in those states are just that good?

A total of 204 persons infected with the outbreak strain of Salmonella Typhimurium have been reported from 22 states linked to cantaloupes.  The number of ill persons identified in each state is as follows: Alabama (13), Arkansas (5), California (2), Florida (1), Georgia (4), Illinois (24), Indiana (22), Iowa (8), Kentucky (63), Massachusetts (2), Michigan (6), Minnesota (5), Mississippi (5), Missouri (13), New Jersey (2), North Carolina (5), Ohio (5), Pennsylvania (2), South Carolina (3), Tennessee (8), Texas (2), and Wisconsin (4).  78 ill persons have been hospitalized. Two deaths have been reported in Kentucky.

A total of 105 persons infected with the outbreak strain of Salmonella Braenderup have been reported to from 16 states since July 1, 2012 linked to mangoes.  The number of ill persons identified in each state is as follows: California (80), Delaware (1), Hawaii (3), Idaho (1), Illinois (1), Louisiana (1), Maine (1), Michigan (1), Montana (1), Nebraska (1), New Jersey (1), New York (3), Oregon (1), Texas (2), Washington (6), and Wisconsin (1).  25 ill persons have been hospitalized. No deaths have been reported.

Assuming you survive the outbreak and recover acutely, what can be the long-term consequences of a Salmonella infection.

A.        Reactive Arthritis

The term reactive arthritis refers to an inflammation of one or more joints, following an infection localized at another site distant from the affected joints.  The predominant site of the infection is the gastrointestinal tract.  Several bacteria, including Salmonella, induce septic arthritis.[1] The resulting joint pain and inflammation can resolve completely over time or permanent joint damage can occur.[2]

The reactive arthritis associated with Reiter’s may develop after a person eats food that has been tainted with bacteria. In a small number of persons, the joint inflammation is accompanied by conjunctivitis (inflammation of the eyes), and uveitis (painful urination). Id.  This triad of symptoms is called Reiter’s Syndrome.[3] Reiter’s syndrome, a form of reactive arthritis, is an uncommon but debilitating syndrome caused by gastrointestinal or genitourinary infections. The most common gastrointestinal bacteria involved are Salmonella, Campylobacter, Yersinia, and Shigella. Reiter’s syndrome is characterized by a triad of arthritis, conjunctivitis, and urethritis, although not all three symptoms occur in all affected individuals.[4]

Although the initial infection may not be recognized, reactive arthritis can still occur. Reactive arthritis typically involves inflammation of one joint (monoarthritis) or four or fewer joints (oligoarthritis), preferentially affecting those of the lower extremities; the pattern of joint involvement is usually asymmetric. Inflammation is common at enthuses—i.e., the places where ligaments and tendons attach to bone, especially the knee and the ankle.

Salmonella has been the most frequently studied bacteria associated with reactive arthritis. Overall, studies have found rates of Salmonella-associated reactive arthritis to vary between 6 and 30%.[5]  The frequency of postinfectious Reiter’s syndrome, however, has not been well described.  In a Washington State study, while 29% developed arthritis, only 3% developed the triad of symptoms associated with Reiter’s syndrome.[6]  In addition, individuals of Caucasian descent may be more likely those of Asian descent to develop reactive arthritis,[7] and children may be less susceptible than adults to reactive arthritis following infection with Salmonella.[8]

A clear association has been made between reactive arthritis and a genetic factor called the human leukocyte antigen (HLA) B27 genotype. HLA is the major histocompatibility complex in humans; these are proteins present on the surface of all body cells that contain a nucleus, and are in especially high concentrations in white blood cells (leukocytes). It is thought that HLA-B27 may affect the elimination of the infecting bacteria or an individual’s immune response.[9] HLA-B27 has been shown to be a predisposing factor in one-half to over two-thirds of individuals with reactive arthritis.[10]  While HLA-B27 does not appear to predispose to the initial infection itself, it increases the risk of developing arthritis that is more likely to be severe and prolonged. This risk may be slightly greater for Salmonella and Yersinia-associated arthritis than with Campylobacter, but more research is required to clarify this.[11]

