Bi-national outbreak of Salmonella Newport infections linked to onions: the United States experience.

From 2016-2019, dry bulb onions were the suspected cause of three multistate outbreaks in the United States. We investigated a large multistate outbreak of Salmonella Newport infections that caused illnesses in both the United States and Canada in 2020. Epidemiologic, laboratory and traceback investigations were conducted to determine the source of the infections, and data were shared among U.S. and Canadian public health officials. We identified 1127 U.S. illnesses from 48 states with illness onset dates ranging from 19 June to 11 September 2020. Sixty-six per cent of ill people reported consuming red onions in the week before illness onset. Thirty-five illness sub-clusters were identified during the investigation and seventy-four per cent of sub-clusters served red onions to customers during the exposure period. Traceback for the source of onions in illness sub-clusters identified a common onion grower in Bakersfield, CA as the source of red onions, and onions were recalled at this time. Although other strains of Salmonella Newport were identified in environmental samples collected at the Bakersfield, CA grower, extensive environmental and product testing did not yield the outbreak strain. This was the third largest U.S. foodborne Salmonella outbreak in the last 30 years. It is the first U.S. multistate outbreak with a confirmed link to dry bulb onions, and it was nearly 10-fold larger than prior outbreaks with a suspected link to onions. This outbreak is notable for its size and scope, as well as the international data sharing that led to implication of red onions as the primary cause of the outbreak. Although an environmental assessment at the grower identified several factors that likely contributed to the outbreak, no main reason was identified. The expedient identification of the outbreak vehicle and response of multiple public health agencies allowed for recall and removal of product from the marketplace, and rapid messaging to both the public and industry on actions to protect consumers; these features contributed to a decrease in cases and expeditious conclusion of the outbreak.

Multistate outbreak of Salmonella Paratyphi B variant L(+) tartrate(+) and Salmonella Weltevreden infections linked to imported frozen raw tuna: USA, March-July 2015.

Foodborne non-typhoidal salmonellosis causes approximately 1 million illnesses annually in the USA. In April 2015, we investigated a multistate outbreak of 65 Salmonella Paratyphi B variant L(+) tartrate(+) infections associated with frozen raw tuna imported from Indonesia, which was consumed raw in sushi. Forty-six (92%) of 50 case-patients interviewed ate sushi during the week before illness onset, and 44 (98%) of 45 who specified ate sushi containing raw tuna. Two outbreak strains were isolated from the samples of frozen raw tuna. Traceback identified a single importer as a common source of tuna consumed by case-patients; this importer issued three voluntary recalls of tuna sourced from one Indonesian processor. Four Salmonella Weltevreden infections were also linked to this outbreak. Whole-genome sequencing was useful in establishing a link between Salmonella isolated from ill people and tuna. This outbreak highlights the continuing foodborne illness risk associated with raw seafood consumption, the importance of processing seafood in a manner that minimises contamination with pathogenic microorganisms and the continuing need to ensure imported foods are safe to eat. People at higher risk for foodborne illness should not consume undercooked animal products, such as raw seafood.

International outbreak of multiple Salmonella serotype infections linked to sprouted chia seed powder - USA and Canada, 2013-2014.

Salmonella is a leading cause of bacterial foodborne illness. We report the collaborative investigative efforts of US and Canadian public health officials during the 2013-2014 international outbreak of multiple Salmonella serotype infections linked to sprouted chia seed powder. The investigation included open-ended interviews of ill persons, traceback, product testing, facility inspections, and trace forward. Ninety-four persons infected with outbreak strains from 16 states and four provinces were identified; 21% were hospitalized and none died. Fifty-four (96%) of 56 persons who consumed chia seed powder, reported 13 different brands that traced back to a single Canadian firm, distributed by four US and eight Canadian companies. Laboratory testing yielded outbreak strains from leftover and intact product. Contaminated product was recalled. Although chia seed powder is a novel outbreak vehicle, sprouted seeds are recognized as an important cause of foodborne illness; firms should follow available guidance to reduce the risk of bacterial contamination during sprouting.

