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A salmonella outbreak in Rhode Island now includes at least twenty-one people with severe illness, and one death, according to reports from public health officials in that state. Health officials are investigating another eighteen illnesses to see if they are tied to the salmonella outbreak.

Officials are focused on zeppole and other pastries which were made by Defusco’s bakery in Johnston, Rhode Island. According to news reports, investigators found pastry shells stored in boxes contaminated with raw eggs, and also found that custard used as filling was not being properly chilled.

Investigators have identified the particular strain of salmonella, known as Salmonella heidelberg, as the suspected organism responsible for the illnesses. They are now trying to determine whether the death of the elderly Rhode Island resident was caused by that particular strain.

The investigation into the food poisoning outbreak began on March 25, 2011, after nearly a dozen elderly residents of a Warwick nursing home became sick after eating pastries from Defusco’s bakery. Since March 12, two dozen victims have required hospitalization for severe illness.

Salmonellosis, the disease caused by salmonella infection or salmonella toxins, leads to diarrhea, fever, vomiting and abdominal cramps. Most people recover without treatment, but in the elderly, in infants, or people with compromised immune systems, the disease can be very severe, requiring hospital admission for rehydration and antibiotic treatment to prevent the spread of infection. Severe infections can lead to reactive arthritis and death.

Prevention of salmonella illnesses is straightforward. Food which may contain the bacteria, such as chicken or pork, must be prepared properly to kill the organism and destroy any salmonella toxin. Eggs and milk, and their products, must be properly prepared, handled, and refrigerated. Infections can also occur from contact with reptiles, pet rodents, and tainted fruits and vegetables. Proper hygiene–washing hands before and after handling food–is also a common sense method of reducing the likelihood of food poisoning.

Each year over 140,000 people suffer from salmonella poisoning in the U.S. and dozens die from the illness.

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