And why does everything getting recalled seem to have salmonella??
With the recent recall of certain lots of Jif Peanut Butter, I thought it was a good time to discuss salmonella. If you do have Jif peanut butter, check the back to see if your UPC code was impacted.
What is salmonella?
Salmonella is a bacteria that we’ve seen prior to this peanut butter recall; and is the number one bacterial cause of diarrhea in my office. In the U.S., it is one of the leading causes of food-borne illness (common culprits include: ingestion of poultry, eggs, and milk products). Which is why you hear about it all the time! Companies and produce managers do their best to ensure quality standards, yet food-borne illnesses happen.
Salmonella can also be associated with fresh produce, meats, contact with pets, and from contact with lizard or reptiles (yes, I’m talking to you Florida families!).
What are the symptoms of salmonella?
Salmonella is a type of bacteria that causes stomach symptoms, but in rare cases the bacteria can enter the bloodstream, joints, or the brain. This is more of a risk for younger children (under 3 months due to their immature immune system and gut).
After exposure of a contaminated food, symptoms would usually appear between 8 to 72 hours.
Common symptoms include:
- Diarrhea
- Abdominal cramping
- And/or fever
For children, bloody stool is more common than it is in adults (especially for children under one). Children older than one can also sometimes present with bloody stool; however they typically have symptoms of vomiting and/or diarrhea. In some patients, we can also see fatigue, headaches, and/or weight loss (although this is rare and more on the range of moderate to severe symptoms).
How is salmonella diagnosed?
Salmonella symptoms can present similarly to stomach viruses and diagnosis can be made with a stool culture (stool is sent off to a lab and can take 2-4 days to return results). If a child is presenting with severe abdominal cramping with the symptoms, sometimes salmonella will be considered without stool cultures or while awaiting the stool cultures.
Because it presents similarly to stomach viruses, I usually recommend testing the stool if the child has blood in their stool, they are looking ill-appearing with blood in the stool, or if diarrhea is persistent beyond 10 days.
What is the clinical course?
The good news is that symptoms are usually self-limited which means they go away without treatment. If there is a fever, it resolves within 48-72 hours and the diarrhea would resolve within 10 days.
When are antibiotics needed?
Most children need fluids and supportive care like they would with a viral stomach bug.
Antibiotics are generally not needed for salmonella in children with mild to moderate symptoms, unless they are under 3 months of age or immunocompromised.
For children over 3 months, the decision to start antibiotics is usually due to the overall clinical appearance of your child.
If your child (of any age) has severe diarrhea (more than 9 stools a day, high or persistent fever, or need for hospitalization); antibiotics are recommended.
The presence of bloody diarrhea does not necessarily indicate the need for antibiotic treatment. What matters most in our clinical decision making is the age of the child and other symptoms such as persistent fever, fatigue, and overall clinical appearance.
Most children do very well and do not need antibiotics.
If your child has salmonella, follow up stool studies are NOT recommended
Many times, parents will want stool cultures confirming the salmonella is gone. This is not recommended because the bacteria can shed for weeks to months in some children so repeat testing can lead to unnecessary interventions.
If your child is treated for salmonella and continues to have SYMPTOMS of salmonella after treatment, seek medical attention.
So when should you see a doctor for these symptoms?
- If your child shows no improvement of “stomach virus” symptoms with 2-3 days. Because salmonella can look similar to stomach viruses (and usually don’t need treatment), we would want to know if stomach virus symptoms linger. In this case, your clinician may want to rule out bacterial causes like salmonella that may or may not need treatment.
- If your child has blood in their stool at any point
- If your child is showing signs of dehydration at any point
How can you reduce risk of salmonella?
- Good hand hygiene during food preparation
- Thoroughly cook eggs, poultry, and meat
- Clean surfaces for food prep thoroughly.
- Wash hands after playing with pets, notably lizards and pet turtles. I practice in Florida where lizard droppings are commonly in our backyards so always wash hands after playing outside!
- Wash bottles for newborns/babies with bottle brush not used to wash other pots and pans.
Remember, that salmonella can happen but risk of complication is LOW. Most of us fare well without any complications.
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