Listeria is a gram-positive, rod-shaped bacterium that is ubiquitous and can grow under either anaerobic (without oxygen) or aerobic (with oxygen) conditions. 

A.        The Prevalence of Listeria in Food and the Environment

Listeriosis is one of the most important bacterial infections worldwide that arises mainly from the consumption of contaminated food.[1] The disease is caused by Listeria monocytogenes, which is considered an opportunistic pathogen that affects mainly those with underlying immune conditions, such as pregnant women, neonates, and elders, resulting in septicemia, meningitis, and/or meningoencephalitis. Of the six species of Listeria, only L. monocytogenes causes disease in humans. It thrives between bacteria 86-98.6oF (30-37oC), but Listeria can grow at temperatures as low as −0.4°C and survive in freezing conditions down to −18°C.[2] This unique quality allows thermal characteristics to be used as a means of differentiating Listeria from other possibly-contaminating bacteria. 

Listeria monocytogenes is omnipresent in nature; it is found widely in such places as water, soil, infected animals, human and animal feces, raw and treated sewage, leafy vegetables, effluent from poultry and meat processing facilities, decaying corn and soybeans, improperly fermented silage, and raw (unpasteurized) milk.[3]

Foodborne listeriosis is relatively rare but is a serious disease with high fatality rates (20%–30%) compared with other foodborne microbial pathogens. Severe L. monocytogenes infections are responsible for high hospitalization rates (91%) among the most common foodborne pathogens, may cause sporadic cases or large outbreaks, and can persist in food-processing environments and multiply at refrigeration temperatures, making L. monocytogenes a significant public health concern.[4]

Ready-to-eat foods are a notable and consistent source of Listeria. For example, a research study done by the Listeria Study Group found that L. monocytogenes grew from at least one food specimen in the refrigerators of 64% of persons with a confirmed Listeria infection (79 of 123 patients), and in 11% of more than 2,000 food specimens collected in the study. Moreover, 33% of refrigerators (26 of 79) contained foods that grew the same strain with which the individual had been infected, a frequency much higher than would be expected by chance. The danger posed by the risk of Listeria in ready-to-eat meats prompted the USDA to declare the bacterium an adulterant in these kinds of meat products and, as a result, to adopt a zero-tolerance policy for the presence of this deadly pathogen. The Code of Federal Regulations includes requirements for the post-lethality control of Listeria in meat and poultry products. This regulation is referred to as “The Listeria Rule” and was enacted in 2003. The rule outlines prevention and control measures that must be taken in processing facilities to reduce the risk of contamination of ready-to-eat products.[5]

B.        Transmission of and Infection with Listeria

Listeria typically spreads to people through contaminated food or water but can also be transmitted from mother to fetus.

Except for the transmission of mother to fetus, human-to-human transmission of Listeria is not known to occur. Infection is caused almost exclusively by the ingestion of the bacteria, most often through the consumption of contaminated food. The most widely accepted estimate of foodborne transmission is 85-95% of all Listeria cases. 

The infective dose—that is, the number of bacteria that must be ingested to cause illness—is not known but is suspected to vary based on the strain. In an otherwise healthy person, an extremely large number of Listeria bacteria must be ingested to cause illness—estimated to be somewhere between 10-100 million viable bacteria (or colony forming units “CFU”) in healthy individuals, and only 0.1-10 million CFU in people at high risk of infection. Even with such a dose, a healthy individual will suffer only a fever, diarrhea, and related gastrointestinal symptoms.

The amount of time from infection to the onset of symptoms—typically referred to as the incubation period—can vary to a significant degree.[6]

According to the CDC, symptoms of Listeria infection can develop at any time from the same day of exposure to 70 days after eating contaminated food. According to the FDA, gastroenteritis (or non-invasive illness) has an onset time of a few hours to 3 days, while invasive illness can have an onset varying from 3 days to 3 months. According to one authoritative text:

The incubation period for invasive illness is not well established, but evidence from a few cases related to specific ingestions points to 11 to 70 days, with a mean of 31 days. In one report, two pregnant women whose only common exposure was attendance at a party developed Listeria bacteremia with the same uncommon enzyme type; incubation periods for illness were 19 and 23 days.

Adults can get listeriosis by eating food contaminated with Listeria, but babies can be born with listeriosis if their mothers eat contaminated food during pregnancy. The mode of transmission of Listeria to the fetus is either transplacental via the maternal bloodstream or ascending from a colonized genital tract. Infections during pregnancy can cause premature delivery, miscarriage, stillbirth, or serious health problems for the newborn. Pregnant women make up around 30% of all infection cases while accounting for 60% of cases involving the 10- to 40-year age group.

C.        Who is most susceptible to Listeria monocytogenes infection?

Several segments of the population are at increased risk and need to be informed so that proper precautions can be taken. The body’s defense against Listeria is called “cell-mediated immunity” because the success of defending against infection depends on our cells (as opposed to our antibodies), especially lymphocytes, otherwise known as “T-cells.” Therefore, individuals whose cell-mediated immunity is suppressed are more susceptible to the devastating effects of listeriosis, including HIV-infected individuals, who have been found to have Listeria-related mortality of 29%. The incidence of Listeria infection in HIV-positive individuals is higher than in the general population. One study found that:

The estimated incidence of listeriosis among HIV-infected patients in metropolitan Atlanta was 52 cases per 100,000 patients per year, and among patients with AIDS it was 115 cases per 100,000 patients per year, rates 65-145 times higher than those among the general population. HIV-associated cases occurred in adults who were 29-62 years of age and in postnatal infants who were 2 and 6 months of age. 

Pregnant women naturally have a depressed cell-mediated immune system. While other systemic bacterial infections may result in adverse pregnancy outcomes at comparable frequencies, L. monocytogenes have notoriety because fetal complications largely occur in the absence of overt illness in the mother, delaying medical intervention. In addition, the immune systems of fetuses and newborns are very immature and are extremely susceptible to these types of infections. 

Other adults, especially transplant recipients and lymphoma patients, are given necessary therapies with the specific intent of depressing T-cells, and these individuals become especially susceptible to Listeria as well. Other adults, especially transplant recipients and lymphoma patients, are given necessary therapies with the specific intent of depressing T-cells, and these individuals become especially susceptible to Listeria as well.

According to the FDA, CDC, and other public health organizations, individuals at increased risk for being infected and becoming seriously ill with Listeria include the following groups:

  • Pregnant women: They are about 10-20 times more likely than other healthy adults to get listeriosis. About one-third of listeriosis cases happen during pregnancy. Fetuses are also highly susceptible to infection and severe complications.
  • Newborns: Newborns can develop life-threatening diseases from perinatal and neonatal infections 
  • Persons with weakened immune systems 
  • Persons with cancer, diabetes, kidney, or gastrointestinal disease 
  • Persons with HIV/AIDS: Individuals with HIV/AIDS are almost 300 times more likely to get listeriosis than people with healthy immune systems. 
  • Persons who take glucocorticosteroid medications (such as cortisone) 
  • Persons of advanced age: One risk assessment showed people over 60 years old were 2.6 times more likely to develop listeriosis than the general population. And in 2011, the median age of diagnosed cases in people who were not pregnant was 71 years old. 

D.        Symptoms of Listeriosis

Only a small percentage of persons who ingest Listeria fall ill or develop symptoms. For those who do develop symptoms because of their infection, the resulting illness is either mild or quite severe, in what is sometimes referred to as a “bimodal distribution of severity.” [7] Listeria can cause two different types of disease syndromes with differing severity. Non-invasive Listeria infection causes gastroenteritis with symptoms such as diarrhea, nausea, and vomiting that resolve on their own. Healthy adults without any immunocompromising conditions typically experience this milder version of the disease. The more severe type of disease caused by Listeria monocytogenes is called listeriosis and is referred to as an invasive illness. 

On the mild end of the spectrum, listeriosis usually consists of the sudden onset of fever, chills, severe headache, vomiting, and other influenza-type symptoms. Along these same lines, the CDC notes that infected individuals may develop fever, muscle aches, and sometimes gastrointestinal symptoms such as nausea or diarrhea. When present, the diarrhea usually lasts 1-4 days (with 42 hours being average), with 12 bowel movements per day at its worst.