B.        Irritable Bowel Syndrome

A recently-published study surveyed the extant scientific literature and noted that post-infectious irritable bowel syndrome (PI-IBS) is a common clinical phenomenon first-described over five decades ago.[12]  The Walkerton Health Study further notes that:

Between 5% and 30% of patients who suffer an acute episode of infectious gastroenteritis develop chronic gastrointestinal symptoms despite clearance of the inciting pathogens.[13]

In terms of its own data, the “study confirm[ed] a strong and significant relationship between acute enteric infection and subsequent IBS symptoms.”[14]  The WHS also identified risk-factors for subsequent IBS, including: younger age; female sex; and four features of the acute enteric illness—diarrhea for > 7 days, presence of blood in stools, abdominal cramps, and weight loss of at least ten pounds.[15]

Irritable bowel syndrome (IBS) is a chronic disorder characterized by alternating bouts of constipation and diarrhea, both of which are generally accompanied by abdominal cramping and pain.[16]  In one recent study, over one-third of IBS sufferers had had IBS for more than ten years, with their symptoms remaining fairly constant over time.[17]  IBS sufferers typically experienced symptoms for an average of 8.1 days per month.[18]

As would be expected from a chronic disorder with symptoms of such persistence, IBS sufferers required more time off work, spent more days in bed, and more often cut down on usual activities, when compared with non-IBS sufferers.[19]  And even when able to work, a significant majority (67%), felt less productive at work because of their symptoms.[20]  IBS symptoms also have a significantly deleterious impact on social well-being and daily social activities, such as undertaking a long drive, going to a restaurant, or taking a vacation.[21]  Finally, although a patient’s psychological state may influence the way in which he or she copes with illness and responds to treatment, there is no evidence that supports the theory that psychological disturbances in fact cause IBS or its symptoms.[22]

Continue Reading 309 sickened by Salmonella Cantaloupe or Mangoes (so far) – What can be long-term consequences?

California hardest hit.

The CDC reports that 105 have been sickened by Salmonella-tainted Mangoes. The recalled mangoes were packed in Mexico and distributed by Splendid Products in Burlingame, California and by North American Produce Sales, Vancouver, BC. The mangoes were sold between July 12, 2012 and August 29, 2012 throughout the United States and Canada. The mangoes were sold as individual fruit with the sticker brand “Daniella.” Each fruit was also marked with a small sticker with one of the following codes: 4051, 4959, 4311, 4584 or 3114.

The number of ill persons identified in each state is as follows: California (80), Delaware (1), Hawaii (3), Idaho (1), Illinois (1), Louisiana (1), Maine (1), Michigan (1), Montana (1), Nebraska (1), New Jersey (1), New York (3), Oregon (1), Texas (2), Washington (6), and Wisconsin (1). Canada has reported 21 ill thus far – British Columbia (16) and Alberta (5).

According to Splendid Products and news sources, the mangoes were sold in the US as individual fruit at Aldi, BI-LO, Copps, Costco, El Super, Food4Less, Giant Eagle, Giant Food, Kroger, Mariano’s, Martin’s Food Market, Metro Market, Pick ‘n Save, Rainbow, Ralph’s, Savemart, Stop & Shop, Topco, TOP Food & Drug, TOPS, Walmart and Whole Foods. In Canada Sobeys and Costco have recalled mangoes. Splendid Products also announced that about 100,000 boxes of the fruit were sold to retailers and wholesalers in the US. A box carries between eight to 10 mangoes. How many mangoes were sold in Canada is unclear.

More illnesses are expected to be counted in both the US and Canada.  In addition, products containing mangoes, such as fruit salads, are expected to be recalled as well.

A total of 204 persons infected with the outbreak strain of Salmonella Typhimurium have been reported from 22 states.

The number of ill persons identified in each state is as follows: Alabama (13), Arkansas (5), California (2), Florida (1), Georgia (4), Illinois (24), Indiana (22), Iowa (8), Kentucky (63), Massachusetts (2), Michigan (6), Minnesota (5), Mississippi (5), Missouri (13), New Jersey (2), North Carolina (5), Ohio (5), Pennsylvania (2), South Carolina (3), Tennessee (8), Texas (2), and Wisconsin (4).

78 ill persons have been hospitalized. Two deaths have been reported in Kentucky.

