PalMD is a practicing internist in the Great Lakes region of the U.S.. Aside from the great joy he finds in his family and his work, he likes communicating some of that joy to others. He has a special interest in the ways patients---and we are all patients at one time or another---are deceived by charlatans. He aims to change the world, one reader at a time. Previous writings can still be found 
Salmonella is lots of fun. Human infection usually involves fever, abdominal cramping, and diarrhea, which is often bloody. Salmonella infections are reasonably common, especially food-borne outbreaks. It's unknown exactly how many people in the U.S. suffer from salmonellosis each year since many probably never seek medical care or never have a stool culture done. The CDC gets approximately 40K reports of salmonella in the U.S. each year with about 400 deaths (the real case number is estimated to be closer to 1.4 million). Most of these cases are preventable.
There are two large outbreaks currently under investigation by the CDC. The first is a bit odd. It involves frogs.
For the last thirty-five years it has been illegal to sell pet turtles with a shell length of less then 4 inches. This size was rather arbitrarily chosen as being just too darned cute and susceptible to being kissed. The ban has been relatively effective; the CDC estimates that it has prevented around 200K infections since 1975.
But salmonella isn't just for reptiles. The CDC is currently investigating a multi-state outbreak of Salmonella Typhimurium infection traceable to pet frogs. These cute little guys swim around in aquariums filling the water with salmonella. When kids reach in to the water...well, you get the idea. The CDC is now reminding us that amphibians, like reptiles, can make you sick.
The second outbreak is food-related (assuming you don't consider aquatic frogs to be "food"). Nearly 200 people across the country have been confirmed infected with a common strain of salmonella ("Montevideo"). The CDC is on it, though. They talked to thirty-nine sick people and thirty-nine controls and found that the sick people were significantly more likely to have eaten salami, and several of them had eaten salami from a single manufacturer. Because of the strong preliminary data, the company has issued a voluntary food recall.
Many Americans are aware that raw eggs and chicken can be sources of salmonella-related illness and take active steps to avoid cross-contamination in the kitchen. I doubt many Americans put a lot of thought into frogs and salami. In fact, I doubt many Americans have encountered a sentence with the words "frog" and "salami" in them. Until now.
Medicine & Health
Comments
Frog legs are quite tasty! Just make sure to treat them like you would any raw meat and cook properly.
Posted by: Noadi | January 25, 2010 11:43 PM
I had pet turtles, frogs, newts as a kid, ( I was allergic to everything else) and in some 20 years of ownership, never did I or friends EVER get salmonella from them.
Mind you, everyone warned us, and we had a very strictly enforced handwashing after handling policy. it was one of the few conditions I had placed on me on owning them, and by golly I wasn't going to let that slide.
Posted by: Nico | January 25, 2010 11:50 PM
It looks like Daniele Inc. is suspecting that black pepper used to season the sausage may be the source of contamination. From what I've read, the company did not test its black pepper before adding it to products http://bit.ly/77y7qI Black pepper has been associated with Salmonella in the past http://bit.ly/6CHbiX
If true, it is unclear how many other products under different brands the black pepper may have gotten into. Did any other companies purchase the same pepper for other products?
In order to prevent illnesses after an initial vehicle has been identified in outbreaks where ingredients may be the source of contamination, USDA and FDA need to improve the traceability of all foods and their ingredients to ensure that the offending ingredient is identified and all products containing the said ingredient are removed from the market. Whether or not those policy changes can occur in this political climate is questionable, given that many small farmers are opposed to existing food safety reform bills claiming they place an undue burden on small farms, not to mention the rising sentiment against bigger government.
Posted by: SrrAB | January 26, 2010 1:07 AM
We got an automatic phone call recording of the salami recall from our local Costco today since they track member purchases. It's just our purchase was in September and already eaten so January is a bit late for a food poisoning warning. It is nice that they tried to warn us though since most people do not stalk product recall lists.
