Category Archives: E. coli

1 dead, 29 sick from E. coli O157 linked to minced meat in Germany

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We report an ongoing, protracted and geographically dispersed outbreak of hemolytic uremic syndrome (HUS) and gastroenteritis in Germany, involving 30 cases since December 2016. The outbreak was caused by the sorbitol-fermenting immotile variant of Shiga toxin-producing (STEC) Escherichia coli O157.

Molecular typing revealed close relatedness between isolates from 14 cases. One HUS patient died. Results of a case–control study suggest packaged minced meat as the most likely food vehicle. Food safety investigations are ongoing.

Ongoing hemolytic uremic syndrome (HUS) outbreak caused by sorbitol-fermenting (SF) shiga toxin-producing Escherichia coli (STEC) O157, Germany, December 2016 to May 2017

Eurosurveillance, vol. 22, issue 21, 25 May 2017, S Vygen-Bonnet, B Rosner, H Wilking, A Fruth, R Prager, A Kossow, C Lang, S Simon, J Seidel, M Faber, A Schielke, K Michaelis, A Holzer, R Kamphausen, D Kalhöfer,S Thole , A Mellmann, A Flieger, K Stark

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22805

 

Nacho cheese-linked botulism cases; how?

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A father of two small kids, Martin Galindo-Larios Jr. has tragically died.
A 33 year old mother of three, Lavinia Kelly, is paralyzed, unable to speak or breathe on her own.
The New York Daily news cites, Theresa Kelly recalling her sister calling, unable to express what was wrong with her. “My phone rings and I pick up the phone it’s her and she can’t articulate a word,” she told the news station. “I’ve never seen my sister not have function of her body or not be able to communicate.”
There are at least eight others ill. From one of the scariest foodborne pathogens, C. botulinum. This is a terrible outbreak with a lot of unknowns.
All because of gas station nacho cheese.
The type of cheese comes in a bag, usually inserted into a dispenser that heats it up and holds it until someone pours it on their Doritos. The cheese linked to these illnesses, from Gehl Foods, is produced aseptically to be stored at room temperature. Unrelated, Gehl Foods had a recall on their dispensers a few years ago due to fire risks.
And much of the information that’s out there points to the cheese being the vehicle, but since all the illnesses are linked to one gas station, Valley Oak Food and Fuel gas station in Walnut Grove, California, it’s likely that storage, handling or both led to the illnesses.
Nozzles on food and beverage dispensers are notorious for soil and have been linked to listeria issues in the past. Its possible that buildup or contamination from hands or food placed a spore in the nozzle area – and it got sucked up into the anaerobic cheese bag. This only becomes an issue if the temperature of the cheese in the dispenser drops lower than 120F or so.
Maybe a food employee took a half empty bag out of the dispenser, and put an old cap back on the bag, and left it out at room temperature for a while (like hours or days) by accident. And then reinstalled it.
Or possibly there was a puncture of the bag in transport or storage that shoved a spore deep inside the cheese – and the product coagulated and hardened, resealing the package.
I’m done speculating now.
I told Laura Geggei at Live Science about botulism, and why it scares me.
The toxin blocks nerve messages, which, in turn, causes people to lose control of their muscles, Chapman told Live Science. For instance, people who have consumed the toxin may have trouble swallowing, droopy eyelids and difficulty breathing, he said.
“They are essentially paralyzed, as the toxin surrounds those nerves and blocks those messages,” Chapman told Live Science.
“People can recover only as the toxin gets scrubbed from their body, which is a long, horrible process,” Chapman said. “Some people never recover from it. I’ve seen cases of people, years later, still walking with a cane [and] having problems with speech.”

OMG: Someone at N.Y. Times said the obvious, use a thermometer, dumbass

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Emily Weinstein of The New York Times mentions the value of thermometers in an otherwise self-indulgent piece.

How do New York Times journalists use technology in their jobs and in their personal lives? Emily Weinstein, The Times’s deputy food editor, discussed the tech she’s using.

“Generally speaking, anything that helps you be more accurate as you work through a recipe — like an instant-read digital thermometer — is worth having.”

So respectable.

Nacho cheese linked to gas station botulism outbreak

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Before I moved to the south I hadn’t thought about a gas station as a place for a meal. Growing up in Ontario (that’s in Canada) I was familiar with a Tim Hortons/gas station combos, but there weren’t a lot of independent stations selling foods like here in North Carolina. Most gas stations are stocked at least with crockpots full of boiled peanuts or metal rollers frying hot dogs. Sometimes there are tacos, tamales, or bbq sandwiches.

