Mespo,

In reading the article, the distinction of a step up from a Rocephin drip (cephalosporin) to a fluoroquinolone (Cipro etc) may not have been clear with the addition of the word ‘and’ in the aricle.

As you may well already know, salmonella re-infection is not uncommon after antibiotic treatment, which is one reason why, when possible, it’s preferable to let the body take care of it, naturally, in all it’s crampy, runny, and feverish unpleasantness, and to avoid dehydration…

Thanks for the support and the info. I am meeting with co-counsel this week to determine the nature and extent of the injury and if there are any lasting effects from the consuming the tainted food. And Buddha I agree, that Patty C is a formidable researcher who speaks softly but carries a big beaker.

You do indeed swing a mean beaker!

mespo,

I’d wish you luck at trial, but I am thinking luck isn’t so much a factor in your litigation practice. Give ‘em Hell!

To our regulars:

I’ve been a little remiss in posting but I have been investigating and signing up my first Peanut Corporation of America food poisoning case this week. It involves a minor who was allegedly sickened by crackers containing peanut butter tainted with Salmonella Typhimurium. Once discovery gets going I will provide any non-privileged information about the outbreak and the case that the rules of ethics permit.

—-

mespo, you’re the Peanuttiest! ;P
As I was looking through Medline for journal articles re nut allergy, I noticed all the recent news items from Reuters on PCA. Unfortunately, I’m prohibited from providing them online.

Peanuts are legumes – not nuts at all. And children are more likely to outgrow their nut allergies than they are their allergy to peanuts!

Here’s a couple of things for your PCA file. If I see anything interesting, I’ll pass it along.

———-
FDA form 483 (Inspectional Observations: Peanut Corporation of America
http://www.fda.gov/ora/frequent/default.htm

ORA Electronic Reading Room
• Peanut Corporation of America (PCA), Blakely, GA:
◦ Amended FDA Form 483 (Inspectional Observations) Jan 9 – Feb 5, 2009 [PDF] (8 pages, 742 KB.)
◦ FDA Form 483 (Inspectional Observations) Jan 9 – 27, 2009 [PDF] (6 pages, 441 KB.)

——–

Nearly 400 People in 42 States Affected in Salmonella typhimurium Outbreak

Neil Osterweil
Information from Industry

Assess clinically focused product information on Medscape.

Click Here for Product Infosites – Information from Industry.

January 8, 2009 — At least 388 people in 42 states have been sickened in an outbreak of Salmonella typhimurium, resulting in at least 70 hospitalizations, the Centers for Disease Control and Prevention (CDC) reports. The source of the outbreak is unknown.

The CDC has not specified which states have been affected in the current outbreak, but the Ohio Department of Health issued a press release on January 6 stating that 50 cases, confirmed by DNA fingerprinting, have been reported, dating back to October 2008. The incidence rate is the second-highest in the nation, the Ohio Department of Health says.

“We’re not contradicting what Ohio is saying,” CDC spokeswoman Lola Russell told Medscape Medical News.

Salmonellosis cases traced to the current outbreak have also been reported in California, Michigan, Arizona, and Texas, according to news agencies.

The typhimurium serotype of Salmonella, the most common cause of salmonellosis in the United States, is commonly found in poultry, raw (unpasteurized) dairy products, produce, and small animals such as reptiles often kept as household pets.

In 2007, Salmonella typhimurium was responsible for 401 cases of salmonellosis in 41 states, in an outbreak traced to consumption of frozen pot pies that had not been fully cooked by consumers, and smaller outbreaks were reported among people who consumed raw milk.

Symptoms and Treatment

Salmonellosis can affect patients of all ages, although the elderly, infants, and those with compromised immunity are at highest risk for severe illness.

Most people infected with enteric Salmonella strains will develop diarrhea, fever, and abdominal cramping within 12 to 72 hours. Salmonellosis is generally self-limiting, lasting 4 to 7 days, and most people who are infected will recover without treatment, although fluid support/replacement may be necessary for cases of severe diarrhea. Some patients may require hospitalization.

The CDC notes that the primary goal of treating Salmonella gastroenteritis is fluid and electrolyte replenishment to counteract depletion and possible imbalance. Antimotility therapies (eg, loperamide, diphenoxylate, paregoric) should not be given if the patient has bloody or mucous stools, and they should not be given to elderly patients at risk for ileus, toxic megacolon, or perforation.

Although uncommon, Salmonella bacteremia can be a serious (although rarely fatal) complication of infection. It requires treatment with intravenous antibiotics, said David R. Syndman, MD, chief of the Division of Geographic Medicine and Infectious Diseases and hospital epidemiologist at Tufts Medical Center in Boston, Massachusetts, in an interview with Medscape Medical News in June 2008.

“The lab would test for susceptibility [of the isolate], but generally you would treat people who have it with intravenous antibiotics, either ceftriaxone, or ciprofloxacin, or levofloxacin,” and if the cephalosporins fail, a quinolone category antibiotic would be the next agent of choice, Dr. Syndman said.

“The debate is whether you should treat people who just have diarrhea with fever — if it’s GI disease only, a lot of patients don’t need to be treated; it’s only if they’re immunocompromised or are over the age of 50, have known prosthetic material or an aortic aneurysm that could be seeded, then you would treat those people as well,” he added.

In recent years, several multidrug resistant variants of Salmonella typhimurium have developed, due to selection pressures from widespread use of antibiotics in veterinary clinics and in animals raised for food, the CDC reports.

