By Daniel J. DeNoon
WebMD Health News

Reviewed by Laura J. Martin, MD

Outbreak Traced to Supplier for Major Groceries, Restaurants

WebMD, Aug. 18, 2010 — Eggs are behind a nationwide salmonella outbreak that caused hundreds of illnesses each week in June and July.

The nationwide egg recall involves more than a dozen major brands that got eggs from Wright County Egg in Galt, Iowa.

CDC and state investigators in California, Colorado, and Minnesota found clusters of salmonella food poisoning among people who ate eggs at the same restaurants. Those restaurants got eggs that came from Wright County Egg.

Investigations continue in Arizona, Connecticut, Massachusetts, Maryland, North Carolina, Nevada, Oregon, Pennsylvania, Tennessee, and Texas. According to a CDC spokeswoman, the outbreak is “pretty much nationwide.”

Meanwhile, the FDA is conducting a thorough investigation of the Iowa firm to which the contaminated eggs were traced. The company says it already has sent all its remaining eggs to a breaker, where they will be pasteurized to kill any salmonella.

Shell eggs included in the recall were shipped since May to food wholesalers, distribution centers, and food service companies in eight states, from which they were distributed nationwide.

The brand names included in the recall are Lucerne, Albertson, Mountain Dairy, Ralph’s, Boomsma’s, Sunshine, Hillandale, Trafficanda, Farm Fresh, Shoreland, Lund, Dutch Farms, and Kemps. Recalled eggs are in six, dozen, and 18-egg cartons.

Stamped on the end of the recalled egg cartons are Julian dates ranging from 136 to 225 and plant numbers 1026, 1413, and 1946. The plant number begins with the letter P and then the number. The Julian date follows the plant number, for example: P-1946 223.  Recalled eggs may be returned to the store for a full refund.

The salmonella strain causing the outbreak is Salmonella Enteritidis, the most common salmonella strain. Usually the CDC gets about 50 reports a week of Salmonella Enteritidis food poisoning; beginning in May there was a fourfold increase in salmonella reports. Each week in late June and early July the CDC received some 200 salmonella samples isolated from patients, all with the same DNA fingerprint.

Symptoms of infection begin 12 to 72 hours after consuming contaminated foods or beverages and include fever, abdominal cramps, and diarrhea. Symptoms usually last four to seven days.

Most people recover without antibiotic treatment, but severe cases can be fatal. People prone to severe illness — particularly severe diarrhea — include the elderly, infants, and those with impaired immune systems, including people on immune suppressive therapy such as cancer chemotherapy.

Salmonella: Protect Yourself Against This Culprit

How to Avoid Food Poisoning From Eggs

If you like your eggs prepared over easy, you may want to change your egg-eating habits. Here’s the CDC’s advice on how to avoid food poisoning from eggs:

  • Don’t eat recalled eggs or products containing recalled eggs. Recalled eggs might still be in grocery stores, restaurants, and homes. Consumers who have recalled eggs should discard them or return them to their retailer for a refund.
  • People who think they might have become ill from eating recalled eggs should consult their health care providers.
  • Keep eggs refrigerated at least to 45 degrees F at all times.
  • Discard cracked or dirty eggs.
  • Wash hands, cooking utensils, and food preparation surfaces with soap and water after contact with raw eggs.
  • Eggs should be cooked until both the white and the yolk are firm and eaten promptly after cooking.
  • Do not keep eggs warm or at room temperature for more than two hours.
  • Refrigerate unused or leftover egg-containing foods promptly.
  • Avoid eating raw eggs.
  • Avoid restaurant dishes made with raw or undercooked, unpasteurized eggs. Restaurants should use pasteurized eggs in any recipe (such as Hollandaise sauce or Caesar salad dressing) that calls for raw eggs.
  • Consumption of raw or undercooked eggs should be avoided, especially by young children, elderly people, and people with weakened immune systems or debilitating illness.

