California Salad Poisoning Incident

Eight individuals were hospitalized in California after consuming a homemade salad that contained Clostridium botulinum, a highly dangerous neurotoxin that can lead to paralysis.

A recent CDC report revealed that on June 21 and June 22, 2024, approximately 31 people gathered for two events in Fresno County where an uncooked nopales salad—made from prickly pear cactus pads—was served.

Not long after, a 42-year-old woman reported symptoms like dizziness, blurred vision, a droopy eyelid, sore throat, gastrointestinal discomfort, and difficulty swallowing. Initially, her symptoms were overlooked, but doctors soon suspected botulism, a rare yet serious poisoning affecting the nervous system, potentially causing breathing issues, muscle paralysis, and even death.

By June 27, 10 attendees—each of whom consumed the salad—sought medical help at two different hospitals in Fresno County, exhibiting symptoms consistent with botulism.

This prompted an investigation by the CDC, alongside the Fresno County Department of Public Health and the California Department of Public Health, to pinpoint the source of the outbreak.

After days of lab work, officials determined that the uncooked nopales in the salad had been left unrefrigerated in 100-degree Fahrenheit heat over both event days, contributing to the contamination with C botulinum.

Ultimately, eight of the ten patients were diagnosed with botulism, making this one of the largest known foodborne outbreaks of the infection in California.

Nopales, a staple in Mexican cuisine, has grown in popularity due to its health benefits. It was confirmed that one of the affected individuals prepared the salad, combining fresh onions, tomatoes, and home-preserved nopales stored in reused commercial jars.

According to the CDC report, the salad-maker boiled the empty jars before adding chopped nopales mixed with a pinch of salt. After packing them tightly, she sealed them with new metal lids and stored them for six weeks in a shed outside her home—something she claimed to have done for years.

However, she was not aware that this method provided an ideal environment for C botulinum spores, which thrive in low-oxygen, low-acid, and moisture-rich conditions at temperatures between 38°F and 113°F.

Norma Sanchez, a communicable disease specialist from the Fresno County Department of Public Health, mentioned they identified the contaminated nopales after examining trash bins.

The spores are often present on the surfaces of fruits and vegetables, and in seafood; in this instance, they quickly multiplied on the uncooked and canned nopales.

All eight diagnosed patients experienced symptoms such as double vision, with seven showing hoarseness, and six reporting dizziness and difficulty swallowing. Notably, the woman with the most severe symptoms consumed the salad at both events.

Consequently, all eight patients faced hospital stays lasting between two and 42 days. Out of these, six were treated in intensive care, and two required invasive mechanical ventilation.

The CDC later confirmed that all individuals diagnosed with botulism survived and recovered. Botulism is uncommon but serious, usually resulting from food or wound contamination.

Typical symptoms include difficulty swallowing, muscle weakness, blurred vision, drooping eyelids, slurred speech, and trouble breathing. For foodborne cases, symptoms generally emerge 12 to 36 hours after ingestion, depending on toxin exposure.

Without timely treatment, the infection can lead to muscle weakness, paralysis, and even death. Patients who do experience paralysis often need to relearn basic tasks such as walking and talking.

The CDC estimates there are about 25 cases of foodborne botulism in the U.S. each year, which is quite rare. Sadly, around five percent of people affected may die from the condition, while others may face long-term disabilities requiring extensive physical therapy.

In light of this incident, the Fresno health department is urging everyone to adhere to proper storing and cooking methods to minimize the risk of botulism. Food susceptible to contamination should be heated to at least 240–250°F and thoroughly cooked.