Incidence and Prevention

About 40,000 cases of salmonellosis are reported in the United States annually, and it is estimated that the actual number of cases may be up to 30-fold higher, because infections are often not reported and because the symptoms are nonspecific and may be mistaken for other bacterial or viral infections.

In a joint briefing with the Food and Drug Administration in June 2008, Ian Williams, PhD, chief of the CDC’s OutbreakNet Team, advised clinicians to watch for cases of foodborne illness and to report any suspected cases of Salmonella infection to local and/or state health authorities, who will then culture samples and report positive results to the CDC.

With this outbreak, the CDC reminded clinicians of advice to give patients about avoiding salmonellosis:

• Cook poultry, ground beef, and eggs thoroughly. Do not eat or drink foods containing raw eggs or raw (unpasteurized) milk.
• If you are served undercooked meat, poultry, or eggs in a restaurant, send it back to the kitchen for further cooking.
• Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with raw meat or poultry.
• Be particularly careful with foods prepared for infants, the elderly, and the immunocompromised.
• Wash hands with soap after handling reptiles, birds, or baby chicks, and after contact with pet feces.
• Avoid direct or even indirect contact between reptiles (turtles, iguanas, other lizards, snakes) and infants or immunocompromised people.
• Do not work with raw poultry or meat and an infant (eg, feed, change diaper) at the same time.
• Mother’s milk is the safest food for young infants. Breast-feeding prevents salmonellosis and many other health problems.

Related Links

Resource Centers

Emerging and Reemerging Infectious Diseases

External Links

FDA Web Page on Salmonella and Peanut Butter

Neil Osterweil is a freelance writer for Medscape.

Medscape Medical News 2009. © 2009 Medscape

Send press releases and comments to news@medscape.net.

That was in NO way intended as a slight to your vast empirical and research skills, my friend. Merely that if you could swing that big a stick, watch out for the woman with the beaker!

Mespo: I hope the young one has recovered and with your help will recover; Good Luck with your case!

“And mespo’s not even the trained scientist of the group . . .”

**********

Exactly, as in most things non-metaphysical, I defer to Patty C.

I’ve been a little remiss in posting but I have been investigating and signing up my first Peanut Corporation of America food poisoning case this week. It involves a minor who was allegedly sickened by crackers containing peanut butter tainted with Salmonella Typhimurium. Once discovery gets going I will provide any non-privileged information about the outbreak and the case that the rules of ethics permit.

http://www.huffingtonpost.com/2009/02/17/cnns-zain-verjee-loves-pe_n_167541.html

Someone’s slip is showing . . .

“My son is allergic to bees — he really would die if stung — so should I make sure that bees are banned? No, he carries an epi pen”

*************

Wonder how’d you react if the airlines decide to install honey bee hives in airports for aesthetic purposes. That buzzing sound is very soothing you know. Still so cavalier about child safety when no good reason exists for the threat to be there?

p.s. mespo, I’m not sure where that 2% number came from
- or, dare I say, if it’s accurate… ;P

National Center for Chronic Disease Prevention and Health Promotion

Food Allergies

http://www.cdc.gov/healthyyouth/foodallergies/

“Food allergy is an abnormal immune response to certain food(s) that the body reacts to as harmful. Estimates of the prevalence of food allergies range from approximately 4% to 8% of children and 2% of adults.1,2 Though reasons for this are poorly understood, the prevalence of food allergies and associated anaphylaxis appears to be on the rise…”

Duke University did a desensitization study in which 8 kids with peanut allergy were given escalating does of peanut protein mixed with applesauce. After 18 months, these kids could tolerate the equivalent of 13 peanuts.

And there are non-allergenic peanuts being developed.

Come on — this is way overblown.

Mrs. Blumenstein: This year’s topic
is `Resolved: The national speed
limit should be lowered to
55 miles per hour.’

Homer: 55? That’s ridiculous!
Sure, it’ll save a few lives,
but millions will be late!

“These peanut allergies are generally mild and very manageable without inconveniencing the vast majority of people who do not have them. And, this allergy frequently goes away over time. So there is no need to feed this illogical crapola.”

******************

Sorry but the experts who study this don’t agree with you:

Experts estimate food allergy occurs in 6 to 8 percent of children 4 years of age or under, and in 4 percent of adults. [15, 20] Approximately 150 Americans, usually adolescents and young adults, die annually from food-induced anaphylaxis.

-Bock SA, Munoz-Furlong A, and Sampson, HA. “Fatalities Due to Anaphylactic Reaction to Foods.” Journal of Allergy and Clinical Immunology 107: 191-193. 2001.

Peanut or tree nut allergies affect approximately 0.6 percent and 0.4 percent of Americans, respectively, and cause the most severe food-induced allergic reactions.

–Sicherer SH, Munoz-Furlong A, and Sampson HA. “Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: A 5-year follow-up study.” Journal of Allergy and Clinical Immunology 112(6):1203-1207. 2003.

Ever seen a kid in anaphylaxis shock? I have. As for “whatever should [you] do”, how about not minimizing adults or children with potentially fatal allergies.

Just as I thought, you don’t have a clue. An opinion, but nothing else.

Prove it.

And while you are at it, prove that there are not contaminated products in that pipe.

Allergies are only part of the need for peanut caution.

Just because YOU are not affected doesn’t make it “unscientific hysteria” or “illogical crapola”. It just means you are not affected. And a sample space of one IS scientifically crap.

So prove it. You know, scientifically. With facts. It’s an exercise doomed to fail, but I’d love to see you try. Be warned there is a Harvard medical researcher lurking here somewhere, so check your work.