Posted by: Adela | January 26, 2010 1:56 AM
It looks like I have a lot to learn. I would never have associated any kind of food poisoning risk with black pepper, or with most other such similar seasonings.
Posted by: Donna B. | January 26, 2010 4:49 AM
Remind me not to sit near you and Mark Crislip at dinner.
Posted by: D. C. Sessions | January 26, 2010 7:22 AM
When I was living in The U.P., attending MRU, there was an outbreak at a hotel restaurant which was ultimately traced
to infected lettuce. The lettuce was used in a lot of different dishes as a condiment, as well as cross-contaminating the salad preparation area.
I would have thought the lactobacillus would have acidified the salami enough to rid it of salmonella.
Posted by: TGAP Dad | January 26, 2010 7:57 AM
Some time back, when the local media were making a lot of noise about the dangers of Salmonella, there was a call-in radio program on the subject. They had booked 2 guests. One was in the "we're all going to die" camp, and the other was in the "no big deal" camp. They couldn't be on at the same time because they couldn't agree not to scream at each other.
I remember one caller who said that he must be the luckiest person in the world, because he never took special precautions with chicken, and "never got sick."
The guest who was on when he called was the "we're all going to die" guest, and he said "Well maybe you got Salmonella and didn't realize it. I mean, maybe you got a little sick in your stomach, or a little diarrhea or something..."
The caller then said "You mean all this brouhaha is over something that might make me a little sick to my stomach one day, or give me a little diarrhea?"
My point is, for many if not most people, Salmonella is an inconvenience. Obviously the danger to many others warrants caution in handling foods, but if it were the threat to human life itself that the media likes to portray, we never would have survived the first 150,000 years.
Posted by: BaldApe | January 26, 2010 10:22 AM
@BaldEagle
You make a valid point, Salmonella is usually 3-5 days of diarrhea, cramps, fever, and sometimes vomiting for most people, and it is self-limiting and typically non-fatal.
I think the main message the "we are all going to die" crowd wants to make is not that Salmonella is the most underestimated killer of our time, but that the illnesses are easily preventable with commonsense kitchen techniques.
It's also in the economic interests of food producers to produce safe food (when possible, typically not with Salmonella on raw chicken) given the existing product liability laws in the US. Spending a a few hundred thousand dollars per year on testing and withholding contaminated products will, in the end, save a company from a few $15 million dollar lawsuits if their product is linked to illnesses that do by chance hospitalize, disable, or kill someone.
Posted by: SrrAB | January 26, 2010 10:42 AM
PalMD wrote:
"It's unknown exactly how many people in the U.S. suffer from salmonellosis each year since many probably never seek medical care..."
and
"...abdominal cramping, and diarrhea, which is often bloody."
ummmm...if you're poohin' blood, don't you think you might want to seek medical care?
Posted by: rob | January 26, 2010 12:18 PM
You would think!
It is estimated that 38 cases of Salmonella occur for every one that is reported.(1) Some just suspect they have "stomach flu" (Norovirus) and tough it out. Often those who seek medical treatment are not cultured because foodborne illnesses are commonly self-limiting and do not require antibiotic treatment for most people in most cases.
Just think about that next time you hear about a Salmonella outbreak. There are pretty decent odds that the actual case count, accounting for under-reporting is ~38 times more than you read in the news.
1. Chalker R, Blaser M. A review of human salmonellosis: III. Magnitude of Salmonella infection in the United States. Rev Infect Dis 1988;10:111-24.
Posted by: SrrAB | January 26, 2010 12:43 PM
I had salmonella once. Homeopathy and scientology cured it. I was better in 5 days!
:-P
Posted by: OleanderTea | January 26, 2010 12:59 PM
@TGAP Dad
The suspected source is the non-irradiated black pepper, which is on the outside of the salumi, where the acids and salts can't get to it as easily.
Of course, the product was also pre-sliced, so any contamination on the slicer blades would also spread the Salmonella across the broad surface of the salumi slice.