Ampicillin-specific rashes.

Ampicillin is one of the most common drugs to elicit a rash, with an overall incidence of 3% to 8%. "Ampicillin-specific" rashes are thought to be nonhypersensitivity reactions and cause maculopapular erythema with minimal irritation or pruritus. If the rash is indeed an ampicillin-specific one, then discontinuation of ampicillin is not mandatory, and subsequent use of ampicillin or other beta-lactam antibiotics is tolerated. On the other hand, true hypersensitivity reactions with urticarial and anaphylactic properties demand prompt discontinuation of the drug and warrant supportive care. Unfortunately, there is no immediate definitive scientific method to differentiate between the two.

Paresthesias: a practical diagnostic approach.

Paresthesias may be caused by central or peripheral nervous system abnormalities. Central nervous system-induced paresthesias are most commonly caused by ischemia, structural or compressive phenomena, infection, inflammation or degenerative conditions. Peripherally induced paresthesias can be caused by entrapment syndromes, metabolic disturbances, trauma, inflammation, connective tissue diseases, toxins, hereditary conditions, malignancies, nutritional deficiencies and miscellaneous conditions. Confirming the diagnosis and establishing an etiology may require appropriate laboratory and radiologic studies, or other studies. In most cases, the specific clinical syndromes associated with the paresthesias, coupled with the presenting neurologic findings, provide the physician with a framework for the diagnosis.

Secondary hypertension: a practical diagnostic approach.

Secondary hypertension is a relatively uncommon, potentially reversible condition for which physicians should maintain a high index of suspicion. When a patient is found to have elevated blood pressure, a through history should be obtained and a complete physical examination should be performed. Depending on the findings, additional screening and diagnostic studies may be necessary. The most common causes of secondary hypertension are renal parenchymal disease, renovascular disease, coarctation of the aorta, pheochromocytoma, primary hyperaldosteronism, thyroid dysfunction and Cushing's syndrome.

Evaluation of primary care residents' knowledge of pharmacotherapy.

BACKGROUND: The study objective was to determine primary care residents' knowledge of pharmacotherapy. METHODS: Eighty primary care residents at five Family Medicine residencies completed a pharmacotherapy survey used to assess their knowledge of drug interactions, adverse drug reactions, and new medications. Residents were asked whether they could benefit from more formal pharmacotherapy instruction. RESULTS: Seventy-seven residents (96%) completed the survey. Scores ranged from 11 to 43 (22% to 86%) out of a possible 50. Scores showed no significant difference on the basis of sex or residency. The only statistically significant difference was between first and third year residents' scores. Third year residents' mean score was 32.39 +/- 8.23 (64.8%). Ninety-one percent of residents believed they could benefit from more formal instruction in pharmacotherapy. CONCLUSIONS: Results suggest that primary care residents' pharmacotherapy knowledge may need improvement. Residents affirmed the need for formal instruction. Therefore, comprehensive pharmacotherapy curricula in primary care residencies should be considered.

Screening for prostate cancer: a comparison of urologists and primary care physicians.

Prostate cancer screening has assumed increased importance with increasing mortality from this cancer. Newer diagnostic tests such as measurement of prostate-specific antigen (PSA) have improved detection of early prostate cancer. To determine practice patterns of prostate cancer screening, surveys were sent to 487 urologists (231 responses) and 542 family physicians (205 responses) in the Southeast inquiring about actual screening practices. In screening asymptomatic patients, the digital rectal examination was used by 99% of the urologists and 98% of the family physicians, with the mean age of screening initiation being 45 +/- 7 years for the urologists and 43 +/- 7 years for the family physicians. Serum PSA was used for screening asymptomatic patients by 98% of the urologists and 87% of the family physicians, with 49 +/- 4 years being the mean age of screening initiation for both specialties. Although differences in screening emerged, both physician groups approximated the recommended screening guidelines.