Collaborative investigation efforts of state, local, and federal public health and regulatory agencies indicate that cantaloupe originating from Chamberlain Farms Produce, Inc. of Owensville, Indiana is a source of this outbreak.  On August 22, 2012, the U.S. Food and Drug Administration (FDA) announced a recall of cantaloupes originating from Chamberlain Farms Produce, Inc.

A total of 105 persons infected with the outbreak strain of Salmonella Braenderup have been reported to PulseNet from 16 states since July 1, 2012.

The number of ill persons identified in each state is as follows: California (80), Delaware (1), Hawaii (3), Idaho (1), Illinois (1), Louisiana (1), Maine (1), Michigan (1), Montana (1), Nebraska (1), New Jersey (1), New York (3), Oregon (1), Texas (2), Washington (6), and Wisconsin (1).

25 ill persons have been hospitalized. No deaths have been reported.

Collaborative investigation efforts of state, local, and federal public health and regulatory agencies indicate that mangoes are a likely source of this outbreak.

On August 24, the Canadian Food Inspection Agency (CFIA) issued a health hazard alert related to certain mangoes following an investigation by Canadian health authorities into an outbreak of illness caused by Salmonella Braenderup.

On August 29, Splendid Products of Burlingame, California issued a voluntary recall of certain lots of Daniella brand mangoes because they may be contaminated with Salmonella bacteria.

My apologies to George Santayana.

Of course cantaloupes and salmonella are fresh on our minds, as the CDC reports a total of 178 persons infected with the outbreak strain of Salmonella Typhimurium have been reported from 21 states. 62 ill persons have been hospitalized and two deaths have been reported in Kentucky.

And, of course who could forget (we apparently did) the CDC’s report on one of the deadliest foodborne outbreaks in US history. Just last year a total of 147 persons infected with any of the five outbreak-associated subtypes of Listeria monocytogenes were reported from 28 states. 99% were hospitalized and Thirty-three outbreak-associated deaths were reported. Ten deaths not attributed to listeriosis occurred among persons who had been infected with an outbreak-associated subtype. Seven of the illnesses were related to a pregnancy; three were diagnosed in newborns and four were diagnosed in pregnant women. One miscarriage was reported.

Although not as large as our more recent failures to learn from history, cantaloupe related outbreaks have occurred in the past and have had just as personal results.

Continue Reading Those who cannot remember the past “cantaloupe outbreaks” are condemned to repeat it

As of today, there have been 21 confirmed cases of Salmonella Braenderup in Canada with 16 in British Columbia and 5 in Alberta according to the Public Health Agency of Canada.

In the US the CDC reported today that a total of 103 persons infected with the outbreak strain of Salmonella Braenderup have been reported from 16 states. The majority of ill persons have been reported from California. Food Safety News and eFoodAlert report that the following states have reported illnesses: California (78), Oregon (1), Washington (6), Texas (2) and New York (3), which leaves 13 cases unaccounted for.

Most persons became ill during July. Among persons for whom information is available, illness onset dates range from July 3, 2012 to August 11, 2012. Ill persons range in age from 1 to 86 years, with a median age of 32 years old. Fifty-five percent of ill persons are female. Among 69 persons with available information, 25 (36%) patients reported being hospitalized.

Mex Y Can Trading, Inc., North American Produce Sales, Fresh Start Foods, Splendid Products LLC and Charlie’s Produce have recalled Daniella Brand Mangoes that have been distributed to at least:

Aldi, BI-LO, LLC, Copps, Costco, El Super, Food4Less, Giant Eagle, Giant Food, Kroger, Mariano’s, Martin’s Food Market, Metro Market, Pick ‘n Save, Rainbow, Ralph’s, Savemart, Stop & Shop, Topco, TOP Food & Drug, TOPS, Walmart and Whole Foods.

kiwi-strawberries-mango-and-cantaloupe.jpgIngredient 1- Mangoes

According to efoodalert, Food Safety News and Lola, as of August 22, 2012 there have been 22 confirmed cases of Salmonella Braenderup in Canada with 17 in British Columbia and 5 in Alberta. In the US, 101 cases of Salmonella Braenderup have been reported. Affected states reporting illnesses due to the outbreak strain include California (75 cases), Oregon (1 case), Washington (6 cases), Texas (2 cases) and New York (3 cases).

