An additional 140 cases of Salmonella Poona infection have been reported during the past week, according to data published by the Centers for Disease Control and Prevention (CDC) today, bringing the multistate outbreak tally to 558 cases,

Iowa and South Dakota each reported a single case becoming the 32nd and 33rd states affected by the outbreak. California leads all states reporting 120 cases, while Arizona follows close by with 95.

112 people have required hospitalization for their illnesses and three people, one from San Diego County, California, one from Pima County, Arizona and one from Texas, have died as a result of the bacterial infection.

The outbreak has been linked, based on epidemiologic, laboratory, and traceback investigations, to cucumbers imported from Mexico and distributed by Andrew & Williamson Fresh Produce. This has resulted in two major recalls in less than three weeks.

Andrew & Williamson Fresh Produce voluntarily recalled all cucumbers sold under the “Limited Edition” brand label during the period from Aug.1, 2015 through Sep. 3, 2015 on Sep. 4. In addition, Custom Produce Sales voluntarily recalled all cucumbers sold under the Fat Boy label starting August 1, 2015 one week later.

Recalled cucumbers were distributed in the states of Alaska, Arizona, Arkansas, California, Colorado, Florida, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Montana, Nevada, New Jersey, New Mexico, North Dakota, Oklahoma, Oregon, South Carolina, Texas, and Utah.

The CDC notes that six of the outbreak strains have been tested for antimicrobial resistance and found to be susceptible to all antibiotics tested. Public health labs in Arizona, Montana, and San Diego have isolated the outbreak strains from the affected cucumbers.

The federal health agency estimates one million Salmonella illnesses annually in the US, accounting for 19,000 hospitalizations and nearly 400 deaths. Salmonella Poona is a relatively rare strain seen in US foodborne outbreaks.

In 2013, Salmonella Poona was one of the outbreak strains linked to small turtles in the US. During the past two decades, Salmonella Poona has been implicated in outbreaks in cantaloupes, honeydew melons and watermelons. Nine outbreaks have been reported from 1998 to 2008.

Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and most persons recover without treatment. However, in some persons, the diarrhea may be so severe that the patient needs to be hospitalized. Many types of this bacteria cause disease in animals, including pets, and people.

CDC serves as lead coordinator during a multistate foodborne disease outbreak between public health partners to detect the outbreak, define its size and extent, and to identify the source. Changing patterns in global food production have resulted in food being distributed over large distances. This combined with increasing integration and consolidation of agriculture and food production can result in a contaminated food rapidly causing a geographically widespread outbreak.

In 2015, including the Salmonella Poona outbreak described above, eight multistate foodborne outbreaks have been investigated to include Listeria monocytogenes in Blue Bell Ice Cream, Salmonella I 4,[5],12:i:- in roasted pig and pork products and a Cyclospora outbreak linked to Mexican cilantro.