The more severe form of the illness occurs when the bacteria infect parts of the body that are typically sterile, such as the blood, brain, liver, and cerebral spinal fluid. The presence of the bacteria in these areas triggers the immune response and can lead to those more severe symptoms. L. monocytogenes has a specific affinity for the central nervous system (CNS), especially in cell-mediated immunodeficient individuals.[8]

As already noted, when pregnant, women have a mildly impaired immune system that makes them susceptible to Listeria infection. If infected, the illness appears as acute fever, muscle pain, backache, and headache. The illness usually occurs in the third trimester, which is when immunity is at its lowest. Infection during pregnancy can lead to premature labor, miscarriage, infection of the newborn, or even stillbirth. Around twenty percent of such infections result in stillbirth or neonatal death. 

Newborns may present clinically with early-onset (less than 7 days) or late-onset forms of infection (7 or more days). Those with the early-onset form are often diagnosed in the first 24 hours of life with septicemia, meningitis, or respiratory distress and have a higher mortality rate. Early-onset listeriosis is most often acquired through trans-placental transmission. Late-onset neonatal listeriosis is less common and less severe than the early-onset form. Clinical symptoms may be subtle and include irritability, fever, poor feeding, and meningitis. The mode of acquisition of late onset listeriosis is poorly understood. 

E.        Complications of Listeria Infection

For those persons who suffer a Listeria infection that does not resolve on its own, the complications can be numerous and possibly severe. The most common complication is septicemia (bacterial infection in the blood), with meningitis being the second most common. Other complications can include inflammation of the brain or brain stem (encephalitis), brain abscess, inflammation of the heart-membrane (endocarditis), septic arthritis, osteomyelitis (infection in the bone), and localized infection, either internally or of the skin. 

Death is the most severe consequence of listeriosis, and it is tragically common. The CDC has estimated that L. monocytogenes is the third leading cause of death from foodborne illness, with approximately 260 of 1,600 people diagnosed dying from their infections. For example, based on 2018 FoodNet surveillance data, 96% of 126 Listeria cases ended up in the hospital, the highest hospitalization rate for pathogenic bacterial infection. This data showed a fatality rate of 21%. According to the FDA, the case-fatality rate increases substantially based on complications, possibly reaching rates of 70% in cases with listeria meningitis, 50% in septicemia cases, and over 80% for perinatal/neonatal infections. In one US study, L. monocytogenes was reportedly the cause of nearly 4% of all cases of bacterial meningitis.

[1]           Reda, W. W., Abdel-Moein, K., Hegazi, A., Mohamed, Y., & Abdel-Razik, K. (2016). Listeria monocytogenes: An emerging food-borne pathogen and its public health implications. The Journal of Infection in Developing Countries, 10(02), 149-154. https://doi.org/10.3855/jidc.6616

[2]           Santos, T., Viala, D., Chambon, C., Esbelin, J., & Hébraud, M. (2019, May 24). Listeria monocytogenes Biofilm Adaptation to Different Temperatures Seen Through Shotgun Proteomics. https://www.frontiersin.org/articles/10.3389/fnut.2019.00089/full. 

[3]           Manning, A. (2019). Microbial Food Spoilage and Food Borne Diseases. In Food microbiology and food processing (pp. 125–130). Chapter 2. ED-TECH PRESS. 

[4]           Arslan, F., Meynet, E., Sunbul, M. et al. The clinical features, diagnosis, treatment, and prognosis of neuroinvasive listeriosis: a multinational study. Eur J Clin Microbiol Infect Dis 34,1213–1221 (2015). https://doi.org/10.1007/s10096-015-2346-5

[5]           USDA Staff. (2014, January 1). Controlling Listeria monocytogenes in Post-lethality Exposed Ready-to-Eat Meat and Poultry Products. https://www.fsis.usda.gov/wps/portal/fsis/topics/regulatory-compliance/guidelines/2014-0001.

[6]           Goulet V, King LA, Vaillant V, de Valk H. What is the incubation period for listeriosis? BMC Infect Dis. 2013; 13:11. Published 2013 Jan 10. doi:10.1186/1471-2334-13-11

[7]           Waldron, C. M. (2017, September 15). The Recovery and Transfer of Aerosolized Listeria Innocua. https://vtechworks.lib.vt.edu/handle/10919/78907. 

[8]           Arslan, F., Meynet, E., Sunbul, M., Sipahi, O. R., Kurtaran, B., Kaya, S., … Mert, A. (2015, June). The clinical features, diagnosis, treatment, and prognosis of neuroinvasive listeriosis: a multinational study. European journal of clinical microbiology & infectious diseases: official publication of the European Society of Clinical Microbiology. https://www.ncbi.nlm.nih.gov/pubmed/25698311.

Screenshot-2025-06-17-at-8.28.59 PM-550x881

FSIS and public health partners are investigating an outbreak of Lm that currently includes 17 ill people in 13 states. As of June 17, 2025, there have been three reported deaths and one fetal loss associated with this outbreak.

FreshRealm establishments in San Clemente, Calif., Montezuma, Ga., and Indianapolis, Ind., are recalling chicken fettuccine alfredo products that may be adulterated with an outbreak strain of Listeria monocytogenes (Lm), the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today. Out of an abundance of caution, the company is voluntarily recalling all products produced prior to June 17, 2025, that are available in commerce under the following brand names.

The following ready-to-eat products were shipped to Kroger and Walmart retail locations nationwide [view labels]:  

  • 32.8-oz. tray packages containing “MARKETSIDE GRILLED CHICKEN ALFREDO WITH FETTUCCINE Tender Pasta with Creamy Alfredo Sauce, White Meat Chicken and Shaved Parmesan Cheese” with best-by date 06/27/25 or prior.
     
  • 12.3 oz. tray packages containing “MARKETSIDE GRILLED CHICKEN ALFREDO WITH FETTUCCINE Tender Pasta with Creamy Alfredo Sauce, White Meat Chicken, Broccoli and Shaved Parmesan Cheese” with best-by date 06/26/25 or prior.
     
  • 12.5 oz. tray packages containing “HOME CHEF Heat & Eat Chicken Fettuccine Alfredo with pasta, grilled white meat chicken, and Parmesan cheese” with best-by date 06/19/25 or prior.                               

The products bear the USDA mark of inspection on the product label as well as establishment numbers “EST. P-50784,” “EST. P-47770,” or “EST. P-47718” printed on the side of the packaging.

FSIS and public health partners are investigating an outbreak of Lm that currently includes 17 ill people in 13 states. As of June 17, 2025, there have been three reported deaths and one fetal loss associated with this outbreak. The outbreak strain of Lm was isolated from ill people on dates ranging from August 2024 – May 2025. The same outbreak strain was isolated from a routine chicken fettuccine alfredo sample collected by FSIS in a FreshRealm establishment in March 2025. The lot of chicken fettuccine alfredo represented by this sample was held during sampling, destroyed, and never entered commerce. The subsequent investigations at the establishment that produced this product, and into the product ingredients, have not identified the source of contamination. FSIS also used purchase records from two ill people to trace purchased chicken fettuccine alfredo products to FreshRealm establishments. An additional two ill people verbally described chicken fettuccine alfredo products they purchased. FSIS identified products produced by FreshRealm that matched the descriptions during follow-up at the retail stores where they shopped. This investigation is ongoing. FSIS is sharing what is currently known regarding products associated with the outbreak as the agency continues to work with public health partners to identify whether a specific ingredient in the chicken fettucine alfredo may be the source of this strain of Lm.

Consumption of food contaminated with Lm can cause listeriosis, a serious infection that primarily affects older adults, persons with weakened immune systems, and pregnant women and their newborns. Less commonly, people outside these risk groups are affected.

Listeriosis can cause fever, muscle aches, headache, stiff neck, confusion, loss of balance and convulsions sometimes preceded by diarrhea or other gastrointestinal symptoms. An invasive infection spreads beyond the gastrointestinal tract. In pregnant women, the infection can cause miscarriages, stillbirths, premature delivery or life-threatening infection of the newborn. In addition, serious and sometimes fatal infections in older adults and people with weakened immune systems. Listeriosis is treated with antibiotics. People in the higher-risk categories who experience flu-like symptoms within two months after eating contaminated food should seek medical care and tell the health care provider about eating the contaminated food.