Oh and nachos with a faucet that squirts cheese.

That kind of cheese has, according to the Sacramento Bee, been linked to a cluster of five cases of botulism at a California gas station.

On Wednesday, Sacramento County Public Health officials pinpointed the source of the botulism outbreak as “prepared food, particularly nacho cheese sauce” from Valley Oak Food and Fuel gas station in the Delta. Five people are hospitalized in serious condition with botulism, a rare but serious paralytic illness caused by a nerve toxin, and an additional patient is suspected of having the illness.

The gas station, which sits on a busy stretch of River Road across from the Walnut Grove Bridge, stopped selling food and drink products on May 5 after the county Department of Environmental Management temporarily revoked its permit. Employees of the gas station refused to comment this week on the suspected outbreak.

Some of the gas station nacho cheeses come in an aseptically sealed bag (right, exactly as shown) that can be stored at room temperature because of how they are processed, despite the high pH and high water activity. Kathy Glass and Ellin Doyle wrote a fantastic summary of the safety of processed cheeses and they highlight three bot outbreaks of cheese sauces in the past.

A single case of fatal botulism in California was associated with the consumption of a Liederkranz Brand canned cheese spread in 1951. Few details are available about the formulation and conditions under which this product was produced and stored. The product label indicated that it was a pasteurized process soft ripened cheese spread with citric acid and vegetable gum added. Moisture and salt levels were not reported, but pH of the product was 5.9.

Two decades later in 1974, a cheese spread with onions was implicated in an outbreak in Argentina that resulted in six cases of botulism and three deaths.. As with the Liederkranz product, this spread was not thermally processed to be commercially sterile nor was it formulated specifically for safety. Laboratory experiments revealed that botulinal toxin was produced in cheese spread samples with a similar formulation (pH 5.7, aw 0.97) after 30 to 70 days’ storage at 30oC.

A third outbreak involving process cheese resulted in eight cases of botulism and one death in Georgia in 1993. The implicated cheese sauce was aseptically canned to eliminate C. botulinum spores; therefore, it was not formulated to prevent botulinal growth. The epidemiological investigation suggested that the product was likely recontaminated in the restaurant with C. botulinum spores and stored at room tempera- ture for several days before use. Inoculation studies of the implicated cheese sauce (pH 5.8, aw 0.96) revealed that botulinal toxin was produced after 8 days’ storage at 22oC.

 

 

We’ve learned lessons but we’re not telling anyone: Public Health England accused of E. coli O55 cover up

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In Dec. 2014, an outbreak of E. coli 055 was identified in Dorset, U.K. with at least 31 sickened. Public Health England (PHE) and local environmental health officials investigated and found nothing, other than cats were also being affected.

Tara Russell of the Bournemouth Echo reports a nurse who fears her family’s lives will never be the same again after contracting the deadly E. coli bug has accused health officials of a ‘cover up.’

Jessica Archer and her nephew Isaac Mortlock, now five, were among the first of 31 people in Dorset who battled for their lives when they were diagnosed with hemolytic uremic syndrome (HUS) as a result of E. coli O55 in summer 2014.

Three years on, Isaac suffers with severe seizures, must be peg fed for 10 hours each night and will need a kidney transplant and Jessica endures crippling head pains, fatigue and depression as a result of the bug.

But though the families’ lives have changed irreversibly, they feel let down by the Public Health England (PHE) investigation.

Jessica, who completed the London Marathon to raise awareness of her family’s plight, said: “This illness has robbed us. We are no longer the same people. It’s very frightening how life can suddenly change in an instant and I’m sure if all the other families were sat around the table they would say exactly the same.

“If someone attempts to murder someone, that is taken very seriously. We have been close to death through whatever reason that may be, yet we feel it was not taken at all seriously and more and more and more people suffered.

“It feels like a cover up and we just believe there are too many questions that have been left unanswered.”

Isaac and Jessica became ill after the family had eaten together at a restaurant. Medics originally put symptoms down to gastroenteritis but they were later diagnosed with a severe life-threatening complication which attacked their kidneys, liver and brain and fought for life. Today Jessica said they face a daily battle for recovery.

“We were discharged within a day of each other and we were so naïve. We thought we’d get our lives back together. How wrong were we.

“I used to be fit and active, now there’s not a day I can say ‘I feel well today.’”

Isaac today suffers severe health and behavioural problems.

