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A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Sat 29 May 2010
Source: The Town Talk [edited]
The outbreak of illnesses that sickened more than 40 people and killed
3 patients at Central Louisiana State Hospital in Pineville appears to
be connected to bacteria from chicken salad served at the facility, a
health official reported Fri 28 May 2010.
Test results found the 3rd most common cause of food poisoning,
[toxin-producing] _Clostridium perfringens_, was to blame for the
outbreak at Central earlier in May 2010, said Dr. David Holcombe,
medical director for Region 6 of the Louisiana Department of Health
and Hospitals' Office of Public Health.
The _C. perfringens_ bacterium appears to have come from the chicken
salad served before patients and staff members began getting sick,
Holcombe said. Those who had the chicken salad at that time were 23
times more likely to show symptoms, which is a good indicator that the
dish was the culprit.
_C. perfringens_ is a naturally occurring organism, but it can spread
to unsafe levels with improper food storage and handling, Holcombe said.
The bacterium explains the cause of sickness in the patients, Holcombe
said, but the test results do not fully spell out the causes of death
for 3 patients. Autopsy and toxicology reports still pending will help
determine what, if any, other factors caused their illnesses to be
fatal.
Starting the morning of 7 May 2010, patients at Central Louisiana
State Hospital began showing symptoms of gastrointestinal problems. By
that night and into the next morning, a 43-year-old woman, 41-year-old
man and 52-year-old man died.
It cannot be transmitted from person to person. Spores of the organism
are heat-resistant and may germinate into the vegetative form of the
bacterium in food that has not been properly stored, Holcombe said,
and they begin producing a toxin that makes people sick once they
enter the lower intestine.
[Byline: David Dinsmore]
--
Communicated by:
ProMED-mail
[The following discussion on _C. perfringens_ associated foodborne
illness is from the FDA's "Bad Bug Book: Foodborne Pathogenic
Microorganisms and Natural Toxins Handbook"
"1. The Organism:
-----------------
_Clostridium perfringens_ is an anaerobic, Gram-positive, sporeforming
rod (anaerobic means unable to grow in the presence of free oxygen).
It is widely distributed in the environment and frequently occurs in
the intestines of humans and many domestic and feral animals. Spores
of the organism persist in soil, sediments, and areas subject to human
or animal fecal pollution.
2. Nature of Acute Disease:
---------------------------
Perfringens food poisoning is the term used to describe the common
foodborne illness caused by _C. perfringens_ type A. A more serious
but rare illness is also caused by ingesting food contaminated with
Type C strains. The latter illness is known as enteritis necroticans
or pig-bel disease.
3. Nature of Disease:
--------------------
The common form of perfringens poisoning is characterized by intense
abdominal cramps and diarrhea which begin 8-22 hours after consumption
of foods containing large numbers of those _C. perfringens_ bacteria
capable of producing the food poisoning toxin. The illness is usually
over within 24 hours but less severe symptoms may persist in some
individuals for 1 or 2 weeks. A few deaths have been reported as a
result of dehydration and other complications.
Necrotic enteritis (pig-bel) caused by _C. perfringens_ is often
fatal. This disease also begins as a result of ingesting large numbers
of the causative bacteria in contaminated foods. Deaths from necrotic
enteritis (pig-bel syndrome) are caused by infection and necrosis of
the intestines and from resulting septicemia. This disease is very
rare in the USA.
Infective dose - The symptoms are caused by ingestion of large numbers
(greater than 10 to the 8th) [100 million] vegetative cells. Toxin
production in the digestive tract (or in test tubes) is associated
with sporulation. This disease is a food infection; only 1 episode has
ever implied the possibility of intoxication (i.e., disease from
preformed toxin).
4. Diagnosis of Human Illness:
------------------------------
Perfringens poisoning is diagnosed by its symptoms and the typical
delayed onset of illness. Diagnosis is confirmed by detecting the
toxin in the feces of patients. Bacteriological confirmation can also
be done by finding exceptionally large numbers of the causative
bacteria in implicated foods or in the feces of patients.
5. Associated Foods:
--------------------
In most instances, the actual cause of poisoning by _C. perfringens_
is temperature abuse of prepared foods. Small numbers of the organisms
are often present after cooking and multiply to food poisoning levels
during cool down and storage of prepared foods. Meats, meat products,
and gravy are the foods most frequently implicated.
6. Relative Frequency of Disease:
---------------------------------
Perfringens poisoning is one of the most commonly reported foodborne
illnesses in the USA. There were 1162 cases in 1981, in 28 separate
outbreaks. At least 10-20 outbreaks have been reported annually in the
USA for the past 2 decades. Typically, dozens or even hundreds of
person are affected. It is probable that many outbreaks go unreported
because the implicated foods or patient feces are not tested routinely
for _C. perfringens_ or its toxin. The Centers for Disease Control and
Prevention (CDC) estimates that about 10 000 actual cases occur
annually in the USA.
7. Course of Disease and Complications:
---------------------------------------
The disease generally lasts 24 hours. In the elderly or infirm,
symptoms may last 1-2 weeks. Complications and/or death only very
rarely occur.
8. Target Populations:
----------------------
Institutional feeding (such as school cafeterias, hospitals, nursing
homes, prisons, etc.) where large quantities of food are prepared
several hours before serving is the most common circumstance in which
perfringens poisoning occurs. The young and elderly are the most
frequent victims of perfringens poisoning. Except in the case of
pig-bel syndrome, complications are few in persons under 30 years of
age. Elderly persons are more likely to experience prolonged or severe
symptoms.
9. Food Analysis:
----------------
Standard bacteriological culturing procedures are used to detect the
organism in implicated foods and in feces of patients. Serological
assays are used for detecting enterotoxin in the feces of patients and
for testing the ability of strains to produce toxin. The procedures
take 1-3 days."
[As noted in the text, this illness is usually related to _in situ_
production of the enterotoxin rather than (as with the more common
staphylococcus-associated foodborne illness) the ingestion of
preformed toxin. The staphylococcal illness usually presents with
vomiting and little if any diarrhea with an incubation period of 4-6
hours, whereas _C. perfringens_ food poisoning causes diarrhea without
much vomiting. Neither illness usually causes significant fever.
Mortality rates in perfringens food poisoning are quite low and
fatalities are very unusual in the non-elderly. Reports are pending on
what co-existing illnesses were present in the decedents. - Mod.LL]
[The interactive HealthMap/ProMED map for Louisiana is available at:
[see also:
2005
----
Food poisoning, teachers - Philippines (Bicol) 20051219.3632
2004
----
Food poisoning, student conference - USA (DC): susp. 20040809.2194
Food poisoning, hotel restaurant - China (HK) 20040713.1880
Food poisoning, clostridial - Croatia (Zagreb) 20040315.0718
1998
----
Clostridium perfringens - China (Hong Kong) 19981216.2375
Pig belly disease - Solomon Islands 19980614.1122]
...................sb/ll/ejp/jw
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