Salmonella is a genus of rod-shaped, Gram-negative, non-spore forming, predominantly motile enterobacteria with diameters around 0.7 to 1.5 µm, lengths from 2 to 5 µm, and flagella which project in all directions (i.e. peritrichous). They are chemoorganotrophs, obtaining their energy from oxidation and reduction reactions using organic sources, and are facultative anaerobes. Most species produce hydrogen sulfide, which can readily be detected by growing them on media containing ferrous sulfate, such as TSI. Most isolates exist in two phases: a motile phase I and a nonmotile phase II. Cultures that are nonmotile upon primary culture may be switched to the motile phase using a Cragie tube. Salmonella is closely related to the Escherichia genus and are found worldwide in cold- and warm-blooded animals (including humans), and in the environment. They cause illnesses such as typhoid fever, paratyphoid fever, and the foodborne illness salmonellosis. Salmonella is properly ˌsælməˈnɛlə voicing the initial letter “L,” since it is named for pathologist Daniel Elmer Salmon.

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Medscape, by Steve Stiles, August 19, 2010 (Dallas, Texas) — Not that many would need further encouragement to eat chocolate regularly, but a prospective observational study of older women in Sweden suggests that partaking of it up to a few times a week can cut the risk of heart failure by about a third [1]. Although many studies of various kinds have linked intake of chocolate, especially flavanol-rich dark chocolate, to improved blood pressure and other cardiovascular benefits, the new population-based study may be the first of its kind to suggest the confection can improve the risk of heart failure in particular.

The adjusted risk of heart failure over nine years declined 26% for women who reported a monthly chocolate intake of one to three servings and by 32% for those who said they ate one or two servings per week; both findings were significant. The analysis, based on >30 000 members of the Swedish Mammography Cohort, was controlled for intake of other foods, body-mass index, exercise levels, family medical history, and other potential influences on heart-failure risk.

But women who reported eating chocolate more often than twice a week didn’t show a reduced heart-failure risk. “Chocolate still comes with a fair amount of calories from sugar and fat, which can be problematic,” observed senior author Dr Murray A Mittleman (Beth Israel Deaconess Medical Center, Boston MA). “We controlled for total calorie intake, so that means for women who were eating larger amounts of chocolate, it was displacing other foods that might be beneficial, such as fruits and vegetables,” he told heartwire .

qFor women who were eating larger amounts of chocolate, it was displacing other foods that might be beneficial, such as fruits and vegetables.

“We think the data are suggesting that if you’re going to have a treat, chocolate is a reasonable choice because it appears to have these beneficial effects, [as long as] you are careful not to overindulge.” His group’s report, with first author Elizabeth Mostofsky (Beth Israel Deaconess Medical Center), is published online August 17, 2010 in Circulation: Heart Failure.

Of course, any benefits depend on the type of chocolate. The flavanols in chocolate believed to confer cardiovascular benefits are concentrated in the cocoa solids (pure chocolate minus the cocoa butter)–so the greater the cocoa content, the better are chocolate’s health effects. Overwhelmingly, according to Mittleman, the chocolate consumed in Sweden is milk chocolate, but in accordance with European standards, its cocoa content is likely to be about 30%. It can therefore be richer in flavanols than some dark chocolate in the US, which is allowed to contain as little as 15% cocoa solids.

The analysis included 31 823 women the Swedish cohort who were 48 to 83 years old at baseline without a history of diabetes, MI, or heart failure who completed questionnaires on intake of specific foods, activity levels, body dimensions, and other issues. Over nine years of follow-up, the rate of hospitalization or death from heart failure was 15.1 cases per 10 000 person-years.

In a finding that mirrors other research, the adjusted heart-failure event hazard ratio (HR) associated with chocolate intake at various levels showed a J-shaped trend that was significant at p=0.0005, with risk falling off significantly in association with either one or two servings per week or one to three servings per month, compared with no regular intake. Risk was neither up or down significantly at higher consumption levels.

Hazard Ratio (95% CI) for Heart Failure Death or Hospitalization by Chocolate Consumption Over Nine Years, Compared to No Regular Chocolate Intake, in the Swedish Mammography Cohort

Frequency of chocolate intake HR (95% CI)*
1 to 3 servings/mo 0.74 (0.58–0.95)
1 to 2 servings/wk 0.68 (0.50–0.93)
3–6 servings/wk 1.09 (0.74–1.62)
>1 servings/d 1.23 (0.73–2.08)

*p for quadratic trend 0.0005

“The [caveat] with this kind of study, of course, is that it’s observational,” Mittleman acknowledged. “It was a prospective cohort study, whereas a number of the short-term studies [showing chocolate effects] on blood pressure were randomized. Having said that, we were able to adjust for a lot of things, like exercise and diet,” he said.