The investigation closed in March 2016 without the affected families being made aware and failed to find the source. The outbreak was only confirmed by PHE in response to enquiries made by the Bournemouth Echo in November 2014 after it struck a children’s nursery in Blandford – months after the initial outbreak.

Jessica said: “We’ve been in the dark throughout with absolutely no communication about the outbreak, investigation or what has happened since. If they’d have thought we were important enough to find the cause, little babies and children may not have been put through the same hell.

“All we can hope for is that lessons have been learned so no other family ever has to go through the same horrendous ordeal we are living. For us, every morning is a constant reminder that life for us will never be the same.”

This is normal in the U.K. where science-based agencies recommend cooking food to the standard of piping hot, and where 252 people were sickened with E. coli O157 in 2010 – 80 hospitalized, one death, possibly linked to potatoes and leeks – and the Food Standards Agency reminded people to wash their produce.

This is some fucked up shit.

Maybe that’s why I like John Oliver so much.

He says he’s British and has no human emotion.

It’s buried way, way down.

Russell of the Bournemouth Echo writes public health officials carried out a review of the E. coli outbreak in Dorset to ‘identify lessons learnt.’

Public Health England said it is a ‘learning organisation’ and ‘reflects on outbreaks’ however refused to reveal what these lessons were.

Dr Sarah Harrison, consultant in health protection at Public Health England South West said: “Our colleagues in Public Health England worked closely with partners to try and identify a possible common source of infection, but the investigations did not identify a single common source. It is very good news that there have been no further cases of infection with this strain in Dorset since the end of the outbreak in 2015, however we remain vigilant.

“PHE is a learning organisation and reflects on outbreaks to identify lessons learnt and to continually improve our response. A review of this outbreak was conducted at the time by staff involved in line with standard procedures.

“E coli VTEC can be a very serious infection and can be passed easily from person to person and young children are particularly easily affected. We know that the bacteria causing the infection can survive in the environment, so good hand hygiene is important to prevent the spread. Wash hands thoroughly using soap and water after using the toilet, before and after handling food and after contact with animals including farm animals. Small children should be supervised in washing their hands. Remove any loose soil before storing vegetables and thoroughly wash all vegetables and fruit that will be eaten raw.”

PHE said the investigation at the time was extensive with involvement from many organisations.

A statement read: “Control measures included extended screening and exclusion of cases and high risk contacts. Public Health England and the Animal and Plant Health Agency put in place enhanced surveillance of faecal samples in Dorset laboratories and environmental sampling to help determine the extent of this organism in the community. The only link common to all the cases was that they either lived in or had close links to the county. The outbreak investigation closed in March 2016.”

As John Oliver would say, cool.

As Jessica Archer would say, fuck off you bureaucratic assholes who spend work time watching goats singing Taylor Swift songs on the the Intertubes.

Bambi poops in water, 4 kids get sick with E. coli O157, 2016

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In May 2016, an outbreak of Shiga toxin–producing Escherichia coli O157 infections occurred among children who had played in a stream flowing through a park. Analysis of E. coli isolates from the patients, stream water, and deer and coyote scat showed that feces from deer were the most likely source of contamination.

In the United States, recreational water is a relatively uncommon source of Shiga toxin–producing Escherichia coli (STEC) O157 outbreaks (1). We describe an outbreak of STEC O157 infections among children exposed to a contaminated stream in northern California, USA, and provide laboratory evidence establishing wildlife as the source of water contamination.

In May 2016, four cases of Shiga toxin (Stx) 1– and 2–producing E. coli O157 infection were reported to a local health department in northern California; investigation revealed a common source of exposure. The case-patients, ranging in age from 1 to 3 years, had played in a stream adjacent to a children’s playground within a city park. Exposure of the case-patients to the stream occurred on 3 separate days spanning a 2-week period. Two case-patients are known to have ingested water while playing in the stream. Two case-patients were siblings. All case-patients had diarrhea and abdominal cramps; bloody diarrhea was reported for 3. One case-patient was hospitalized with hemolytic uremic syndrome.

The stream is a second-order waterway located in a northern California community of ≈7,500 residents. At the time of exposures, stream flow was <30 ft3/s. The land upstream is not used for agricultural activities such as livestock production. The community is serviced by a public sewer system; inspection of sewer lines indicated no breach to the system.