FSIS is concerned that some products may be in consumers’ refrigerators or freezers. Consumers who have purchased these products are urged not to consume them. 

Listeria:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Listeria outbreaks. The Listeria lawyers of Marler Clark have represented thousands of victims of Listeria and other foodborne illness outbreaks and have recovered over $900 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Listeria lawyers have litigated Listeria cases stemming from outbreaks traced to a variety of foods, such as lettuce, polony, deli meat, cantaloupe, cheese, celery and milk.   

If you or a family member became ill with a Listeria infection after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Listeria attorneys for a free case evaluation.

Additional Resources:

Charlier

Over two decades ago I tried an E. coli case against a school that sickened eleven kids. We won at trial, but the school’s lawyers appealed. We were fortunate to have Charlie Wiggins brief and argue our position on appeal. Charlie, in his standard bow tied way, argued that a taco was a product and that the school was the manufacturer. It therefore was strictly liable for manufacturing and selling a defective product (one with E. coli in it). It was justice for these eleven kids and has made it clear that manufacturers of food are held to a high standard. Thank you Charlie. You are missed.

The Finley School District denied it was the manufacturer of the taco despite the fact that it prepared and served a taco lunch for its students using frozen ground beef supplied by Northern States Beef. The District thawed and cooked the meat;  drained off the fat and rinsed the meat;  added refried beans, tomato paste, and seasonings;  and mixed it up.   It then delivered the meat mixture in pans to the schools, including Finley Elementary, for distribution from cafeterias.

Eleven children became infected with E. coli O157:H7 bacteria in October 1998.   Ten attended Finley Elementary.   The eleventh was a two-year-old playmate of two of the affected students.   The Benton-Franklin Health District investigated.   Members of the Washington State Department of Health and the National Centers for Disease Control joined the investigation.   Dr. John Kobayashi, epidemiologist for communicable diseases for the Washington State Department of Health, headed the investigation.   The investigative team concluded:

As no other common school activity was identified other than eating at the school cafeteria, it is reasonable to conclude that a meal served at the school was the likely source of illness.   Cattle are the known reservoir of E. coli O157:H7.   Thus, it is likely that consuming the ground beef served in the tacos was the vehicle.

The Appellate Court concluded: On the merits, the District denies that it was a “manufacturer” as defined by the Product Liability Act, in any event.   Procedurally, the District argues that this is a fact question for the jury and should not, therefore, have been resolved as a question of law.

As to the District’s argument that the question is one of fact, we note that the material facts here were not disputed.   The District conceded that it stored, thawed, cooked, drained, rinsed, seasoned, and mixed what started out as frozen ground beef.   The question of what legal consequences might flow from these activities-whether this constitutes manufacturing-was then properly decided by the court as a matter of law.   See, e.g., Harris v. Ski Park Farms, Inc., 120 Wash.2d 727, 736, 844 P.2d 1006 (1993).

Under the Act, a “ ‘manufacturer’ includes a product seller who designs, produces, makes, fabricates, constructs, or remanufactures the relevant product or component part of a product before its sale to a user or consumer.”  RCW 7.72.010(2).   Since the relevant synonyms are not defined by the statute, we give them their dictionary definition.  Washburn v. Beatt Equip. Co., 120 Wash.2d 246, 259-61, 840 P.2d 860 (1992).

To “design” includes “the process of selecting the means and contriving the elements, steps, and procedures for producing what will adequately satisfy some need.”   Webster’s Third New International Dictionary 611 (1993).   To “produce” means “to give being, form, or shape to:  make often from raw materials.”   Webster’s, at 1810.  “Make” includes “to bring (a material thing) into being by forming, shaping, or altering material.”   Webster’s, at 1363.   “Fabricate” includes “to form into a whole by uniting parts.”   Webster’s, at 811.  “Construct” includes “to form, make, or create by combining parts or elements.”   Webster’s, at 489.

 Here, the District began the process with 180 pounds of frozen ground beef.   The frozen beef was thawed and then cooked in a steam kettle.   Once cooked, the fat was drained off.   The meat was rinsed.   And refried beans, tomato paste, and seasonings were added.   The taco meat was later scooped onto a tortilla along with other condiments and side dishes and then served.

The District thus had a “design” for cooking this meat-its recipe.   It made taco meat by combining ground beef with other ingredients.   It then used the taco meat as part of its taco lunch.   The District’s cooking process falls neatly into each of the definitions for “produce,” “make,” “fabricate,” and “construct.”   Webster’s, at 1810, 1363, 811, 489.

The District was not merely a retailer.   The reason for excluding nonmanufacturing retailers from strict liability is to distinguish “between those who have actual control over the product and those who act as mere conduits in the chain of distribution.”  Buttelo v. S.A. Woods-Yates Am. Mach. Co., 72 Wash.App. 397, 404, 864 P.2d 948 (1993).   The District did not simply resell frozen ground beef, seasonings, and tortillas as a grocery store would.   It took raw ingredients and made a taco lunch out of them.   It then sold them.

The District is a manufacturer-a manufacturer of tacos.

Charlie Wiggins passed away peacefully on May 27th on Bainbridge Island due to complications from Parkinson’s disease. He was 77. He was a loving husband, father, and grandfather who was respected and loved by many.

Charlie’s life was shaped by his kindness, optimism, and a deep passion for justice. This passion took him from Albania, where he assisted in the judiciary’s transition to democracy, to the Washington State Supreme Court, where he served from 2010 until his retirement in 2020.

When looking back on his time as a Supreme Court Justice, Charlie considered the McCleary vs. Washington decision to be the most impactful of his tenure. This ruling resulted in the state increasing funding for basic K-12 education by billions of dollars.

Prior to serving on the Court, Charlie operated a law firm on Bainbridge Island specializing in appellate law and served as a judge on the Washington Court of Appeals. His legal career began in 1976 at the firm Edwards, Sieh, Wiggins & Hathaway. It was on the ferry commuting from his home on Bainbridge Island to the law firm in Seattle where he met his wife, Nancy.

Giving back was always important to Charlie. A dedicated member of Rolling Bay Presbyterian Church, he served as an elder and joined youth mission trips to build homes in Tijuana. In 2010, the Kitsap Bar Association honored Charlie with its Humanitarian Award for organizing attorneys to build homes for single mothers. In 2004, he was named Volunteer of the Year by the Union Gospel Mission legal clinic and also served as president of the Washington Chapter of the American Judicature Society. Over the years he also volunteered with many other organizations.

Charlie never sat still. Some of his hobbies included building a wooden kayak, digging geoducks, juggling, and re-enacting the Washington State Constitutional Convention in costume. He snowboarded well into his seventies, much to his family’s dismay. All family trips included Charlie dragging along his fancy case of poker chips, in hopes of starting a game or two. Charlie was never without his signature bow tie in court or in the office. His collection numbered well over 100.

As the son of a career warrant officer, Charlie grew up around the world. When Charlie was two, the family transferred via troop ship to Panama at the tail end of a hurricane. Much to Charlie’s delight, his crib rolled port to starboard across the cabin, possibly spawning his lifelong love of boating. He and his family enjoyed many boating trips to the San Juans.

He graduated magna cum laude and Phi Beta Kappa from Princeton University and received his Juris Doctorate from Duke Law School.

Charlie is survived by his wife Nancy, their children Amy (Michael) and Sam (Kayla), his grandchildren Jude and Thora, and his three sisters, Jane, Helen, and Elizabeth. He is preceded in death by his parents, Charles and Jane Wiggins.

Pistachio Cream, Cucumbers and Eggs – not a great combination.

Pistachio Cream: The FDA and CDC, in collaboration with state and local partners, are investigating illnesses in a multistate outbreak of Salmonella Oranienburg infections linked to Emek-brand Pistachio Cream manufactured by Emek Dogal Saglik Urunleri Iklim Gida Insaat San Tic Ltd Sti in Turkey and imported to wholesale distributors, restaurants, and food service locations in the United States. 

FDA was notified by the Minnesota Department of Health about a cluster of Salmonella illnesses and two Salmonella positive samples of Emek-brand Pistachio Cream product that matched clinical cases by whole genome sequencing (WGS) in this outbreak. As of June 13, 2025, a total of four cases infected with the outbreak strain of Salmonella have been reported from two states. Of the four cases with information available, all four (100%) reported eating pistachio cream. Three of the four cases reported eating pistachio cream at the same restaurant.

