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Outbreak Linked to Louisiana Hospital

By Dan Flynn and Suzanna Schreck

Late last week, Dr. David Holcombe, medical director for Region 6 of the Louisiana Department of Health and Hospitals' Office of Public Health, announced that chicken salad served at the Central Louisiana State Hospital was the likely source of a Clostridium perfringens outbreak among patients and staff at the hospital in early May.  

More than 40 people became ill with Clostridium perfringens infections and a 43-year-old woman, 41-year-old man, and 52-year-old man died after eating chicken salad at the hospital.  Epidemiologic findings indicated that people who ate the chicken salad were 23 times more likely to show symptoms of Clostridium perfringens infection than people who did not eat the salad.  

Environmental findings from the outbreak have not yet been released, although food safety experts are speculating that improper cooling could have played a role in the outbreak.

According to the Centers for Disease Control and Prevention (CDC), "By sporulating, [Clostridium perfringens] can survive high temperatures during initial cooking; the spores germinate during cooling of the food, and vegetative forms of the organism multiply if the food is subsequently held at temperatures of 60 F-125 F (16 C-52 C). If served without adequate reheating, live vegetative forms of C. perfringens may be ingested. The bacteria then elaborate the enterotoxin that causes the characteristic symptoms of diarrhea and abdominal cramping."

The common form of Clostridium perfringens poisoning is characterized by intense abdominal cramps and diarrhea which begin 8-22 hours after consumption of foods containing large numbers of Clostridium perfringens bacteria.  The illness is usually over within 24 hours but less severe symptoms may persist in some individuals for 1 or 2 weeks.

Deaths reported in connection with Clostridium perfringens infection are typically due to dehydration or other complications.  Pending autopsy and toxicology reports will help public health investigators determine whether other factors contributed to the three deaths.  

Clostridium perfringens poisoning is confirmed by detecting the toxin in the feces of patients or by finding large numbers of bacteria in foods implicated as the source of illness.  

Meat, meat products, and gravy are the foods most often implicated as the source of Clostridium perfringens food poisoning outbreaks.  Small numbers of the bacteria can multiply during cool down and storage of cooked foods.

The CDC reports, "Perfringens poisoning is one of the most commonly reported foodborne illnesses in the U.S. ... 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. ...

"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."

Full post as published by Food Safety News on June 02, 2010 (boomark / email).