Lots of news about Salmonella infecting a Georgia Peanut butter plant, leading to recalls of several popular brands and perhaps a hundred cases of Salmonella.

LINK and LINK have some details.

Now, there is not a lot of Salmonella around. We see outbreaks on and off, and usually the people with it are with diarrhea but often quite sick, with bloody BM and high temperatures.

About 40,000 people a year are diagnosed with it, and about 600 a year die from it.

However, it’s been twenty years since I saw a case.

Usually the patient comes in sick: throwing up, fever, and diarrhea. Often they are sick enough to put in the hospital, and often you see bloody BM which is very scary. They are sick 5 to seven days. Probably a lot of mild cases never get diagnosed, because we don’t always culture the BM to see what is causing diarrhea, since most cases are from viruses.

Salmonella is one of the problems with those big egg factories that the PETA types get excited over. Disease spreads through the chicken farm, and raw eggs can spread it to normal people. That’s why for years there has been a rule to eliminate “sunny side up” eggs.

It is also found in other animals. I had one patient, a little girl, who got it from her pet turtle, back when you could still buy tiny turtles as pets.

LINK is to an article with all the medical information.

In ordinary forms of salmonella, you don’t treat with antibiotics, since they don’t really make you better faster, and treating just makes it more likely you can become a carrier. After an infection, you continue to “shed” the bacteria for four to six weeks, but if you get antibiotics, it can last longer. But antibiotics are used for complicated cases, such as the old, the young, and with sickle cell disease, where it can for some reason infect bones (a nasty infection called osteomyelitis).

The dirty little secret about salmonella is that it’s spread not only through uncooked food, but through the finger/feces root. Chickens, of course, are dirty animals, so those who have chicken farms have to keep the coops clean and watch for sick animals and destroy them aggressively. Cooking eggs and washing chicken and disinfecting the surfaces where you prepared the chickens needs to be done carefully to prevent the spread through poultry.

But where did the contamination come in peanuts? Especially since Peanuts have to be roasted, canning requires high temperatures and sterile jars.

So there will have to be an investigation of the entire factory, and it’s cleaning techniques.

But there is another way to get the food poisoning: dirty fingers. A carrier can spread it if he or she does not wash their hands carefully after using the rest room. Did you ever hear of Typhoid Mary? Well, typhoid is a severe version of Salmonella, and Mary was a cook who carried it, and refused to stop cooking. So one of the things that will have to be investigated is if there is a carrier among those who handled the peanuts during their processing.

Finally, in these days of bioterror, that also has to be considered, although it is unlikely. Typhoid might be a good WMD, but ordinary salmonella is just too wimpy to be of much use as a weapon, unless one is like that nutty commune in Oregon who contaminated the salad bar to win an election.

But until the reason is found, a lot of peanut butter is going to be thrown out.

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Nancy Reyes is a retired physician who lives in the rural Philippines with her husband. Her webpage is Finest Kind Clinic and Fishmarket, and she posts medical essays to Hey Doc Xanga Blog

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