Basics on the food-bourne illness

Ask The Expert // Salmonella

June 19, 2008|By Holly Selby

We've all heard the warning issued by the Centers for Disease Control and Prevention that more than 200 people in the United States have been infected with salmonella after eating raw tomatoes grown in certain areas of the country. Salmonella is a bacterium that typically causes gastrointestinal symptoms such as diarrhea, says Dr. John Cmar, a specialist in infectious disease at Sinai Hospital. The illness typically lasts four to seven days, but in some people, including the very young or old, it can cause death.

What is salmonella?

It is a bacterium that usually lives in the intestinal tracts of some animals or on the surfaces of some animals including ... some reptiles, such as iguanas. It is not associated with human beings and, in fact, when humans are exposed to it, [it] results in an infection.

What are the symptoms?

Usually, the infection causes what we refer to as a GI infection. So people who get it usually have fever, cramps, diarrhea and vomiting, and sometimes the diarrhea can be bloody.

There are many different types of salmonella, including a kind that causes typhoid fever, and sometimes those different types can cause different presentations. With typhoid fever, for example, the patients start with the gastrointestinal symptoms, but those go away, and the dominant symptom is fever.

The Saintpaul type of salmonella that we've been hearing about with tomatoes does cause the gastrointestinal symptoms I've mentioned.

Some of these symptoms are also associated with other illnesses. How do you know when to go to the doctor?

If you consume salmonella, it takes from 12 hours to as long as three days to show up as an infection. If you have symptoms like diarrhea that won't go away, or if you feel that you may have been exposed to salmonella, it is important to go to a doctor. With salmonella, usually the symptoms are severe. And if you have symptoms that are very severe, I wouldn't hesitate to consult your doctor.

How is salmonella treated?

In most cases, the doctor will make sure the patient gets plenty of fluids and will give him supportive care (bed rest, fluids, Tylenol for severe discomfort). But in some cases, the doctor will decide antibiotics will help. But it hasn't been shown in studies that giving antibiotics makes the salmonella infection go away.

Younger children, the elderly and people with problems with their immune systems may be prone to more severe symptoms, and in these cases, the patient can die.

If I suspected a patient had salmonella, I would get a sample of their stool so that we could identify it positively. If it is salmonella, we would pass that information along to the FDA [Food and Drug Administration] and CDC.

Does salmonella have lasting effects?

For the most part, especially with this particular type of salmonella, there is no lasting effect. But some people can be "carriers": The infection can go away but can be carried in their stool, so there is some concern that they can pass it on in their stool. But for the most part, there is no lasting effect.

Sometimes, rarely, people can have the infection enter their bloodstream and that can cause infections in other places in the body separate from the GI tract, and these can cause death. For example, children can get meningitis or older people can get bone infections.

What do you tell your patients diagnosed with salmonella?

I usually tell them to be doubly diligent when washing their hands, because they can spread the disease, and to make sure they are getting plenty of fluids. If they have severe nausea or diarrhea, then I may consider hospitalizing them to give IV fluids.

How can you prevent salmonella?

In this case (of reports that some tomatoes may be contaminated with salmonella), we are talking about concerns about food exposure. So you can go to the CDC Web site to get current reports about which tomatoes are of concern and where they were grown.

Beyond that, the basic recommendations are: Don't buy or eat any tomatoes that look damaged, because the infection may be inside. And keep tomatoes separate from raw meat and poultry.

Always when preparing food, wash your hands thoroughly. Then wash the tomatoes thoroughly. Salmonella is very difficult to wash off, so if you suspect them of being contaminated, throw them away.

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