As of Monday, the Rhode Island Department of Health reports 33 possible cases of Salmonella with 17 hospitalized in an outbreak linked to holiday pastries called zeppole. (Wednesday update: 43 ill, possibly including one fatality; 22 hospitalized.)

Having over one third of victims in a Salmonella outbreak require hospitalization is a rarity.  A high hospitalization rate speaks to the dangerous nature of the particular strain of bacteria involved, sometimes, or to the population of people to whom the contaminated food items were sold. 

The Rhode Island Health Department’s news release Sunday indicates that it may be the latter, in the Defusco’s Bakery Salmonella outbreak, that is responsible for so many hospitalizations.

Defusco’s zeppoles were sold or served at 19 different places across Rhode Island — to American Bakery Supplies, in West Warwick, which then distributed the contaminated zeppoles to Roch’s Market and Touch of Class Catering in West Warwick (among other locations), and Meal Works in Coventry.  Meal Works, which is a catering company, served the zeppoles at events on March 17 and 18 at West Warwick Manor Senior Center, St John and Paul Church in Coventry, Sparrow Point (senior facility) in West Warwick, and Crescent Park Manor in Riverside.

Zeppole are a traditional treat served during St. Joseph’s Day celebrations.

According to the Rhode Island Health Department, the custard used to fill the St. Joseph’s Day zeppoles and eclairs hadn’t been stored at safe temperatures. And the pre-baked holiday pastry shells were packed away in egg crates, possibly exposing them to contaminated raw egg residue.

Most people (not all) recover from Salmonella infections, but the notion that Salmonella illnesses consist of just a few days of diarrhea is totally incorrect.  (See the story of Barb Pruitt, who lost 4 feet of her small intestine due to Salmonella infection)  And the risk is heightened for the elderly, particularly where preparation and storage conditions for the contaminated food item may have led to large inoculating doses of bacterial ingestion (question: was Defusco’s pooling their eggs too?)

There are several relatively complex reasons why the elderly suffer more severe Salmonella infections.  First, the aging of their gastrointestinal tracts reduces peristalsis, or the natural ability of the GI tract to propel contents through and out the system.  This delayed clearance of food, and the bacteria that they contain, means longer periods of contact between the bacteria and the lining of the GI tract.  This gives the bacteria more time to do their ugly job before being shed from the system.  Second, the elderly, as a group, have a higher incidence of co-morbidities (i.e. other illnesses or conditions), which presents a host of medical problems and threats in the context of a severe Salmonella infection.