The mangoes that are subject to the recall were bought between July 12 and August 24, have a price look-up (PLU) number of 4959, and are labeled as Daniella mangoes. Late last week a Canadian produce importer recalled its Daniella mangoes from Mexico after they were linked to Salmonella Braenderup infections. Giant Food of Landover, Md., following a voluntary recall by Splendid Products, announced it removed from sale Daniella mangos due to possible Salmonella Braenderup contamination. (See, past Mango Outbreaks)

Ingredient 2 – Cantaloupes

Also, today the FDA and CDC announced that cantaloupe collected from Chamberlain Farms Produce, Inc., based in Owensville, Indiana, has tested positive for the Salmonella Typhimurium outbreak strain that has so far sickened 178 people from 21 states. The number of ill persons identified in each state is as follows: Alabama (13), Arkansas (3), California (2), Georgia (3), Illinois (21), Indiana (18), Iowa (7), Kentucky (56), Massachusetts (2), Michigan (6), Minnesota (4), Mississippi (5), Missouri (12), New Jersey (2), North Carolina (3), Ohio (4), Pennsylvania (2), South Carolina (3), Tennessee (6), Texas (2), and Wisconsin (4). 62 ill persons have been hospitalized. Two deaths have been reported in Kentucky.

FDA investigators were at the farm from August 14 to August 16 collecting samples from surface areas and from cantaloupe. So far joint investigations by state, local, and federal authorities point to cantaloupe from Chamberlain Farms as a source of the outbreak. According to earlier reports, officials were exploring other possible sources and whether other types of melon were involved. Earlier in the investigation, tests by Kentucky’s state public health lab found the outbreak strain in samples from two cantaloupes collected from a retail location.  (see, past Cantaloupe Outbreaks)

After the final update on December 8, investigators learned that a Listeria isolate that had been isolated from a sample of cut cantaloupe from a patient’s home during the outbreak investigation had a PFGE pattern combination that was different from the four known pattern combinations in the outbreak. A search of the PulseNet database for matching DNA fingerprint patterns from isolates collected during the outbreak time period identified one human matching isolate. The person from whom the Listeria was isolated reported eating cantaloupe before becoming ill; this case was added to the case count.

082712map.jpgA total of 147 persons infected with any of the five outbreak-associated subtypes of Listeria monocytogenes were reported to CDC from 28 states. The number of infected persons identified in each state was as follows: Alabama (1), Arkansas (1), California (4), Colorado (40), Idaho (2), Illinois (4), Indiana (3), Iowa (1), Kansas (11), Louisiana (2), Maryland (1), Missouri (7), Montana (2), Nebraska (6), Nevada (1), New Mexico (15), New York (2), North Dakota (2), Oklahoma (12), Oregon (1), Pennsylvania (1), South Dakota (1), Texas (18), Utah (1), Virginia (1), West Virginia (1), Wisconsin (2), and Wyoming (4).

Among persons for whom information was available, reported illness onset ranged from July 31, 2011 through October 27, 2011. Ages ranged from <1 to 96 years, with a median age of 78 years. Most ill persons were over 60 years old. Fifty-eight percent of ill persons were female. Among the 145 ill persons with available information on whether they were hospitalized, 143 (99%) were hospitalized. Thirty-three outbreak-associated deaths were reported: Colorado (9), Indiana (1), Kansas (3), Louisiana (2), Maryland (1), Missouri (3), Montana (1), Nebraska (1), New Mexico (5), New York (2), Oklahoma (1), Texas (2), and Wyoming (2). Among persons who died, ages ranged from 48 to 96 years, with a median age of 81 years. In addition, one woman pregnant at the time of illness had a miscarriage. Ten deaths not attributed to listeriosis occurred among persons who had been infected with an outbreak-associated subtype. State and local public health officials reviewed causes of death listed on death certificates to determine whether to attribute these deaths to listeriosis. Deaths included in this review occurred as recently as February 29, 2012.

Seven of the illnesses were related to a pregnancy; three were diagnosed in newborns and four were diagnosed in pregnant women. One miscarriage was reported.