Retailers, restaurants, and distributors that purchased Emek-brand Pistachio Cream with a use-by date of October 19, 2026 (TETT: 19/10/26 (DD/MM/YY)) and production code PNO: 241019 should not serve, sell, or further distribute product. FDA is working to determine where the affected Emek-brand Pistachio Cream was sold in the United States and if other lots or products were impacted.

Cucumbers: As of May 30, 2025, a total of 45 people infected with the outbreak strain of Salmonella have been reported from 18 states. Eight sick people reported taking a cruise during the seven days prior to becoming sick, all departing from locations in Florida. Three people traveled on the same ship. Sick people were aboard 6 different cruise ships that departed the United States between March 30 and April 12. Illnesses started on dates ranging from April 2, 2025, to May 10, 2025. Of the 40 people with information available, 16 have been hospitalized and no deaths have been reported. Alabama 1, California 1, Colorado 1, Florida 6, Georgia 7, Illinois 4, Indiana 1, Kansas 1, Kentucky 1, Massachusetts 1, Michigan 2, North Carolina 3, New York 3, Ohio 4, Pennsylvania 3, South Carolina 2, Tennessee 1 and Virginia 3.

DNA fingerprinting is performed on bacteria using a method called whole genome sequencing (WGS). WGS showed that bacteria from sick people’s samples are closely related genetically. This suggests that people in this outbreak got sick from the same food.

People reported buying and eating cucumbers from a variety of locations including grocery stores, restaurants, hospitals and on cruise ships. FDA’s traceback investigation identified Bedner Growers Inc. as the common grower of cucumbers in this outbreak.

FDA conducted an inspection at Bedner Farm, Inc. in April 2025 as a follow up to a previous outbreak. During their inspection, environmental samples were collected. An environmental sample was identified as the outbreak strain of Salmonella.

As part of this investigation, FDA collected a product sample of Bedner Growers, Inc., cucumbers from a distribution center in Pennsylvania. Salmonella was detected in the sample of cucumbers. Whole Genome Sequencing analysis determined that the product sample contained Salmonella Montevideo, which matched the strain of Salmonella linked to illnesses in this outbreak.

Other types of Salmonella were detected in the cucumber sample collected, originating from Bedner Growers, Inc. In addition to Salmonella Montevideo, multiple other strains of Salmonella, unrelated to this outbreak investigation, matched other isolates in the National Center for Biotechnology Information’s database that occurred in 2025 and previous years. CDC is working to determine if additional human illnesses match these additional strains. Further analysis of the sample is pending.

CDC advises businesses to not sell or serve whole cucumbers grown by Bedner Growers Inc. and distributed by Fresh Start Produce Sales, Inc. between April 29, 2025, and May 19, 2025, while the investigation is ongoing. If you have any whole cucumbers in your home and can’t tell where they are from, throw them out.

In June 2024, the CDC announced a multistate outbreak of salmonellosisassociated with cucumbers. As of August 22, 2024, a total of 551 cases had been reported by 34 states and the District of Columbia. Cases of Salmonella Africana (n=282) and Salmonella Braenderup (n=269) were detected. CDC and FDA combined investigations of these two serotypes as they shared several similarities, including where and when illnesses occurred, the demographics of ill people and the foods they reported eating before they became sick. Illnesses started on dates ranging from March 11, 2024 to July 26, 2024. Of 456 people with information available, 155 were hospitalized. No deaths were reported. FDA’s traceback investigation identified Bedner Growers, Inc. in Florida as one of the suppliers of cucumbers in this outbreak.

Eggs: As of June 5, 2025, a total of 79 people infected with the outbreak strain of Salmonella have been reported from 7 states (Arizona 3, California 63, Kentucky 1, Nebraska 2, New Jersey 2, Nevada 4, Washington 4). Six ill people in Kentucky, New Jersey, and Washington reported traveling to California and Nevada before they got sick. Illnesses started on dates ranging from February 24, 2025 to May 17, 2025. Of the 61 people with information available, 21 have been hospitalized. No deaths have been reported.

State and local public health officials are interviewing people about the foods they ate in the week before they got sick. Of the 30 people interviewed, 27 (90%) reported eating eggs. State health officials identified illness sub-clusters at two restaurants. An illness sub-cluster is a group of unrelated sick people who all ate at the same location or event, such as a restaurant. Investigating sub-clusters can help identify a food item eaten by all the sick people that could be the source of the outbreak. Eggs were served at both sub-cluster locations.

Whole Genome Sequencing (WGS). showed that bacteria from sick people’s samples are closely related genetically. This suggests that people in this outbreak got sick from the same food.

Epidemiologic, laboratory, and traceback data show that eggs distributed by August Egg Company may be contaminated with Salmonella Enteritidis and may be making people sick.

FDA conducted an inspection at August Egg Company’s processing facility and collected samples for testing. Some samples tested positive for Salmonella. WGS showed that the Salmonella in the samples are closely related to Salmonella from sick people.

People reported buying many different brands of eggs from multiple stores. FDA conducted a traceback investigation based on where the ill people reported shopping or eating during the timeframe of interest, and August Egg Company was identified as a common supplier of eggs.

On June 6, 2025, August Egg Company recalled eggs. CDC is advising people not eat, sell, or serve recalled eggs.

According to the FDA, California-based August Egg Company of Hilmar is recalling 1,700,000 dozen brown cage-free and brown certified organic eggs due to potential contamination. A total of 79 people infected with the outbreak strain of Salmonella have been reported from seven states. Illnesses started on dates ranging from February 24, 2025, to May 17, 2025. Twenty-seven of 30 cases with information available reported exposure to eggs or an egg containing dish before becoming ill. There have been 21 hospitalizations, and no deaths have been reported.

Recalled brown cage free eggs and brown certified organic eggs were sold under multiple different brand names at restaurants and retailers. These eggs should no longer be available for sale. Recalled brown cage free eggs and brown certified organic eggs were supplied by August Egg Company, Hilmar, CA.

The recalled eggs have a printed Julian Date between “32” and “126” followed by a plant code number “P-6562” or “CA-5330” on the egg carton or package. The recalled eggs sold at retail stores are packed in fiber or plastic cartons, with the above codes printed on one side of the carton.

Brands the recalled eggs were sold under include: Clover, First Street, Nulaid, O Organics, Marketside, Raleys, Simple Truth, Sun Harvest, and Sunnyside.

Recalled brown cage free eggs and brown certified organic eggs were distributed from February 3, 2025, through May 15, 2025, with sell by dates from March 4, 2025, to June 4, 2025, in California and Nevada to retail locations including Save Mart, FoodMaxx, Lucky, Smart & Final, Safeway, Raleys, Food 4 Less, and Ralphs. 
The eggs were also distributed from February 3, 2025, through May 6, 2025, with sell by dates from March 4, 2025, to June 19, 2025, to Walmart locations in California, Washington, Nevada, Arizona, Wyoming, New Mexico, Nebraska, Indiana, and Illinois.

The recalled eggs have a printed Julian Date between “32” and “126” followed by a plant code number “P-6562” or “CA-5330” on the egg carton or package. The recalled eggs sold at retail stores are packed in fiber or plastic cartons, with the above codes printed on one side of the carton.

Salmonella:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $900 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.  

If you or a family member became ill with a Salmonella infection, including Reactive Arthritis or Irritable bowel syndrome (IBS), after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Salmonella attorneys for a free case evaluation.

Additional Resources:

The FDA and CDC, in collaboration with state and local partners, are investigating illnesses in a multistate outbreak of Salmonella Oranienburg infections linked to Emek-brand Pistachio Cream manufactured by Emek Dogal Saglik Urunleri Iklim Gida Insaat San Tic Ltd Sti in Turkey and imported to wholesale distributors, restaurants, and food service locations in the United States. 

FDA was notified by the Minnesota Department of Health about a cluster of Salmonella illnesses and two Salmonella positive samples of Emek-brand Pistachio Cream product that matched clinical cases by whole genome sequencing (WGS) in this outbreak. As of June 13, 2025, a total of four cases infected with the outbreak strain of Salmonella have been reported from two states. Of the four cases with information available, all four (100%) reported eating pistachio cream. Three of the four cases reported eating pistachio cream at the same restaurant.

