Document Detail

An outbreak of enterotoxigenic Escherichia coli associated with sushi restaurants in Nevada, 2004.
MedLine Citation:
PMID:  18491967     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In August and November 2004, 2 clusters of diarrhea cases occurred among patrons of 2 affiliated sushi restaurants (sushi restaurant A and sushi restaurant B) in Nevada. In August 2004, a stool sample from 1 ill sushi restaurant A patron yielded enterotoxigenic Escherichia coli (ETEC). In December 2004, we investigated a third cluster of diarrhea cases among sushi restaurant B patrons. METHODS: We defined a case as diarrhea in a person who ate at sushi restaurant B from 3 December through 13 December 2004. Control subjects were individuals who dined with case patients but did not become ill. Duplex polymerase chain reaction was used to detect genes coding for heat-stable and heat-labile enterotoxins of ETEC. RESULTS: One-hundred thirty patrons of sushi restaurant B reported illness; we enrolled 36 case patients and 29 control subjects. The diarrhea-to-vomiting prevalence ratio among patients was 4.5. Illness was associated with consumption of butterfly shrimp (estimated odds ratio, 7.2; 95% confidence interval, 1.1 to infinity). The implicated food was distributed to many restaurants, but only sushi restaurant B patrons reported diarrhea. We observed poor food-handling and hand hygiene practices at sushi restaurant B. Stool samples from 6 of 7 ill patrons and 2 of 27 employees who denied illness yielded ETEC. CONCLUSIONS: ETEC was identified as the etiologic agent of a large foodborne outbreak at a sushi restaurant in Nevada. Poor food-handling practices and infected foodhandlers likely contributed to this outbreak. Although ETEC is a well-documented cause of domestic foodborne outbreaks, few laboratories can test for it. Earlier recognition of ETEC infections may prevent subsequent outbreaks from occurring.
Seema Jain; Lei Chen; Amy Dechet; Alan T Hertz; Debra L Brus; Kathleen Hanley; Brenda Wilson; Jaime Frank; Kathy D Greene; Michele Parsons; Cheryl A Bopp; Randall Todd; Michael Hoekstra; Eric D Mintz; Pavani K Ram
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  47     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-04     Completed Date:  2008-07-03     Revised Date:  2008-08-20    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1-7     Citation Subset:  IM    
Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS A-38, Atlanta, GA 30333, USA.
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MeSH Terms
Bacterial Toxins / genetics
DNA Fingerprinting
DNA, Bacterial / genetics
Diarrhea / epidemiology*,  microbiology*
Disease Outbreaks*
Drug Resistance, Bacterial
Electrophoresis, Gel, Pulsed-Field
Enterotoxigenic Escherichia coli / classification,  genetics,  isolation & purification*
Enterotoxins / genetics
Escherichia coli Infections / epidemiology*,  microbiology*
Escherichia coli Proteins / genetics
Feces / microbiology
Food Handling / methods
Food Microbiology*
Middle Aged
Nevada / epidemiology
Reg. No./Substance:
0/Bacterial Toxins; 0/DNA, Bacterial; 0/Enterotoxins; 0/Escherichia coli Proteins; 0/heat stable toxin (E coli); 0/heat-labile enterotoxin, E coli

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