The 2018 Salmonella Adelaide Outbreak
As of July 24, 2018, 77 people infected with the outbreak strain of Salmonella Adelaide were reported from nine states – Arkansas 1, Florida 1, Illinois 7, Indiana 14, Kentucky 1, Michigan 39, Missouri 11, Ohio 2, Tennessee 1.
Illnesses started on dates ranging from April 30, 2018, to July 2, 2018. Ill people ranged in age from less than 1 year to 97, with a median age of 67. Among ill people, 67% were female. Out of 70 people with information available, 36 (51%) were hospitalized. No deaths were reported.
Epidemiologic and traceback evidence indicated that pre-cut melon supplied by the Caito Foods, LLC of Indianapolis, Indiana was the likely source of this multistate outbreak.
In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Thirty-six (64%) of 56 people interviewed reported eating pre-cut melon purchased from grocery stores, including cantaloupe, watermelon, or a fruit salad mix with melon. Twelve other people reported eating melon but did not specify whether it was pre-cut.
Information collected from stores where ill people shopped indicated that Caito Foods, LLC supplied pre-cut melon to these stores. On June 8, 2018, Caito Foods, LLC recalled fresh-cut watermelon, honeydew melon, cantaloupe, and fresh-cut fruit medley products containing one of these melons that were produced at the Caito Foods facility in Indianapolis, Indiana.
The 2019 Salmonella Carrau Outbreak
The CDC reported this evening, a multistate investigation which began on April 2, 2019, when PulseNet identified the outbreak. As of April 12, 2019, 93 people infected with the outbreak strain of Salmonella Carrau have been reported from nine states – Alabama 1, Illinois 5, Indiana 18, Kentucky 16, Michigan 19, Minnesota 3, Missouri 3, Ohio 27, Wisconsin 1.
Illnesses started on dates ranging from March 4, 2019, to March 31, 2019. Ill people range in age from less than one to 98 years, with a median age of 53. Fifty-seven percent are female. Of 53 people with information available, 23 (43%) have been hospitalized. No deaths have been reported.
Epidemiologic and traceback evidence indicate that pre-cut melon supplied by Caito Foods LLC of Indianapolis, Indiana is the likely source of this multistate outbreak.
In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Thirty (77%) of 39 people interviewed reported eating pre-cut melons purchased from grocery stores, including pre-cut cantaloupe, watermelon, honeydew, or a fruit salad mix or fruit tray with melon. Four additional people reported eating pre-cut melon outside the home.
Information collected from stores where ill people shopped indicates that Caito Foods LLC supplied pre-cut melon to these stores. On April 12, 2019, Caito Foods, Inc., pre-cut watermelon, honeydew melon, cantaloupe, and pre-cut fruit medley products containing one of these melons produced at the Caito Foods LLC facility in Indianapolis, Indiana.
A Real Impact
Jacob Novero is a 22-year-old man residing with his mother, sister, and younger brother in Fishers, Indiana. He hopes to give back to his community by pursing a Criminal Justice degree at IVY Tech College in order to help troubled juveniles. To help pay for his education, Jacob works security for Live Nation concerts but, unfortunately, was forced to miss multiple days of work in May 2018 due to a Salmonella illness he contracted after eating pre-cut fruit purchased at Wal-Mart.
Jacob recalls the weekend he purchased the fruit in order to prepare a thoughtful meal for his mother:
On May 12 of this year, I went to Walmart to buy my mom a nice Mother’s Day breakfast. The items I purchased included containers of fresh fruit which had pre-cut cantaloupe, honey dew, blueberries, and watermelon in them. No one really wanted the fruit, so I ate quite a bit of it, hoping it wouldn’t spoil. Over the next few days my life changed, and it hasn’t been the same since.
I became sick with what I thought was the stomach flu or some type of bug the next day. My symptoms didn’t clear up as the week went on. I tried to go to work Saturday the 19th for the first concert of the season. I was unable to complete my shift due to being so weak and experiencing diarrhea, and abdominal pain. I came home and continued to feel worse, so I went directly to the emergency room.