Guess what I'm working on! yea!
Posted by: Rogue Epidemiologist | January 26, 2010 2:03 PM
Rogue Epidemiologist, I thought it was pastrami (not salami) that has the black pepper on the outside. Most salami I've seen had whole peppercorns in its midst.
Just curious-- I love to learn about food! :) I prefer mine irradiated, btw!
Posted by: Perky Skeptic | January 26, 2010 6:37 PM
Oh, perky, there are so many yummy types of salami. Some day if you are near Ann Arbor, stop by Zingerman's and ask for a taste of each one.
IIRC, there was an outbreak of food borne disease from a California salami ten or fifteen years ago too.
Posted by: PalMD | January 26, 2010 7:50 PM
I had Salmonella two years ago. God, I though I was dying. I ended up going to the emergency room and they admitted me into the hospital and I stayed a day and a half. Of course that was before I know what i now know.
My brother got the same thing at the same time. We ate at the same place, of course. He was sick but his wife is a nurse and she took care of him. I wasn't so fortunate. Here's what I'll do next time. I will be sure to have some charcoal tablets in stock.
Charcoal
Charcoal binds toxins in the digestive tract so that they can be excreted out with the stool. It removes toxic substances from the colon and bloodstream.
Acidophilus
Replaces essential intestinal bacteria.
Colloidal Silver
It has an antimicrobial effect, especially for bacteria. It is a natural antibiotic that destroys viruses, bacteria, and fungi as well as promotes healing.
Ginger
Take 500 mg in capsule form every two hours. Ginger reduces intestinal inflammation and lessens the effects of food poisoning.
General Recommendations
At the first sign of food poisoning take a dropperful of alcohol free Goldenseal. This herb is a natural antibiotic that aids in destroying bacteria in the colon. It also has strong activity against a variety of bacteria such as E. Coli. NOTE: Do not take for more than one week at a time!
Red Clover aids in blood cleansing
At the first sign of food poisoning take 5 charcoal pills, and take 5 more six hours later separately from other supplements.
Vomiting and diarrhea can cause serious dehydration. Replace lost fluids and electrolytes with clean water or other drinks designed for rehydration such as Gatoraid, etc.
Fiber supplements such as Oat Bran, Phylum Husks, etc. as well as colon cleanse supplements removes bacteria that have attached themselves to the colon walls, and prevents them from entering the bloodstream. These supplements help speed full recovery and reduce symptoms.
Other Products
Aerobic Life Industries Aerobic 07 (This supplement destroys Salmonella)
http://www.aerobiclife.com/products/frm_o7_aero_o7.html
Posted by: Doctor I.M. A. Smartone | January 26, 2010 10:01 PM
Anyone here ever heard of Charcoal tablets, ginger, colloidal silver and such?
Charcoal
Charcoal binds toxins in the digestive tract so that they can be excreted out with the stool. It removes toxic substances from the colon and bloodstream.
Potassium
Restores proper electrolyte balance lost due to vomiting.
Colloidal Silver
It has an antimicrobial effect, especially for bacteria. It is a natural antibiotic that destroys viruses, bacteria, and fungi as well as promotes healing.
Ginger
Take 500 mg in capsule form every two hours. Ginger reduces intestinal inflammation and lessens the effects of food poisoning.
General Recommendations
At the first sign of food poisoning take a dropperful of alcohol free Goldenseal. This herb is a natural antibiotic that aids in destroying bacteria in the colon. It also has strong activity against a variety of bacteria such as E. Coli. NOTE: Do not take for more than one week at a time!
Red Clover aids in blood cleansing
At the first sign of food poisoning take 5 charcoal pills, and take 5 more six hours later separately from other supplements.
Vomiting and diarrhea can cause serious dehydration. Replace lost fluids and electrolytes with clean water or other drinks designed for rehydration such as Gatoraid, etc.