Retailers, restaurants, and distributors that purchased Emek-brand Pistachio Cream with a use-by date of October 19, 2026 (TETT: 19/10/26 (DD/MM/YY)) and production code PNO: 241019 should not serve, sell, or further distribute product. FDA is working to determine where the affected Emek-brand Pistachio Cream was sold in the United States and if other lots or products were impacted.

As of May 30, 2025, a total of 45 people infected with the outbreak strain of Salmonella have been reported from 18 states. Eight sick people reported taking a cruise during the seven days prior to becoming sick, all departing from locations in Florida. Three people traveled on the same ship. Sick people were aboard 6 different cruise ships that departed the United States between March 30 and April 12. Illnesses started on dates ranging from April 2, 2025, to May 10, 2025. Of the 40 people with information available, 16 have been hospitalized and no deaths have been reported. Alabama 1, California 1, Colorado 1, Florida 6, Georgia 7, Illinois 4, Indiana 1, Kansas 1, Kentucky 1, Massachusetts 1, Michigan 2, North Carolina 3, New York 3, Ohio 4, Pennsylvania 3, South Carolina 2, Tennessee 1 and Virginia 3.

https://www.marlerblog.com/files/2025/06/Complaint-for-Damages-ED1-L0323225xA1DCA.pdf

DNA fingerprinting is performed on bacteria using a method called whole genome sequencing (WGS). WGS showed that bacteria from sick people’s samples are closely related genetically. This suggests that people in this outbreak got sick from the same food.

People reported buying and eating cucumbers from a variety of locations including grocery stores, restaurants, hospitals and on cruise ships. FDA’s traceback investigation identified Bedner Growers Inc. as the common grower of cucumbers in this outbreak.

FDA conducted an inspection at Bedner Farm, Inc. in April 2025 as a follow up to a previous outbreak. During their inspection, environmental samples were collected. An environmental sample was identified as the outbreak strain of Salmonella.

As part of this investigation, FDA collected a product sample of Bedner Growers, Inc., cucumbers from a distribution center in Pennsylvania. Salmonella was detected in the sample of cucumbers. Whole Genome Sequencing analysis determined that the product sample contained Salmonella Montevideo, which matched the strain of Salmonella linked to illnesses in this outbreak.

Other types of Salmonella were detected in the cucumber sample collected, originating from Bedner Growers, Inc. In addition to Salmonella Montevideo, multiple other strains of Salmonella, unrelated to this outbreak investigation, matched other isolates in the National Center for Biotechnology Information’s database that occurred in 2025 and previous years. CDC is working to determine if additional human illnesses match these additional strains. Further analysis of the sample is pending.

CDC advises businesses to not sell or serve whole cucumbers grown by Bedner Growers Inc. and distributed by Fresh Start Produce Sales, Inc. between April 29, 2025, and May 19, 2025, while the investigation is ongoing. If you have any whole cucumbers in your home and can’t tell where they are from, throw them out.

In June 2024, the CDC announced a multistate outbreak of salmonellosisassociated with cucumbers. As of August 22, 2024, a total of 551 cases had been reported by 34 states and the District of Columbia. Cases of Salmonella Africana (n=282) and Salmonella Braenderup (n=269) were detected. CDC and FDA combined investigations of these two serotypes as they shared several similarities, including where and when illnesses occurred, the demographics of ill people and the foods they reported eating before they became sick. Illnesses started on dates ranging from March 11, 2024 to July 26, 2024. Of 456 people with information available, 155 were hospitalized. No deaths were reported. FDA’s traceback investigation identified Bedner Growers, Inc. in Florida as one of the suppliers of cucumbers in this outbreak.

Salmonella:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $900 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.  

If you or a family member became ill with a Salmonella infection, including Reactive Arthritis or Irritable bowel syndrome (IBS), after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Salmonella attorneys for a free case evaluation.

Additional Resources:

According to the FDA, California-based August Egg Company of Hilmar is recalling 1,700,000 dozen brown cage-free and brown certified organic eggs due to potential contamination. A total of 79 people infected with the outbreak strain of Salmonella have been reported from seven states. Illnesses started on dates ranging from February 24, 2025, to May 17, 2025. Twenty-seven of 30 cases with information available reported exposure to eggs or an egg containing dish before becoming ill. There have been 21 hospitalizations, and no deaths have been reported.

Recalled brown cage free eggs and brown certified organic eggs were sold under multiple different brand names at restaurants and retailers. These eggs should no longer be available for sale. Recalled brown cage free eggs and brown certified organic eggs were supplied by August Egg Company, Hilmar, CA.

The recalled eggs have a printed Julian Date between “32” and “126” followed by a plant code number “P-6562” or “CA-5330” on the egg carton or package. The recalled eggs sold at retail stores are packed in fiber or plastic cartons, with the above codes printed on one side of the carton.

Brands the recalled eggs were sold under include: Clover, First Street, Nulaid, O Organics, Marketside, Raleys, Simple Truth, Sun Harvest, and Sunnyside.

Recalled brown cage free eggs and brown certified organic eggs were distributed from February 3, 2025, through May 15, 2025, with sell by dates from March 4, 2025, to June 4, 2025, in California and Nevada to retail locations including Save Mart, FoodMaxx, Lucky, Smart & Final, Safeway, Raleys, Food 4 Less, and Ralphs. 
The eggs were also distributed from February 3, 2025, through May 6, 2025, with sell by dates from March 4, 2025, to June 19, 2025, to Walmart locations in California, Washington, Nevada, Arizona, Wyoming, New Mexico, Nebraska, Indiana, and Illinois.

The recalled eggs have a printed Julian Date between “32” and “126” followed by a plant code number “P-6562” or “CA-5330” on the egg carton or package. The recalled eggs sold at retail stores are packed in fiber or plastic cartons, with the above codes printed on one side of the carton.


Item Name 		Plant Number Carton UPC 
Clover Large Brown Organic 12 eggs P-6562 or CA-5330 070852010427 
First Street Large Brown Cage Free Loose 1 case=150 eggs P-6562 or CA-5330 041512039638 
Nulaid Medium Brown Cage Free 12 eggs P-6562 or CA-5330 071230021042 
Nulaid Jumbo Brown Cage Free 12 eggs P-6562 or CA-5330 071230021011 
O Organics Cage Free Large Brown  6 eggs P-6562 or CA-5330 079893401522 
O Organics Large Brown  12 eggsP-6562 or CA-5330 079893401508 
O Organics Large Brown 18 eggs P-6562 or CA-5330 079893401546 
Marketside Large Cage Free Brown Organic 12 eggs P-6562 or CA-5330 681131122771 
Marketside Large Cage Free Brown Organic 18 eggs P-6562 or CA-5330 681131122801 
Marketside Large Brown Cage Free 12 eggs P-6562 or CA-5330 681131122764 
Marketside Large Brown Cage Free 18 eggs P-6562 or CA-5330 681131122795 
Raleys Large Brown Cage Free 12 eggs P-6562 or CA-5330 046567033310 
Raleys Large Brown Cage Free 18 eggs P-6562 or CA-5330 046567040325 
Raleys Organic Large Brown Organic 12 eggs  P-6562 or CA-5330 046567028798 
Raleys Organic Large Brown Organic 18 eggs  P-6562 or CA-5330 046567040295 
Simple Truth Medium Brown Cage Free 18 eggs P-6562 or CA-5330 011110099327 
Simple Truth Large Brown Cage Free 18 eggsP-6562 or CA-5330 011110873743 
Sun Harvest Cage Free Large Brown Organic  12 eggs P-6562 or CA-5330 041512131950 
Sun Harvest Cage Free Large Brown Organic  18 eggs P-6562 or CA-5330 041512131950 
Sunnyside Large Brown Cage Free 12 eggs P-6562 or CA-5330 717544211747 
Sunnyside Large Brown Cage Free 18 eggs P-6562 or CA-5330 717544211754 
Sunnyside Cage Free Large Brown Organic 12 eggs P-6562 or CA-5330 717544201441 
Sunnyside Cage Free Large Brown Organic 18 eggs P-6562 or CA-5330 717544211761 
Loose Small Brown Cage Free-1 box= 6 flats (1 flat= 30 eggs) P-6562 or CA-5330 NA 
Loose Medium Brown Cage Free -1 box= 6 flats (1 flat= 30 eggs) P-6562 or CA-5330 NA 
Loose Medium Brown Organic -1 box= 6 flats (1 flat= 30 eggs) P-6562 or CA-5330 NA 
Loose Large Brown Organic -1 box=6 flats(1 flat=30 eggs) P-6562 or CA-5330 NA 
Loose Jumbo Brown Cage Free -1 box=5 flats(1 flat=20 eggs) P-6562 or CA-5330 NA 
Loose Jumbo Brown Organic -1 box=5 flats(1 flat=20 eggs) P-6562 or CA-5330 NA 
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Current E. coli Salmonella Outbreak

