CDC: Multistate Outbreak of Salmonella Linked to Crested Geckos

 

# 10,057

 

Although they don’t talk with engaging British accents or try to sell you insurance, multi-colored Crested geckos are nonetheless popular pets in the United States, and are found in many pet stores across the nation.  But as we’ve seen with baby chicks (see It Happens Every Spring) and with pet turtles, reptiles can sometime carry and spread Salmonella.

 

This week the CDC has issued a multistate alert due to an outbreak of Salmonella Muenchens,  which appears linked to the handling of pet geckos.  At least 20 people have been affected, although that may be an undercount since not everyone is sickened enough to seek medical care.

 

 

The CDC’s outbreak investigation offers the following advice.

Study: Intra-Continental Spread of Invasive Non-Typhoidal Salmonella

 

 Salmonella typhimurium bacteria – Credit CDC PHIL

 

 

# 6599

 

You might not think there’d be much of a connection between an emergent serotype of Salmonella and the HIV epidemic in Sub-Saharan Africa - but if researchers from the Wellcome Trust Sanger Institute have it right - this highly pathogenic bacterial strain may have had a powerful viral ally.

 

There are more than 2500 serovars of Non-Typhoidal Salmonella (NTS) that can produce gastroenteritis or other infections in humans. Taken together, these Gram negative, anaerobic bacteria are believed to be the second most common source of food poisoning in the United States.

 

Those infected often develop diarrhea, fever, vomiting, and abdominal cramps that may persist for several days.

 

In the western world most recover without treatment, although the CDC estimates that nearly 400 people infected die each year in the United States (Cite  CDC Food borne Illness Estimates).

 

In developing countries, Non-typhoidal Salmonella can (and does) exact a much higher toll, particularly among those who may be malnourished or suffer from chronic ailments such as malaria and HIV.

 

In recent years researchers have also noted a much more virulent form of NTS, spreading across sub-Saharan Africa, that they’ve dubbed  Invasive Non-Typhoidal Salmonella (iNTS). 

 

Not only is it a multi-drug resistant strain, it is fatal in about 25% of those who contract it.

 

Today, we’ve a study that appears in Nature Genetics that links the Intracontinental spread and evolution of this invasive and severe form of Salmonella to the emergence and spread of HIV.

 

Intracontinental spread of human invasive Salmonella Typhimurium pathovariants in sub-Saharan Africa

Chinyere K Okoro,Robert A Kingsley,Thomas R Connor,Simon R Harris,Christopher M Parry,Manar N Al-Mashhadani,Samuel Kariuki,Chisomo L Msefula,Melita A Gordon,Elizabeth de Pinna,John Wain,Robert S Heyderman,Stephen Obaro,Pedro L Alonso,Inacio Mandomando,Calman A MacLennan, Milagritos D Tapia,Myron M Levine,Sharon M Tennant,Julian Parkhill & Gordon Dougan

Published online 30 September 2012

 

While the bulk of the study is behind a pay wall, the Abstract is available, as is this press release from the Wellcome Trust Sanger Institute.

 

New pathogen epidemic identified in sub-Saharan Africa

Researchers track the spread of human invasive non-Typhoidal Salmonella in sub-Saharan Africa

A new study out today (Sunday 30 September) reveals that the emergence and spread of a rapidly evolving invasive intestinal disease, that has a significant mortality rate (up to 45%) in infected people in sub-Saharan Africa, seems to have been potentiated by the HIV epidemic in Africa.

 

The team found that invasive non-Typhoidal Salmonella (iNTS) disease is caused by a new form of the bacteria Salmonella Typhimurium that has spread from two different focal hubs in Southern and Central Africa beginning 52 and 35 years ago, respectively. They also found that one of the major contributing factors for the successful spread of iNTS was the acquisition of genes that afford resistance to several front line drugs used to treat blood-borne infection such as iNTS.

 

iNTS is a blood-borne infection that kills approximately one of four people in sub-Saharan Africa who catch it. Yet, in the rest of the world, NTS is a leading cause of acute inflammatory diarrhoea that is self-limiting and tends to be fatal in less than 1 per cent of people infected. The disease is more severe in sub-Saharan Africa than the rest of the world because of factors such as malnutrition, co-infection with malaria or HIV and potentially the novel genotype of the Salmonella bacteria.

