Caramel apples are responsible for a listeria outbreak that has already cost the lives of at least four people around the United States.

Listeria from commercially-prepared caramel apples has been diagnosed in 28 patients, living in 10 different states. Five people have died, so far, after being hospitalized with listeria infections, and the disease contributed to at least four of the fatalities. The youngest patient is seven years old, and the oldest is 92. More than two-thirds of the subjects in the analysis are male. Nine of the 28 cases were found in pregnant women or their newborns.

The Centers for Disease Control and Prevention (CDC) is advising consumers to avoid caramel apples, as well as those covered in nuts, chocolate, or sprinkles, until further guidelines can be developed by the agency.

"At this time, no illnesses related to this outbreak have been linked to apples that are not caramel-coated and not prepackaged or to caramel candy... Investigators are rapidly working to determine specific brands or types of commercially produced, prepackaged caramel apples that may be linked to illnesses and to identify the source of contamination," CDC officials stated in a press release.

Listeria is an often-fatal disease, caused by an infection of the bacteria Listeria monocytogenes. The disease usually affects newborn babies, the elderly, pregnant women, and people with compromised immune systems. Symptoms usually begin three to 70 days after infection, and include loss of balance, fever, headaches, muscles aches and convulsions.

At least 629 Americans have been diagnosed with listeria in 2014. Infection can usually be avoided through proper food sanitation practices and refrigeration, according to the Centers for Disease Control and Prevention.

The Pulsenet system, which tracks outbreaks of disease around the nation, was utilized to find cases which may be part of the current outbreak of listeria.

After performing DNA analysis on bacteria recovered from subjects, researchers identified two outbreak clusters. One of the patients was found to be infected with both varieties of the bacteria.

"Although caramel apples are often a fall seasonal product, contaminated commercially produced, prepackaged caramel apples may still be for sale at grocery stores and other retailers nationwide or may be in consumers' homes. These products could have a shelf life of more than one month," the CDC warns Americans.

People who have commercially-prepared caramel apples in their homes are being advised to throw the candied fruit away. The products should be wrapped in plastic to prevent animals from eating the potentially-contaminated food.

There is no evidence of listeria infections caused by homemade caramel apples.

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