Health officials have traced a small outbreak of cholera in Silver Spring to a brand of frozen coconut milk, and ordered stores and restaurants throughout Maryland to get rid of the product.
State Health Secretary Nelson J. Sabatini said yesterday that three people who attended a party on Aug. 16 contracted the disease when they ate a pudding with a coconut milk topping. One of the patients was hospitalized, but all recovered from the potentially fatal disease, he said.
The product is sold under the brand name "Asian Best Frozen Fresh Coconut Milk," which is exported by Jack Hong Co. Ltd. of Bangkok, Thailand. The local distributor, Eastland Food Corp. of Columbia, which shipped the product to stores east of the Mississippi, is telling its customers to pull the coconut milk from the shelves, according to Mr. Sabatini.
Reuters reported yesterday that the food distributor also recalled "Asian Best" frozen coconut candy after samples were found to be contaminated with salmonella bacteria, a germ that can cause severe diarrhea.
Mr. Sabatini said the person who prepared the dessert in Silver Spring reported cooking the topping to the boiling point. Boiling usually kills the cholera bacterium, but he said it is possible that the topping was not cooked long enough.
The health department learned of the cases nine days after the patients got ill, he said. Investigators contacted the patients, asked them what they ate and began testing various foods.
The bacterium was finally isolated in the coconut milk in laboratory tests performed by the U.S. Food and Drug Administration. All six people who attended the party said they ate the dessert.
"About three-fourths of the people who get exposed to cholera can get infected and have no symptoms at all," said Dr. Diane Dwyer, chief health department epidemiologist. "A lot of people might catch it and never know it."
Cholera is a serious infection of the small intestine that produces profuse watery diarrhea that can lead to rapid dehydration and often death. In developing nations, it is often spread through contaminated water and sewage.
The disease is treated by replacing the lost fluids with a solution of water, salts and sugar, and also by giving antibiotics.
The Silver Spring patients became infected with a bacterial strain ordinarily found in Asia -- not the one responsible for an epidemic that has raged across South America, where 300,000 cases have been diagnosed.
"We've tested other brands of frozen coconut milk and have not found the bacterium," Mr. Sabatini said. "Canned coconut products are also not a risk."
So far, no other cholera cases have been reported to the health department. The three cases were the first in Maryland since someone contracted the disease in 1988 by eating raw oysters from the Gulf of Mexico.
Cholera is extremely uncommon in the United States. As of Sept. 7, 17 cases had been reported this year to the federal Centers for Disease Control.