 

"The immune system susceptibility provided by HIV, malaria and malnutrition at a young age, may provide a population in sub-Saharan Africa that is large enough for this detrimental pathogen to enter, adapt, circulate and thrive," says Chinyere Okoro, joint first author from the Wellcome Trust Sanger Institute. "We used whole genome sequencing to define a novel lineage of Salmonella Typhimurium that is causing a previously unrecognised epidemic across the region. Its genetic makeup is evolving into a more typhoid like bacteria, able to efficiently spread around the human body"

 

<SNIP>

 

"There has been some evidence that this disease can be passed from human to human. Now the race is on to discover how NTS is actually transmitted in sub-Saharan Africa so that effective intervention strategies can be implemented."

 

(Continue . . . )

 

 

And for more on all of this, here’s Debra McKenzie’s article for New Scientist.

 

 

HIV could be turning salmonella nastier

 

18:00 30 September 2012 by Debora MacKenzie

 

A nastier kind of salmonella infection has emerged alongside the HIV epidemic in Africa. The finding is the first evidence that HIV might be allowing new human pathogens to evolve in immunosuppressed people.

 

(Continue . . . )

 

That Duck May Look Clean, But . . .

 

 

# 6410

 

The CDC is investigating an outbreak of Salmonella Montevideo involving 66 persons across 20 states linked to the handling of live poultry (baby chicks or ducklings or both) sold via mail-order hatcheries and  agricultural feed stores.

 

You may recall that similar warnings have gone out in the past regarding Human Salmonella Infections Linked to Small Turtles.   Like turtles, poultry can sometimes carry and spread the salmonella bacteria, which makes good hand hygiene particularly important after touching these birds. 

 

In this case, the CDC’s investigation has traced the infected birds to a Hatchery in Springfield, Missouri.  You can read the details at:

 

 

Multistate Outbreak of Human Salmonella Montevideo Infections Linked to Live Poultry

Highlights

• Read the Advice to Consumers »
• A total of 66 persons infected with the outbreak strain of Salmonella Montevideo have been reported from 20 states.
  • The number of ill persons identified in each state is as follows: Alaska (1), California (2), Colorado (1), Georgia (1), Illinois (1), Indiana (8), Iowa (2), Kansas (10), Kentucky (1), Massachusetts (1), Missouri (22), Nebraska (5), Nevada (1), New York (1), North Carolina (1), Ohio (1), Oklahoma (4), South Dakota (1), Vermont (1), and Wyoming (1).
  • 16 ill persons have been hospitalized.  One death was reported in Missouri, but Salmonella infection was not considered a contributing factor in this person’s death.
  • 35% of ill persons are children 10 years of age or younger.
• Epidemiologic, laboratory, and traceback findings have linked this outbreak of human Salmonella infections to contact with chicks, ducklings, and other live baby poultry from Estes Hatchery in Springfield, Missouri.
• Mail-order hatcheries, agricultural feed stores, and others that sell or display chicks, ducklings, and other live poultry should provide health-related information  [PDF - 1 page] to owners and potential purchasers of these birds prior to the point of purchase. This should include information about the risk of acquiring a Salmonella infection from contact with live poultry.

 

 

There are over 2,500 serotypes of Salmonella, and . Salmonella Montevideo ranks among the 10 most common strains.  According to the CDC, the Clinical Features/Signs and Symptoms of infection are:

 

Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12-72 hours after infection. Infection is usually diagnosed by culture of a stool sample. The illness usually lasts from 4 to 7 days. Although most people recover without treatment, severe infections may occur. Infants, elderly persons, and those with weakened immune systems are more likely than others to develop severe illness. When severe infection occurs, Salmonella may spread from the intestines to the bloodstream and then to other body sites and can cause death unless the person is treated promptly with antibiotics.

 

 

For more  information about Salmonella, you may wish to check out the CDC’s Salmonella FAQ.

Referral: McKenna On Drug Resistant Salmonella

 

 

# 5732

 

 

Maryn McKenna, author of Superbug: The Fatal Menace of MRSA and of the Superbug Blog, has posted this evening with fresh details on the dual Salmonella outbreaks I blogged on this morning.

 

She includes breaking news on the recall of 36 million pounds of ground turkey by Cargill Inc. over reports of possible Salmonella contamination.