As of June 5, 2025, a total of 79 people infected with the outbreak strain of Salmonella have been reported from 7 states (Arizona 3, California 63, Kentucky 1, Nebraska 2, New Jersey 2, Nevada 4, Washington 4). Six ill people in Kentucky, New Jersey, and Washington reported traveling to California and Nevada before they got sick. Illnesses started on dates ranging from February 24, 2025 to May 17, 2025. Of the 61 people with information available, 21 have been hospitalized. No deaths have been reported.

State and local public health officials are interviewing people about the foods they ate in the week before they got sick. Of the 30 people interviewed, 27 (90%) reported eating eggs. State health officials identified illness sub-clusters at two restaurants. An illness sub-cluster is a group of unrelated sick people who all ate at the same location or event, such as a restaurant. Investigating sub-clusters can help identify a food item eaten by all the sick people that could be the source of the outbreak. Eggs were served at both sub-cluster locations.

Whole Genome Sequencing (WGS). showed that bacteria from sick people’s samples are closely related genetically. This suggests that people in this outbreak got sick from the same food.

Epidemiologic, laboratory, and traceback data show that eggs distributed by August Egg Company may be contaminated with Salmonella Enteritidis and may be making people sick.

FDA conducted an inspection at August Egg Company’s processing facility and collected samples for testing. Some samples tested positive for Salmonella. WGS showed that the Salmonella in the samples are closely related to Salmonella from sick people.

People reported buying many different brands of eggs from multiple stores. FDA conducted a traceback investigation based on where the ill people reported shopping or eating during the timeframe of interest, and August Egg Company was identified as a common supplier of eggs.

On June 6, 2025, August Egg Company recalled eggs. CDC is advising people not eat, sell, or serve recalled eggs.

According to the FDA, California-based August Egg Company of Hilmar is recalling 1,700,000 dozen brown cage-free and brown certified organic eggs due to potential contamination. A total of 79 people infected with the outbreak strain of Salmonella have been reported from seven states. Illnesses started on dates ranging from February 24, 2025, to May 17, 2025. Twenty-seven of 30 cases with information available reported exposure to eggs or an egg containing dish before becoming ill. There have been 21 hospitalizations, and no deaths have been reported.

Recalled brown cage free eggs and brown certified organic eggs were sold under multiple different brand names at restaurants and retailers. These eggs should no longer be available for sale. Recalled brown cage free eggs and brown certified organic eggs were supplied by August Egg Company, Hilmar, CA.

The recalled eggs have a printed Julian Date between “32” and “126” followed by a plant code number “P-6562” or “CA-5330” on the egg carton or package. The recalled eggs sold at retail stores are packed in fiber or plastic cartons, with the above codes printed on one side of the carton.

Brands the recalled eggs were sold under include: Clover, First Street, Nulaid, O Organics, Marketside, Raleys, Simple Truth, Sun Harvest, and Sunnyside.

Recalled brown cage free eggs and brown certified organic eggs were distributed from February 3, 2025, through May 15, 2025, with sell by dates from March 4, 2025, to June 4, 2025, in California and Nevada to retail locations including Save Mart, FoodMaxx, Lucky, Smart & Final, Safeway, Raleys, Food 4 Less, and Ralphs. 
The eggs were also distributed from February 3, 2025, through May 6, 2025, with sell by dates from March 4, 2025, to June 19, 2025, to Walmart locations in California, Washington, Nevada, Arizona, Wyoming, New Mexico, Nebraska, Indiana, and Illinois.

The recalled eggs have a printed Julian Date between “32” and “126” followed by a plant code number “P-6562” or “CA-5330” on the egg carton or package. The recalled eggs sold at retail stores are packed in fiber or plastic cartons, with the above codes printed on one side of the carton.

Past Salmonella Egg Outbreaks

In September 2024, CDC announced a multistate outbreak investigation of Salmonella Enteritidis infections associated with eggs. As of October 17, 2024, a total of 93 people infected with the outbreak strain had been reported from 12 states. Illness onset dates ranged from May 23, 2024 to September 13, 2024. Of 87 people with information available, 34 were hospitalized. No deaths were reported. The Wisconsin Department of Agriculture, Trade, and Consumer Protection traced the source of eggs supplied to restaurants where ill people ate before they got sick. Records show that Milo’s Poultry Farms supplied eggs to those restaurants. FDA conducted an inspection at Milo’s Poultry Farms and collected samples. FDA’s analysis showed the outbreak strain of Salmonella was found in the packing facility and the hen egg laying house. On September 6, 2024, Milo’s Poultry Farms recalled eggs. WGS analysis of bacteria from 83 people’s samples and 72 environmental samples were predicted to be not susceptible to ciprofloxacin and were related to a strain of Salmonella Enteritidis that was also isolated from chicken. The outbreak was declared over on October 18, 2024.

In June 2023, California public health officials investigated an outbreak of Salmonella Enteritidis infections associated with eggs served at a restaurant. Fifteen people were ill. Three people were hospitalized. No one died.

In July 2023, public health officials at the Alaska Department of Health investigated an outbreak of Salmonella Enteritidis infections associated with a sit-down dining restaurant. Twenty-four people were ill. One person was hospitalized. No one died. Menu items made with eggs were the implicated vehicles of transmission.

In March 2019 the Nevada Division of Public Health investigated an outbreak of Salmonella Typhimurium infections linked to the Grille at Gold Dust West in Elko, Nevada. Thirty-eight cases were identified. Of these, 29 were laboratory confirmed. Two of these were restaurant employees but they were not implicated as the source of the outbreak. Illnesses occurred between February 27, 2019 and March 16, 2019. Eggs were the suspected contaminated vehicle.

In September 2018 Forty-four people were infected with an indistinguishable strain of Salmonella Enteritidis associated with consuming eggs from Gravel Ridge Farms. Illnesses were reported from 11 states. Illness onsets ranged from May 17, 2018 to August 26, 2018. Twelve people were hospitalized. No one died

On September 8, 2018, Gravel Ridge Farms recalled cage free large eggs because they might be contaminated with Salmonella. Recalled eggs had a “best if used by” dates of July 25, 2018 through October 3, 2018.

In April 2018 the FDA announced a voluntary recall of shell eggs because of the potential for contamination with Salmonella Braenderup. As of April 16, 2018 there were 35 illnesses reported by 9 states: Colorado, Florida, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Virginia and West Virginia. Eleven people had been hospitalized. No deaths were reported. Illness onset dates ranged from November 16, 2017 to April 14, 2018. The affected eggs were from plant number P-1065 with the Julian date range of 011 through date of 102 printed on either the side portion or the principal side of the carton or package, or plant number P-1359D and Julian date 048A or 049A with Best By dates of APR 02 and APR 03.

In February 2017 public health officials in Oklahoma investigated an outbreak of Salmonella Enteritidis among residents at a long-term care facility located in Oklahoma City. Nine people reported symptoms. Six were laboratory confirmed with Salmonella Enteritidis. Two people were hospitalized. One person died. The suspected source of illness was soft, cooked eggs.

In early October 2016 the CDC, the Missouri Department of Health and Senior Services and Department of Agriculture, several states and the FDA announced an outbreak of Salmonella Oranienburg infections linked to consumption of shell eggs distributed by Good Earth Egg Company of Bonne Terre, Missouri as the likely source of infections in the outbreak. As of October 3, 2016 there were 8 people infected with the outbreak strains of Salmonella Oranienburg. Two people were hospitalized. There were no deaths. The first outbreak associated case experienced onset in April 2016. Cases resided in Missouri, Illinois and Kansas. Good Earth Egg Company recalled all its shell eggs because of the potential contamination. Recalled eggs were distributed throughout the Midwest.

