Outbreak of Clostridium perfringens food poisoning linked to leeks in cheese sauce: an unusual source.

Alex Bhattacharya,Saran Shantikumar,Damon Beaufoy,Musarrat Afza,Dan Todkill,Adrian Allman,Deborah Fenelon,Andrea Normington,Karen Reynolds

doi:10.1017/s095026882000031x

Alex Bhattacharya, Saran Shantikumar + Show 7 more

Open Access

https://doi.org/10.1017/s095026882000031x

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Abstract

Between 11-13 December 2018, local public health authorities in the West Midlands, England were alerted to 34 reports of diarrhoea with abdominal cramps. Symptom onset was ~10 h after diners ate Christmas meals at a restaurant between 7-9 December 2018. A retrospective case-control study, environmental and microbiological investigations were undertaken to determine the source and control the outbreak. An analytical study was undertaken with odds ratios (OR) and 95% confidence intervals (CI). Forty persons were recruited to the analytical study (28/40 cases). Multivariable analysis found that leeks in cheese sauce was the only item associated with illness (aOR 51.1; 95% CI 4.13-2492.1). Environmental investigations identified significant lapses in food safety, including lapses in temperature control during cooking and hot holding, likely cross-contamination between raw and cooked foods and the reuse of leftover cheese sauce for the next day's service. No food samples were taken during the exposure period. Two faecal samples were positive for Clostridium perfringens with one confirming the enterotoxigenic gene. Cheese sauce is an unusual vehicle for the organism and the first time this has been reported in England.

Highlights

Clostridium perfringens is a Gram-positive, spore-forming bacterium which causes illness in humans through the production of toxins
One group of five diners (Group E) ate at the dinner service which was prepared during the day; the remaining 97 diners ate at the lunch service which had been prepared overnight
Shropshire Council was made aware of four additional cases among the staff at the restaurant; they were excluded from the analytical study as we could not establish food exposures or exposure dates

Summary

Introduction

Clostridium perfringens is a Gram-positive, spore-forming bacterium which causes illness in humans through the production of toxins. Occurring in the environment, soil, water and in the gut flora of humans and animals, C. perfringens is a common source of food poisoning in the United Kingdom [1, 2]. Ingestion of toxin-producing C. perfringens results in food poisoning, with an incubation period between 5–24 h, commonly associated with diarrhoea and abdominal pain [2]. The United Kingdom (UK) infectious intestinal disease 2 study estimated 90 000 C. perfringens cases per year, with an incidence of 1.5/1000 person years; only 17% of C. perfringens cases were estimated to present to their general practitioner [4]. In England, it is estimated that 8–13% of gastrointestinal foodborne outbreaks are associated with C. perfringens [2, 5, 6]

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