 

As this is a subject with which she is well acquainted, I would urge you to direct your browser to her site to read:

 

 

Highly Resistant Salmonella: Poultry, Antibiotics, Borders, Risk

• By Maryn McKenna  August 3, 2011  |  

The Global Spread Of Drug Resistant Salmonella

 

 

# 5731

 

 

Salmonella infections – like most infectious diseases – go underreported in the United States and around the world. For many, infection is mild and often brief, and so medical treatment is never sought.

 

Those cases that do end up reported to the CDC usually represent only the tip of the iceberg – or in this case, a pyramid – of the actual number of cases. 

 

Photo Credit CDC

 

Salmonella is believed to be the second most common source of food poisoning, and in the United States alone is estimated to be responsible for more than 1 million illnesses, over 19,000 hospitalizations, and more than 370 deaths every year.

 

(Cite  CDC Food borne Illness Estimates)

 

In recent years we’ve seen outbreaks associated with Peanut butter, Papayas, sprouts, and currently, the CDC is investigation a multi-state outbreak linked to ground turkey.

 

 

This latest outbreak is of a strain known as Salmonella Heidelberg, which the CDC notes “is resistant to many commonly prescribed antibiotics; this antibiotic resistance can increase the risk of hospitalization or possible treatment failure in infected individuals.”

 

 

More than 2500 serotypes of Salmonella have been identified, and nearly all can cause illness in humans. For severe cases of severe Salmonellosis, antibiotics from the fluoroquinolone class - (ie. ciprofloxacin) are the drug of choice.

 

But since the 1990s, doctors have seen a steady rise in antibiotic resistance in a number of Salmonella strains.  This from the World Health Organization.

 

 

Drug-resistant Salmonella

Multidrug-resistant (MDR) strains of Salmonella are now encountered frequently and the rates of multidrug-resistance have increased considerably in recent years. Even worse, some variants of Salmonella have developed multidrug-resistance as an integral part of the genetic material of the organism, and are therefore likely to retain their drug-resistant genes even when antimicrobial drugs are no longer used, a situation where other resistant strains would typically lose their resistance.

 

All of which serves as prelude to a new report in the Journal of Infectious Diseases on the rise, and global spread, of a multi-drug resistant strain of salmonella called S. Kentucky.

 

First a link the article, then I’ll return with more.

 

International Spread of an Epidemic Population of Salmonella enterica Serotype Kentucky ST198 Resistant to Ciprofloxacin

Simon Le Hello, Rene S. Hendriksen, Benoı ˆt Doublet, Ian Fisher,  Eva Møller Nielsen, Jean M. Whichard,Brahim Bouchrif, Kayode Fashae, Sophie A. Granier, Nathalie Jourdan-Da Silva,Axel Cloeckaert, E. John Threlfall, Frederick J. Angulo, Frank M. Aarestrup, John Wain, and Francois-Xavier Weill

National Salmonella surveillance systems from France, England and Wales, Denmark, and the United States identified the recent emergence of multidrug-resistant isolates of Salmonella enterica serotype Kentucky displaying high-level resistance to ciprofloxacin.

(Continue . . . )

 

Salmonella Kentucky was first isolated and described in the 1930s, by the Department of Animal Pathology in Lexington, Kentucky.

 

Although many of the news headlines this morning are portraying this resistant strain as something `new’, this strain has been spreading for nearly a decade.

 

in 2006, the lead author of today’s study published a letter in the CDC’s MMWR  on the emergence of Ciprofloxacin resistant S. Kentucky among French travelers returning from northeast and eastern Africa in 2002.

 

Ciprofloxacin-resistant Salmonella Kentucky in Travelers

François-Xavier Weill,* Sophie Bertrand,† Françoise Guesnier,* Sylvie Baucheron,‡ Patrick A.D. Grimont,* and Axel Cloeckaert‡

What is new is the number of drug-resistant cases, and their geographic spread, over the past few years.  In 2002, there were 3 reported cases. In 2008, 174 cases were identified.

 

The resistant strain has been dubbed the ST198-X1 CIP^R  Kentucky clone  to identify its resistant characteristics, and has been slowly increasing among isolates of Salmonella Kentucky identified in France, England and Wales, and Denmark over the past decade. 

 

Specifically, these researchers found that:

• of the nearly 500 isolates of S. enterica serotype Kentucky tested in France, 200 were drug resistant.
• In England and Wales, roughly 1/3rd have been shown to be resistant.  And in Demark, 45 of 114 isolates are listed as CIP^{R .}
• Thus far, out of 679 S. Kentucky isolates identified in the United States, none have been found to be resistant.