Twenty-two people were sickened with Salmonella Enteritidis from raw eggs used in Father’s Day brunch dishes served at Tallulah’s Restaurant in Seattle. One person was hospitalized. No one died. The infections were traced to crab and ham eggs Benedict dishes.

In May 2016 state and local public health officials in Ohio investigated a foodborne illness outbreak among customers of Oak Grove Eatery, a restaurant located in Wooster. A total of 29 ill cases were identified. Seventeen cases were laboratory confirmed with the outbreak strain of Salmonella Enteritidis. One person who was culture positive for Salmonella acquired their infection secondarily through contact with an ill Oak Grove Eatery patron. Two of the ill cases were employees of the restaurant. Seven patients were hospitalized. No one died. A case control study was conducted. Statistical analysis of foods consumed strongly implicated hollandaise sauce as the contaminated food item, (Relative risk 9.47; 95% confidence interval 1.4-4.61, p-value 0.0000095).

What is Salmonella?

There are two Salmonella species: Salmonella enterica (S. enterica) and Salmonella bongori (S. bongori). S. bongoristrains predominantly colonize cold-blooded reptiles, whereas S. enterica strains are capable of infecting both humans and mammals.[1] Based on factors such as morphology, structure, mode of reproduction, and other criteria, the two species are further classified into subgroups called serotypes or serovars. More than 2,600 serotypes have been described for Salmonella, and they are characterized by the type(s) of animal they are found in or by the clinical symptoms they cause.[2] Of these, less than 100 are responsible for most human Salmonella infections.[3]

Salmonellae are widely distributed in nature and are found in the intestinal tract of wild and domesticated animals and in humans. Salmonella poisoning can occur when a person ingests contaminated fecal particles transmitted by another infected human or animal.[4]

Salmonella enterica serotypes Typhi, Sendai, and Paratyphi A, B, or C are found exclusively in humans. These serotypes, collectively referred to as typhoidal Salmonella, cause enteric fever (also known as typhoid or paratyphoid fever if caused by serotypes Typhi or Paratyphi, respectively).[5] Most often, enteric fever is acquired through ingestion of food or water contaminated with human feces. Most U.S. residents who are diagnosed with typhoidal Salmonella are infected while traveling abroad in areas where typhoid fever and paratyphoid fever are common. Three types of vaccines against S. Typhi are commercially available, although there is still not a single licensed vaccine available against S. Paratyphi A.[6]Persons planning to travel outside of the United States are advised to find out if a vaccine for typhoid fever is recommended (see www.cdc.gov/travel).

Most Salmonella infections are caused by eating contaminated food. One study found that 87% of all confirmed cases of Salmonella are foodborne. Foods of animal origin, including meat, poultry, eggs, or dairy products can become contaminated with Salmonella. Eating uncooked or inadequately cooked food—or food cross contaminated with uncooked or undercooked products—can lead to human infections. As explained in a comprehensive report issued by the U.S. Department of Agriculture’s Economic Research Service:

Salmonella contamination occurs in a wide range of animal and plant products. Poultry products and eggs are frequently contaminated with S. Enteritidis, while beef products are commonly contaminated with S.Typhimurium. Other food sources of Salmonella may include raw milk or other dairy products and pork.

In the past two decades, consumption of produce, especially sprouts, tomatoes, fruits, leafy greens, nuts, and nut butters, has been associated with Salmonella illnesses.[7] The surface of fruits and vegetables may be contaminated by human or animal feces. Changes in food consumption and production, as well as the rapid growth of international trade in agricultural products, have facilitated the transmission of Salmonella associated with fresh fruits and vegetables. 

In the United States, Salmonella is the second most isolated bacterial pathogen when laboratory diagnosis of diarrhea is sought.[8] However, passive laboratory surveillance, which uses voluntary reporting by health care providers and facilities, captures only a fraction of illnesses that occur. Furthermore, only a small proportion of illnesses are confirmed by laboratory testing and reported to public health agencies. Thus, researchers rely on quantitative statistical modeling to estimate the incidence of foodborne illness. These estimates are used to direct policy and interventions.

Salmonella infections can produce a broad range of disease, from no symptoms to severe illness. The most common clinical presentation is acute gastroenteritis. Symptoms commonly include diarrhea and abdominal cramps, often accompanied by fever of 100°F to 102°F (38°C to 39°C). More serious infections may also involve bloody diarrhea, vomiting, headache, and body aches.[9]

The incubation period, or the time from ingestion of the bacteria until the symptoms start, is generally 6 to 72 hours; however, there is evidence that in some situations the incubation can be longer than 10 days. People with salmonellosis usually recover without treatment within three to seven days. Nonetheless, Salmonella bacteria can persist in the intestinal tract and stool for many weeks after the resolution of symptoms—on average, one month in adults and longer in children.[10]

S. Typhi and S. Paratyphi can cause systemic illness if they invade the bloodstream (termed “bacteremia”). “Septicemia” or “sepsis” (bloodstream infection or “blood poisoning”) occurs if the bacteria multiply in the blood and cause the immune system to respond by activating inflammatory mechanisms. This may result in the development of “systemic inflammatory response syndrome,” or “SIRS.” SIRS includes tachycardia, tachypnea, fever, and abnormal white blood cell count. When the bacteria involved are S. Typhi or S. Paratyphi, this serious illness is called enteric typhoid, or paratyphoid fever. Symptoms may start gradually and include fever, headache, malaise, lethargy, and abdominal pain. In children, it can present seemingly innocuously as a non-specific fever. The incubation period for S. Typhi is usually 8 to 14 days, but it can range from three to 60 days. For S. Paratyphi infections, the incubation period is like that of nontyphoidal Salmonella—one to 10 days.[11]

Medical treatment is acutely important, though, if the patient becomes severely dehydrated or if the infection spreads from the intestines. Persons with severe diarrhea often require re-hydration, usually with intravenous (IV) fluids. But antibiotics are not necessary or indicated unless the infection spreads from the intestines, at which time the infection can be treated with ampicillin, gentamicin, trimethoprim/sulfamethoxazole, or ciprofloxacin. Unfortunately, though, some Salmonella bacteria have become resistant to antibiotics, largely because of the use of antibiotics to promote the growth of feed animals.[12]

[1]           Hernandez, A. K. C. Salmonella bongori. Poultry and Avian Diseases. Encyclopedia of Agriculture and Food Systems. https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/salmonella-bongori.

[2]           Boore AL, et al. (2015). Salmonella enterica Infections in the United States and Assessment of Coefficients of Variation: A Novel Approach to Identify Epidemiologic Characteristics of Individual Serotypes, 1996–2011. PloS One. 10(12): e0145416

[3]           Besser JM. (2018). Salmonella epidemiology: a whirlwind of change. Food Microbiol. 71:55-9.

[4]           Chiu, C.-H. (2019). Salmonella, Non-Typhoidal Species (S. Choleraesuis, S. Enteritidis, S. Hadar, S. Typhimurium). http://www.antimicrobe.org/b258.asp. 

[5]           Ohad eGal-Mor, Erin C Boyle, & Guntram A. Grassl. (2014). Same species, different diseases: how and why typhoidal and non-typhoidal Salmonella enterica serovars differ. Frontiers in Microbiology, 5. https://doi.org/10.3389/fmicb.2014.00391

[6]           Id.

[7]           National Typhoid and Paratyphoid Fever Surveillance Annual Summary, 2015.” Centers for Disease Control and Prevention, 6 Nov. 2018. Available at: https://www.cdc.gov/typhoid-fever/reports/annual-report-2015.html. 

[8]           “National Enteric Disease Surveillance: Salmonella Annual Report, 2016.” Centers for Disease Control and Prevention, 28 Feb. 2018. Available at: https://www.cdc.gov/nationalsurveillance/pdfs/2016-Salmonella-report-508.pdf. 

[9]           “Salmonella.” Centers for Disease Control and Prevention, 24 Jun. 2020. Available at: https://www.cdc.gov/salmonella/. 

[10]         Id.

