A tainted starter for tempeh soybean meat substitute is being recalled after an outbreak of a rare type of salmonella that has sickened more than 90 people, mostly in North Carolina.

Indonesianfoodsmart.com of Rockville, Md., is voluntarily recalling all packages of its tempeh starter yeast because of the potential for salmonella contamination, the company announced Wednesday.

The product was used to make previously recalled packages of unpasteurized soybean tempeh recalled May 1 by Smiling Hara of Asheville, N.C.  Lab tests showed the product was contaminated with a strain of Paratyphi B salmonella, the same strain detected in at least 88 illnesses in North Carolina, mostly in Buncombe County, health officials said.

A handful of illnesses have been reported in a few other states, said Gaylen Ehrlichman, a spokeswoman for the Buncombe County Department of Health.

The tempeh starter was imported from Indonesia. After federal Food and Drug Administration officials notified the Maryland company of the problem, the firm discontinued operations.

Infections in this outbreak have been spread by eating the product, by contact with surfaces contaminated by the product and through person-to-person contact, health officials said.

It’s not clear whether the outbreak is over. The Centers for Disease Control and Prevention estimates that for every case of salmonella reported, about 29 go undetected. Using that multiplier, more than 2,270 people may have been sickened by the tainted tempeh and the starter.

More on vitals:

• Tainted tempeh linked to salmonella outbreak
• Nearly 1,000 dogs now sick from jerky treats, FDA reports say
• Heavy metal singer slammed by salmonella sushi

North Carolina health officials have confirmed that tempeh contaminated with a rare strain of salmonella is responsible for an outbreak of food poisoning that has sickened at least 46 people. 

The Buncombe County Department of Health announced that the outbreak strain of Paratyphi B salmonella is the same as that detected in packages of tempeh recalled May 1 by Smiling Hara of Asheville, N.C. 

Smiling Hara voluntarily recalled 12-ounce packages of unpasteurized soybean tempeh produced between Jan. 11 and April 11. The containers are marked with a best-by date of July 11, 2012 through Oct. 25, 2012. Tempeh is a meat substitute used in vegetarian cuisine.

“Anyone with this product in their possession should not eat it,” North Carolina Agriculture Commissioner Steve Troxler said in a statement. “Smiling Hara launched the recall after samples collected by the N.C. Department of Agriculture and Consumer Services during a routine inspection tested positive for salmonella.”

At least seven people have been hospitalized because of illness. Victims range in age from 4 to 79, health officials said. No deaths have been reported.

Those who are sick include people who ate tempeh, people who had contact with food items contaminated by the tempeh, and those connected to those who became ill. In this outbreak, new cases are continuing to be spread by person-to-person contact. 

Health officials urged residents to seek medical care if they've consumed the tempeh and develop symptoms of salmonella poisoning, including diarrhea, fever, headache and cramping that usually begins one to 10 days after exposure. The infection typically lasts four to seven days, but can last longer. 

More cases of salmonella poisoning may be detected. The Centers for Disease Control and Prevention estimates that for every case actually reported, 29.3 cases actually occur. Using that multiplier, as many as 1,348 people may have become ill in this outbreak.

Related:

Should you be grossed out by 'meat glue?'

200 now sick in salmonella sushi outbreak

First lawsuit filed in salmonella sushi outbreak