 

This particular strain has been isolated from chickens and turkeys in several African nations (Ethiopia, Morocco, and Nigeria) and in the Middle East.

 

The authors suggest that the common use of fluoroquinolones - including ciprofloxacin - in chicken and turkey production in Nigeria and Morocco may have contributed to this strain’s emergence and spread.

 

All of which highlights the need for better surveillance of our global food supply, and for greater restrictions on the indiscriminate agricultural use of antibiotics.

Salmonella-Related Egg Recall Expands

 

 

 

# 4834

 

 

The shell egg recall over possible Salmonella-related contamination continues to grow, with a 23rd state (Michigan) now involved.  Lisa Schnirring writing for CIDRAP News has the latest, after which I’ll return with some FDA and CDC resources.

 

 

States affected by egg recall grow to 23

Lisa Schnirring Staff Writer

Aug 25, 2010 (CIDRAP News) – Agriculture officials in Michigan said yesterday that eggs connected to the national Salmonella-related recall have been distributed in the state, though it wasn't mentioned in recall notices by the two Iowa companies at the center of the investigation, Wright County Egg and Hillandale Farms.

 

The Michigan Department of Agriculture said in a statement that an ongoing traceback investigation has revealed that some of the companies' customers are distributors and wholesalers that sold the eggs to Michigan customers.

 

Michigan's announcement raises the number of states affected by the recall to 23, according to a review of company recall notices. The two companies have recalled about 500 million eggs. Four smaller companies that repackaged and resold the eggs from the two companies have also issued recalls.

(Continue. . . )

 

 

The FDA maintains a webpage on this recall, and continually adds new resources and links.

 

Recall of Shell Eggs

Updated August 26, 2010

Topics on this page:

• Introduction
• Identifying Recalled Brands and Products
• News Updates
• Consumer Health Information
• Information about Egg Safety and Salmonella
• Investigation into the Salmonella and Shell Egg Outbreak

---

Introduction

An outbreak of Salmonella Enteritidis (SE) that has sickened hundreds of people across the country has led to a recall of shell eggs. On August 13, Wright County Egg voluntarily conducted a nationwide recall of shell eggs on 3 of its 5 farms. Further epidemiologic and traceback information led to Wright County Egg expanding its recall on August 18 to cover all 5 farms and 380 million eggs (according to company figures). The FDA is monitoring the recall, including conducting audit checks at retail stores, wholesalers, and distributors to make sure the recalled shell eggs are being removed from the market. The FDA is in ongoing communications with Wright County Egg to ensure that appropriate preventive measures are put in place to reduce the risk of recurrence.

(Continue . . . )

 

The CDC meanwhile offers some advice on how to limit your chances of contracting Salmonella  Enteritidis from shell eggs on their Tips to Reduce Your Risk of Salmonella from Eggs webpage.

 

What are the specific actions I can take to reduce my risk of a Salmonella Enteritidis infection?

1. Keep eggs refrigerated at ≤ 45° F (≤7° C) at all times.
2. Discard cracked or dirty eggs.
3. Wash hands, cooking utensils, and food preparation surfaces with soap and water after contact with raw eggs.
4. Eggs should be cooked until both the white and the yolk are firm and eaten promptly after cooking.
5. Do not keep eggs warm or at room temperature for more than 2 hours.
6. Refrigerate unused or leftover egg-containing foods promptly.
7. Avoid eating raw eggs.
8. Avoid restaurant dishes made with raw or undercooked, unpasteurized eggs. Restaurants should use pasteurized eggs in any recipe (such as Hollandaise sauce or Caesar salad dressing) that calls for raw eggs.
9. Consumption of raw or undercooked eggs should be avoided, especially by young children, elderly persons, and persons with weakened immune systems or debilitating illness.

Who is most at risk for getting Salmonella Enteritidis?

The elderly, infants, and those with impaired immune systems may have a more severe illness. In these patients, the infection may spread from the intestines to the blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics.

How do I know if I have Salmonella Enteritidis?

A person infected with the Salmonella Enteritidis bacterium usually has fever, abdominal cramps, and diarrhea beginning 12 to 72 hours after consuming a contaminated food or beverage. The illness usually lasts 4 to 7 days, and most persons recover without antibiotic treatment. However, the diarrhea can be severe, and the person may be ill enough to require hospitalization.