Indiana University Methodist Hospital
On May 19, 2018, Jacob presented to Indiana University, Saxony Hospital, where William Wixom, DO evaluated him in the emergency department at 10:45 PM. In triage, Jacob described a two-day history of diarrhea, which had been constant since its onset. It was watery without containing any blood, and it became worse if he tried to eat or drink anything, and he also felt feverish and dizzy. Jacob stated he had a migraine the day before, but that had gone away. He had not been vomiting. He was unable to work the whole day that day and left early, too sick to stay. In response to questions about his exposure history, Jacob stated that he could not think of any sick contacts or suspicious food ingestion. He indicated that he did not have a history of bowel problems.
On exam, Dr. Wixom found Jacob to have a high normal temperature of 99.7ºF, and he had a rapid pulse of 128. His blood pressure was elevated at 153/92. Dr. Wixom noted no other abnormalities and sent blood and urine to the lab for analysis. The lab soon returned results that were unremarkable for anything but a slightly low potassium and sodium. Dr. Wixom administered a bolus of intravenous fluids to treat Jacob for dehydration, adding electrolytes to replete his deficiencies. He also gave Jacob IV promethazine for nausea and IV ketorolac for pain. After a period of observation in the ER, Dr. Wixom deemed Jacob stable enough to continue his convalescence at home, diagnosing him with “acute diarrhea” and “migraine.” He discharged him from the ER with a prescription for loperamide to slow down his diarrhea. Dr. Wixom recommended a follow-up visit with his PCP for his high blood pressure and advised him to try to stay hydrated while he had diarrhea, giving him a handout on gastroenteritis. Jacob was advised to return if he developed worsening symptoms or did not get better.
Return to the IU ER
Unfortunately, Jacob’s symptoms persisted and steadily grew worse, prompting him to return to the ER on May 20, 2018. At 4:27 PM, Manisha Agarwala, MD evaluated him for diarrhea that was now ongoing for three days. It was perhaps even worse, with seven episodes that day alone. He stated that he had not tried taking the Imodium (loperamide) until about half an hour before returning to the ER. Dr. Agarwala observed that Jacob had been in the ER just the night before, and he had been unable to produce a stool specimen while there. His exam was similar to Dr. Wixom’s a few hours earlier, with a continually elevated heart rate, but his blood pressure had normalized. Jacob was finally able to produce a stool sample, which Dr. Agarwala sent to the lab for analysis.  As Jacob’s stool sample was formed, it reduced Dr. Agarwala’s suspicion that he had toxigenic C. difficile ; nevertheless, that test was requested along with an enteric culture. A new set of blood work resulted in unremarkable findings. Jacob was released from the ER with instructions to keep taking Imodium and slowly advance his diet as tolerated.
Community Health Network
In the morning on May 21, 2018, Jacob went to see Aaron Scott Carlisle, MD at Community Health in follow-up of his ER visits and for continuing symptoms. Dr. Carlisle did not have the ER records to review; however, Jacob was able to describe the visits and what had been done so far. He stated he had a fever of 100.9ºF at home during the night, and he began seeing some blood in his stools the day before. He still had diarrhea up to eight times a day, most of which were streaked with blood and mucous. His abdomen was tender to examination that day as well. At this point, Dr. Carlisle suspected that Jacob had diverticulitis and wanted to start him on antibiotics. He chose to start him on oral ciprofloxacin twice daily for ten days, together with metronidazole three times a day for the same duration. In addition, he ordered a CT of Jacob’s abdomen and pelvis. Meanwhile, he wanted him to go back to the ER if he got worse.
Community Hospital North
After seeing Dr. Carlisle, Jacob presented to Community Hospital North at 12:05 PM, where radiologist David M. Kurlander, MD performed an unenhanced CT of his abdomen and pelvis. Dr. Kurlander observed mild, descending colonic wall thickening, but no diverticula. He thought this was consistent with colitis, which could be either infectious, inflammatory, or ischemic. He notified Jacob’s physicians of his findings.
Late that same evening, Jacob returned to the hospital, […]
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