Hew Hallock reports this morning that – “Search goes on for source of Salmonella.”  So far the source of the outbreak – most likely a common source given the number of ill people – has not been announced. 

“As of Tuesday, March 18, 2008 we still have 18 confirmed cases and now have 56 cases that meet the clinical definition for salmonella infection,” said Julie Geiser, director of the Alamosa County Nursing Service. “Four persons have been hospitalized in conjunction with the outbreak. We have not yet determined a source for the bacteria.” Geiser said the Colorado Department of Public Health and Environment is assisting local health workers interview those families who have been infected. The interview uses an extensive seven-page questionnaire that is used to find a commonality among those who have been infected.

Rumors have been circulating about where the salmonella came from, said Geiser, but she warned, despite those rumors, that no location has been identified or confirmed as the place where the contamination began. “Clearly these are rumors and we haven’t made a determination,” she said.

Salmonella is one of the most common enteric (intestinal) infections in the United States. Salmonellosis (the disease caused by Salmonella) is the second most common form of bacterial foodborne illness after Campylobacter infection. It is estimated that 1.4 million cases of salmonellosis occur each year in the U.S.; 95% of those cases are foodborne-related. Approximately 220 of each 1000 cases result in hospitalization and eight of every 1000 cases result in death. About 500 to 1,000 or 31% of all food-related deaths are caused by Salmonella infections each year. Salmonellosis is more common in the warmer months of the year.

Salmonella infection occurs when the bacteria are ingested, typically from food derived from infected food-animals, but it can also occur by ingesting the feces of an infected animal or person. Food sources include raw or undercooked eggs/egg products, raw milk or raw milk products, contaminated water, meat and meat products, and poultry. Raw fruits and vegetables contaminated during slicing have been implicated in several foodborne outbreaks.

Reiter’s syndrome is a form of reactive arthritis. It is uncommon but can be a debilitating syndrome that follows a gastrointestinal or genitourinary infection. 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 (Hill Gaston & Lillicrap, 2003). The reactive arthritis associated with Reiter’s syndrome may develop after a person eats food that has been tainted with bacteria. 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 an enthesis (a places where ligaments and tendons attach to bone), especially the knee and the ankle.