Fiber supplements such as Oat Bran, Phylum Husks, etc. as well as colon cleanse supplements removes bacteria that have attached themselves to the colon walls, and prevents them from entering the bloodstream. These supplements help speed full recovery and reduce symptoms.
Other Products
Aerobic Life Industries Aerobic 07 (This supplement destroys Salmonella)
Posted by: Mr. Doctor | January 26, 2010 10:07 PM
You might want to look up how many rat turds are allowed in a pound of peppercorns. (It's a little terrifying how many rat turds are allowed in everything -- that black-bean burrito you're eating probably has one or two rat turds in it.) My wife's father was involved in designing a machine to separate rat turds from peppercorns (corns in bin A, turds in bin B), 'cause they look almost alike, but have slightly different physical properties. Picking the turds out by hand is something everybody gave up on early.
Posted by: Nathan Myers | January 26, 2010 10:20 PM
PalMD,
Whatever happened to your White Coat Underground forum? I cannot find it anywhere.
Posted by: Hecklel | January 27, 2010 2:23 AM
So if only about 1 in 38 cases are reported, does that mean that the bloody stools & other serious symptoms are (relatively) rare -- because most of the people who get the milder version just don't go to the doctor?
Posted by: intercostalwaterway | January 27, 2010 5:16 AM
@PAL-- Oooooooooh, a deli with a SALAMI-TASTING??? That's better than a wine-tasting IMO! :) :) :)
@Nathan Myers-- But would irradiated rat turds add a bold new flavor without the bacteria? :D
Per the unreported cases, there are so many different possible causes of stomach-upset-with diarrhea that it doesn't surprise me many people would just tough it out thinking it's a stomach virus when they might in fact have encountered Salmonella.
Posted by: Perky Skeptic | January 27, 2010 10:30 AM
I suspect there's also a problem where if people are that sick, they don't want to leave the house and spend a chunk of time in their doctor's waiting room (or that of an urgent care clinic or ER), especially if they expect to be told "rest and get plenty of fluids, diluted gatorade is good." If you expect to have to run to the bathroom at any moment, you probably don't want to be driving somewhere, much less waiting for a bus.
That's the time and comfort issue: Add in that a significant number of the people getting salmonella will be uninsured, and that even a copay can be a problem for some people, especially if they've just lost a couple of days' pay because they don't get paid sick time or have none left.
Both of those will tend to keep people from going to the doctor with things that don't last too long.
Posted by: Vicki | January 27, 2010 12:19 PM
From what I understand, (I'm not an MD) bloody stools are much more common during infections with Enterohemorrhagic E. coli (O157:H7 and other Shiga-Toxin producing E. coli). Of course, Salmonella is capable of causing bloody stools in some people depending on the serovar, but as far as foodborne pathogens, E. coli O157 is most likely to cause this symptom.
For more info on why only 1 in 38 cases of Salmonella (and 1 in 20 cases of E. coli O157) are reported to State and Local Health Agencies you could study this CDC resource.
http://www.cdc.gov/foodnet/surveillance_pages/burden_pyramid.htm
Posted by: SrrAB | January 27, 2010 4:24 PM
@BaldApe: For the most part I agree with you... It was actually an FDA publication telling people how dangerous raw eggs were that convinced me NOT to worry about raw eggs until I am elderly or unless I became immuno-suppressed for some reason.
One thing that was a bit of a reality check though... 11 months ago I became a dad, and of course I don't want to risk an infant getting contaminated! But I had already gotten in the habit of being fairly blase about kitchen practices (it's not like I'm using the same cutting board for raw chicken and for veggies or anything, but e.g. I wasn't super concerned about maybe spilling a little bit of raw egg on the counter here and there) and it took a little bit of time to re-train myself. So I suppose one could make an argument in favor of being uber-paranoid all the time, just as a good habit.
But yeah, as a healthy adult, using FDA-published data I estimated that I could eat a raw egg every single day for the next 50 years and only have one instance of food poisoning. Not that worried...
Posted by: James Sweet | February 1, 2010 1:24 PM