Over the past few months, more than 1,000 people in the U.S.A. and Canada were infected with a bacteria called Salmonella. The Centers for Disease Control and Prevention investigation can be read here.

“… red onions from Thomson International Inc., were the likely source of the outbreak. Other onion types (such as white, yellow, or sweet yellow) were also likely to be contaminated because the onions were grown and harvested together… On August 1, 2020, Thomson International Inc., recalled all red, yellow, white, and sweet yellow onions because they may be contaminated with Salmonella. Other companies also recalled onions or foods made with recalled onions. Consumers, restaurants, and retailers should not eat, serve, or sell recalled onions and products.”

Here is the Thomson International Inc. recall notice.

Here is the list of recalled products made with onions.

What is Salmonella infection?

Salmonella is a group of bacteria with many different types. The type responsible for most infections in humans is carried by chickens, cows, pigs, and pet reptiles (turtles, lizards, and iguanas). Most infections with Salmonella spread to people through contaminated food such as meat, eggs, and vegetables.

Why mention this now?

Salmonella can cause special problems in individuals with sickle cell disease and thalassemia: bone infection (osteomyelitis) or joint infection (septic arthritis) to include:

• Diarrhea, especially bloody diarrhea
• Fever for many days
• Prolonged pain in a bone or joint
• Can be multiple sites, often symmetrical
• Redness and swelling at the site of pain
• Treatment might require bone biopsy, weeks of antibiotics, and sometimes surgery

Why does this happen in sickle cell disease?

Most likely 3 reasons:

1. Sickle cell damage to the cells lining the gut allows Salmonella to enter the bloodstream more easily.
2. Sickle cell disease reduces the immune system’s ability to clear bacteria from the bloodstream.
3. The expanded bone marrow, due to high production of red cells and bone marrow sites damaged by lack of oxygen, are places where Salmonella bacteria can hide and grow.

Salmonella contamination is linked to poor sanitation.

What you can do

• If your household has onions or products with onions purchased in the summer, check whether they are on the recall list.
• If you have fevers and diarrhea, see your doctor promptly.
• If you have bone pain or joint pain with features different from your usual sickle cell pains (redness, swelling, lasting a long time, unusual site), see your doctor.
• Use good food-handling practices for meat, eggs, and vegetables.
• Cook food properly at recommended temperatures.
• Avoid touching pet reptiles.
• Avoid street food that may involve dishes made with raw onions.