Salmonella: Red or Green?
2008; Lippincott Williams & Wilkins; Volume: 30; Issue: 10 Linguagem: Inglês
10.1097/01.eem.0000338243.34172.5a
ISSN1552-3624
Autores Tópico(s)Identification and Quantification in Food
ResumoNew Mexico, the state with the highest infection rate in the recent Salmonella out-break, has an official state question: red or green? (http://abqstyle.com/albuquerque_living) The query refers to which kind of chile you'd like with your meal. The Centers for Disease Control and Prevention has the same question. Was the Salmonella Saintpaul infection associated with consumption of fresh red tomatoes or varieties of green peppers? Since April, 1368 S. Saintpaul infections were reported in 43 states and the District of Columbia. Several Canadians also became ill after travel to the United States. After New Mexico, Texas has the highest infection rate. The rate of illness is highest in those 20 to 29 and lowest in those 5 to 20 and older than 80. There have been at least 272 hospitalizations and two deaths. The latest reported onset date is July 24, but it takes two to three weeks from illness onset to its report. The rate of illness peaked between May 20 and June 10 when the average number of new infections was 33 per day. Many patients with diarrhea do not have stool cultures, so it is likely that the outbreak is much more extensive than reported. (www.cdc.gov/salmonella/saintpaul) Near the end of July, S. Saintpaul with the outbreak genetic fingerprint was detected in jalapeño peppers grown in Mexico and distributed in the United States. Serrano peppers and agricultural water sampled on a farm that supplied the distribution center in McAllen, TX, were positive for the outbreak strain. FDA lab results confirmed that the out-break originated from both jalapeño and Serrano peppers. Although current tomato crops are clear of Salmonella, they may have contributed to cases earlier in the outbreak because cross-contamination is possible. (www.cdc.gov/salmonella/saintpaul) It may seem unusual that it took more than two months to definitively link an organism with specific food products, but putative causes of an outbreak are detected by trace-back investigations. Foods eaten by ill persons are compared with those eaten by healthy people. Initially, fresh tomatoes, jalapeño peppers, and cilantro were implicated. Then Serrano peppers were added to the list, and cilantro was removed. Fresh tomatoes and peppers are often eaten together in salsa. Limiting the investigation was that people frequently cannot remember what foods they ate. Determining the ingredients of specific food items is even more difficult. When foods are mixed and eaten in the same dish, all items may be statistically linked to illness. During investigations, perishable foods are rarely still available for laboratory testing. This makes tracing suspect items back to growers, processors, and distributors so crucial. In this instance, case-control studies revealed outbreaks associated with consumption of only jalapeño peppers, both jalapeño peppers and tomatoes but not Serrano peppers, and Serrano peppers and tomatoes but not jalapeños. No one food could be associated with all cases. Outbreaks involving more than one food product are rare. (www.cdc.gov/salmonella/saintpaul) There are usually about 40,000 cases of Salmonella reported yearly, which underestimates the total number of cases. About 400 deaths occur yearly. Those under 5 are five times more likely to become infected, and salmonellosis is more common in the summer than winter. (www.cdc.gov/nczved/dfbmd/disease_listing/salmonellosis_gi.html) Treating Salmonella Infection Symptoms of Salmonella infection are typical of those organisms that completely invade the colonic mucosa. Incubation period is one to three days. There is fever, abdominal cramping, and white and red blood cells in the stool. Diarrhea from non-typhoidal strains of Salmonella is usually self-limited, and resolves in four to seven days. Bacteremia is rare, unless the patient is immunocompromised, such as from AIDS, cancer, or connective tissue disease. (Nat Rev Microbiol 2004;2[9]:747.) Reiter's syndrome, conjunctivitis, arthritis, and urethritis occur in a small number of patents. After infection with Salmonella typhimurium (typhoid fever), many patients become chronic carriers, and many people without a history of clinical infection also may be carriers. Diagnosis is by stool culture. Antibiotic treatment is reserved for those with severe illness, immunocompromise, or those prevented from returning to work. Salmonella infection may be treated with fluoroquinolones, but there is increasing drug resistance, mostly from the use of antibiotics to promote growth in food animals. Clinical trials are currently underway to determine efficacy and dosing regimens for azithromycin and gatafloxacin for drug-resistant Salmonella. (Trans R Soc Trop Med Hyg 2004; 98:413.) There is no vaccine. Salmonella contamination may be found in raw or uncooked eggs, poultry, and meat. Raw eggs may not be unrecognized in foods such as homemade salad dressing, ice cream, or cookie dough. Raw or unpasteurized milk also may be contaminated, and Salmonella also has been spread by reptiles such as turtles. In the outbreaks in the past 18 months, the following food items have been implicated: Malt-O-Meal cereals (www.cdc.gov/salmonella/agona), cantaloupes from Honduras (www.cdc.gov/salmonella/litchfield), Banquet brand pot pies (www.cdc.gov/salmonella/4512eyeminus.html), dry pet food (www.cdc.gov/salmonella/schwarzengrund.html), and Peter Pan and Great Value peanut butter (www.cdc.gov/ncidod/dbmd/diseaseinfo/salmonellosis_2007/022707_outbreak_notice.htm). Fresh tomatoes and jalapeño and Serrano peppers are most often found in fresh salsa, pico de gallo, and guacamole, foods that might accompany any meal in New Mexico (goes great with eggs). The most popular bagel flavor in New Mexico after all is green chile cheese (personal communication; my daughter the bagel expert; her summer job requires that she ask, “What flavor cream cheese?”). So it is not surprising that New Mexico leads in the rate of infections involving these products. The answer to the CDC question may be both red and green. This is also the official New Mexico answer, although we say “Christmas.” Tomatoes were implicated, but the ones currently on the market are not contaminated. Jalapeño peppers are currently implicated, and the jury is still out on Serrano peppers. There is a strong epidemiologic associated with tomatoes early in the outbreak, so the role of those tomatoes is still being studied. Jalapeño and Serrano peppers are definitively implicated, but tomatoes currently on the market are safe. Consumers should not eat either pepper raw if it was grown in Mexico. The information here is current as of Aug. 13, 2008, but S. Saintpaul is an active outbreak, so information will undoubtedly be updated. For the most current information, visit www.cdc.gov/salmonella/ saintpaul and www.fda.gov/oc/opacom/hottopics/tomatoes.html
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