[11]         Miller, S. and Pegues, D. “Salmonella Species, Including Salmonella Typhi” in Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, Sixth Edition, Chap. 220, pp. 2636-50 (2005).

[12]         Medalla, F., Gu, W., Mahon, B. E., Judd, M., Folster, J., Griffin, P. M., & Hoekstra, R. M. (2016). Estimated Incidence of Antimicrobial Drug-Resistant Nontyphoidal Salmonella Infections, United States, 2004-2012. Emerging infectious diseases, 23(1), 29–37. https://doi.org/10.3201/eid2301.160771

There are two Salmonella species: Salmonella enterica (S. enterica) and Salmonella bongori (S. bongori). S. bongori strains predominantly colonize cold-blooded reptiles, whereas S. enterica strains are capable of infecting both humans and mammals.[1] Based on factors such as morphology, structure, mode of reproduction, and other criteria, the two species are further classified into subgroups called serotypes or serovars. More than 2,600 serotypes have been described for Salmonella, and they are characterized by the type(s) of animal they are found in or by the clinical symptoms they cause.[2] Of these, less than 100 are responsible for most human Salmonella infections.[3]

  1. Where Does Salmonella Come From?

Salmonellae are widely distributed in nature and are found in the intestinal tract of wild and domesticated animals and in humans. Salmonella poisoning can occur when a person ingests contaminated fecal particles transmitted by another infected human or animal.[4]

Salmonella enterica serotypes Typhi, Sendai, and Paratyphi A, B, or C are found exclusively in humans. These serotypes, collectively referred to as typhoidal Salmonella, cause enteric fever (also known as typhoid or paratyphoid fever if caused by serotypes Typhi or Paratyphi, respectively).[5] Most often, enteric fever is acquired through ingestion of food or water contaminated with human feces. Most U.S. residents who are diagnosed with typhoidal Salmonella are infected while traveling abroad in areas where typhoid fever and paratyphoid fever are common. Three types of vaccines against S. Typhi are commercially available, although there is still not a single licensed vaccine available against S. Paratyphi A.[6] Persons planning to travel outside of the United States are advised to find out if a vaccine for typhoid fever is recommended (see www.cdc.gov/travel). 

Most Salmonella infections are caused by eating contaminated food. One study found that 87% of all confirmed cases of Salmonella are foodborne. Foods of animal origin, including meat, poultry, eggs, or dairy products can become contaminated with Salmonella. Eating uncooked or inadequately cooked food—or food cross contaminated with uncooked or undercooked products—can lead to human infections. As explained in a comprehensive report issued by the U.S. Department of Agriculture’s Economic Research Service:

Salmonella contamination occurs in a wide range of animal and plant products. Poultry products and eggs are frequently contaminated with S. Enteritidis, while beef products are commonly contaminated with S.Typhimurium. Other food sources of Salmonella may include raw milk or other dairy products and pork.

In the past two decades, consumption of produce, especially sprouts, tomatoes, fruits, leafy greens, nuts, and nut butters, has been associated with Salmonella illnesses.[7] The surface of fruits and vegetables may be contaminated by human or animal feces. Changes in food consumption and production, as well as the rapid growth of international trade in agricultural products, have facilitated the transmission of Salmonella associated with fresh fruits and vegetables. 

In the United States, Salmonella is the second most commonly isolated bacterial pathogen when laboratory diagnosis of diarrhea is sought.[8] However, passive laboratory surveillance, which uses voluntary reporting by health care providers and facilities, captures only a fraction of illnesses that actually occur. Furthermore, only a small proportion of illnesses are confirmed by laboratory testing and reported to public health agencies. Thus, researchers rely on quantitative statistical modeling to estimate the incidence of foodborne illness. These estimates are used to direct policy and interventions.

  1. What are the Symptoms of Salmonellosis?

Salmonella infections can produce a broad range of disease, from no symptoms to severe illness. The most common clinical presentation is acute gastroenteritis. Symptoms commonly include diarrhea and abdominal cramps, often accompanied by fever of 100°F to 102°F (38°C to 39°C). More serious infections may also involve bloody diarrhea, vomiting, headache, and body aches.[9]

The incubation period, or the time from ingestion of the bacteria until the symptoms start, is generally 6 to 72 hours; however, there is evidence that in some situations the incubation can be longer than 10 days. People with salmonellosis usually recover without treatment within three to seven days. Nonetheless, Salmonella bacteria can persist in the intestinal tract and stool for many weeks after the resolution of symptoms—on average, one month in adults and longer in children.[10]

  1. Treatment of Salmonellosis

S. Typhi and S. Paratyphi are capable of causing systemic illness if they invade the bloodstream (termed “bacteremia”). “Septicemia” or “sepsis” (bloodstream infection or “blood poisoning”) occurs if the bacteria multiply in the blood and cause the immune system to respond by activating inflammatory mechanisms. This may result in the development of “systemic inflammatory response syndrome,” or “SIRS.” By definition, SIRS includes tachycardia, tachypnea, fever, and abnormal white blood cell count. When the bacteria involved are S. Typhi or S. Paratyphi, this serious illness is called enteric typhoid, or paratyphoid fever. Symptoms may start gradually and include fever, headache, malaise, lethargy, and abdominal pain. In children, it can present seemingly innocuously as a non-specific fever. The incubation period for S. Typhi is usually 8 to 14 days, but it can range from three to 60 days. For S. Paratyphi infections, the incubation period is similar to that of nontyphoidal Salmonella—one to 10 days.[11]

Medical treatment is acutely important, though, if the patient becomes severely dehydrated or if the infection spreads from the intestines. Persons with severe diarrhea often require re-hydration, usually with intravenous (IV) fluids. But antibiotics are not necessary or indicated unless the infection spreads from the intestines, at which time the infection can be treated with ampicillin, gentamicin, trimethoprim/sulfamethoxazole, or ciprofloxacin. Unfortunately, though, some Salmonella bacteria have become resistant to antibiotics, largely as a result of the use of antibiotics to promote the growth of feed animals.[12]

[1]           Hernandez, A. K. C. Salmonella bongori. Poultry and Avian Diseases. Encyclopedia of Agriculture and Food Systems. https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/salmonella-bongori.

[2]           Boore AL, et al. (2015). Salmonella enterica Infections in the United States and Assessment of Coefficients of Variation: A Novel Approach to Identify Epidemiologic Characteristics of Individual Serotypes, 1996–2011. PloS One. 10(12): e0145416

[3]           Besser JM. (2018). Salmonella epidemiology: a whirlwind of change. Food Microbiol. 71:55-9.

[4]           Chiu, C.-H. (2019). Salmonella, Non-Typhoidal Species (S. Choleraesuis, S. Enteritidis, S. Hadar, S. Typhimurium). http://www.antimicrobe.org/b258.asp. 

[5]           Ohad eGal-Mor, Erin C Boyle, & Guntram A. Grassl. (2014). Same species, different diseases: how and why typhoidal and non-typhoidal Salmonella enterica serovars differ. Frontiers in Microbiology, 5. https://doi.org/10.3389/fmicb.2014.00391

[6]           Id.

[7]           National Typhoid and Paratyphoid Fever Surveillance Annual Summary, 2015.” Centers for Disease Control and Prevention, 6 Nov. 2018. Available at: https://www.cdc.gov/typhoid-fever/reports/annual-report-2015.html. 

[8]   National Enteric Disease Surveillance: Salmonella Annual Report, 2016.” Centers for Disease Control and Prevention, 28 Feb. 2018. Available at: https://www.cdc.gov/nationalsurveillance/pdfs/2016-Salmonella-report-508.pdf. 

[9]           “Salmonella.” Centers for Disease Control and Prevention, 24 Jun. 2020. Available at: https://www.cdc.gov/salmonella/. 

[10]         Id.

[11]         Miller, S. and Pegues, D. “Salmonella Species, Including Salmonella Typhi” in Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, Sixth Edition, Chap. 220, pp. 2636-50 (2005).

[12]         Medalla, F., Gu, W., Mahon, B. E., Judd, M., Folster, J., Griffin, P. M., & Hoekstra, R. M. (2016). Estimated Incidence of Antimicrobial Drug-Resistant Nontyphoidal Salmonella Infections, United States, 2004-2012. Emerging infectious diseases, 23(1), 29–37. https://doi.org/10.3201/eid2301.160771