“There are data that show the effect of chocolate on blood pressure and other vascular markers are similar in men and women, so there’s no strong reason to believe the effects [seen in this study] would be any different in men,” according to Mittleman. “[However,] it would be important to get the data in men to be certain.”

The study was supported by the Swedish Research Council, the Swedish Foundation for International Cooperation in Research and Higher Education, and the US National Institutes of Health. The authors had no disclosures.

WsbMD, Laurie Barclay, MD, August 19, 2010 — Tai chi may be a helpful intervention for patients with fibromyalgia, according to the results of a single-blind, randomized trial reported in the August 19 issue of the New England Journal of Medicine.

“Previous research has suggested that tai chi offers a therapeutic benefit in patients with fibromyalgia,” write Chenchen Wang, MD, MPH, from Tufts Medical Center, Tufts University School of Medicine in Boston, Massachusetts, and colleagues. “…[Tai chi] combines meditation with slow, gentle, graceful movements, as well as deep breathing and relaxation, to move vital energy (or qi) throughout the body. It is considered a complex, multicomponent intervention that integrates physical, psychosocial, emotional, spiritual, and behavioral elements.”

Fibromyalgia was defined by American College of Rheumatology 1990 criteria. Participants (n = 66) were randomly assigned 1:1 to receive classic Yang-style tai chi or a control intervention consisting of wellness education and stretching. In both groups, participants received 60-minute sessions twice weekly for 12 weeks.

Fibromyalgia Impact Questionnaire (FIQ) score (ranging from 0 – 100) at the end of 12 weeks was the main study outcome, with higher scores indicating more severe symptoms. Secondary outcomes were summary scores on the physical and mental components of the Medical Outcomes Study 36-Item Short-Form Health Survey. To assess durability of the response, these tests were performed again at 24 weeks.

Improvements in the FIQ total score and quality of life in the tai chi group were clinically important. For this group, mean baseline and 12-week FIQ scores were 62.9 ± 15.5 and 35.1 ± 18.8, respectively, vs 68.0 ± 11 and 58.6 ± 17.6, respectively, in the control group. The mean between-group difference from baseline in the tai chi group vs the control group was −18.4 points (P < .001).

The tai chi group also fared better than the wellness intervention group in physical component scores of the Short-Form Health Survey (28.5 ± 8.4 and 37.0 ± 10.5 for the tai chi group vs 28.0 ± 7.8 and 29.4 ± 7.4 for the control group; between-group difference, 7.1 points; P = .001) and mental component scores (42.6 ± 12.2 and 50.3 ± 10.2 vs 37.8 ± 10.5 and 39.4 ± 11.9, respectively; between-group difference, 6.1 points; P = .03).

These improvements were still present at 24 weeks (FIQ score between-group difference, −18.3 points; P < .001), with no reported adverse events.

Limitations of this study include lack of double blinding, lack of generalizability because treatment was delivered by a single tai chi master at a single center, and follow-up limited to 24 weeks.

“In conclusion, our preliminary findings indicate that tai chi may be a useful treatment in the multidisciplinary management of fibromyalgia,” the study authors write. “Longer-term studies involving larger clinical samples are warranted to assess the generalizability of our findings and to deepen our understanding of this promising therapeutic approach.”

The National Center for Complementary and Alternative Medicine, the American College of Rheumatology Research and Education Foundation Health Professional Investigator Award, and the Boston Claude D. Pepper Older Americans Independence Center Research Career Development Award supported this study. The contents of the journal article are solely the responsibility of the study authors and do not necessarily represent the official views of the National Center for Complementary and Alternative Medicine or the National Institutes of Health. Disclosure forms provided by the study authors are available with the full text of the original article here .

N Engl J Med. 2010;363:743-754.