Water samples were collected from the exposure site 7 days after the last case-patient was exposed and weekly thereafter for 17 weeks; samples were tested quantitatively for fecal indicator organisms. Throughout the study period, all water samples exceeded recreational water quality limits for E. coli and enterococci levels (2). Water samples were also cultured for STEC isolation and PCR detection of stx1 and stx2 (3). Stx1- and Stx2-producing E. coli O157 were isolated from stream water each week for the first 4 weeks. Additionally, an Stx2-producing E. coli non-O157 strain was isolated from the stream in the first week of sampling. Enrichment broth cultures of water samples were also positive by PCR for stx1 and stx2 for the first 4 weeks of sampling. Thereafter, both stx1 and stx2, or stx2 only, were intermittently detected in enrichment broth cultures for 9 additional weeks.

In the absence of an obvious source (e.g., upstream agricultural operation or sewer leak), wildlife was considered as a possible contributor to water contamination. Thirteen fresh wildlife scat specimens were collected along the stream for STEC culture and PCR. Of the 13 scat specimens, 8 originated from deer, 2 from raccoon, and 1 each from coyote, turkey, and river otter. Six scat specimens (4 deer, 1 coyote, 1 river otter) were positive for stx1 and stx2 or for stx2 by PCR (Technical Appendix[PDF – 16 KB – 1 page]). Stx1- and Stx2-producing E. coli O157 were isolated from deer scat and coyote scat. An Stx2-producing E. coli non-O157 strain was isolated from a deer scat specimen. The animal origin of the coyote and river otter scat specimens were definitively identified by partial DNA sequencing of mitochondrial cytochrome b (4).

To assess strain relatedness, we compared STEC O157 isolates from the case-patients, water, deer scat, and coyote scat by using pulsed-field gel electrophoresis (PFGE) and multilocus variable-number tandem-repeat analysis (MLVA) (5). PFGE patterns for XbaI-digested genomic DNA were highly similar among all isolates; only slight variations were found in the lower-sized bands (Figure). PFGE patterns for genomic DNA samples digested with BlnI also demonstrated a high degree of similarity (data not shown). Furthermore, MLVA profiles were identical for the case-patient, water, and deer scat isolates; only the coyote scat isolate differed from the main profile by 2 repeats at a single locus (VNTR_3).

This study provides laboratory evidence linking STEC O157 infections with the ingestion of recreational water that was probably contaminated by wildlife scat. Wild ruminants, including deer and elk, are known carriers of STEC and have been connected to outbreaks of human infections (6–9). We detected STEC in 50% of deer scat specimens collected from the stream bank. One of these specimens, found 1.5 miles upstream of the exposure site, contained an E. coli O157 isolate that was highly similar by molecular subtyping to case-patient and water isolates. These findings support the likelihood that feces from deer carrying STEC were the source of water contamination or, at the very least, contributed to the persistence of STEC in the water. It is unknown whether the STEC detected in coyote and river otter scat represents carriage or transitory colonization within these animals.

The common risk factor among the case-patients in this STEC O157 outbreak was exposure to a natural stream within a city park. After the outbreak was recognized, signs warning of bacterial contamination were posted along the stream. No further STEC O157 infections attributed to stream water exposure were reported.

Dr. Probert is the assistant director for the Napa-Solano-Yolo-Marin County Public Health Laboratory. His research interests focus on the development of molecular diagnostic tools for the detection of infectious agents.

Acknowledgment

We thank Frank Reyes, Keith Snipes, and Nailah Souder for their technical assistance; the County of Marin Health and Human Services and Environmental Health Services for information about the epidemiologic and environmental investigation; and the Microbial Diseases Laboratory Branch of the California Department of Public Health and the Santa Clara County Public Health Laboratory for the molecular subtyping data.

References

Heiman KE, Mody RK, Johnson SD, Griffin PM, Gould LH. Escherichia coli O157 outbreaks in the United States, 2003–2012. Emerg Infect Dis. 2015;21:1293–301. DOIPubMed

United States Environmental Protection Agency. 2012. Recreational water quality criteria. Office of Water 820-F-12–058 [cited 2017 Apr 13]. https://www.epa.gov/sites/production/files/2015-10/documents/rwqc2012.pdf

Probert WS, McQuaid C, Schrader K. Isolation and identification of an Enterobacter cloacae strain producing a novel subtype of Shiga toxin type 1. J Clin Microbiol. 2014;52:2346–51. DOIPubMed

Parson W, Pegoraro K, Niederstätter H, Föger M, Steinlechner M. Species identification by means of the cytochrome b gene. Int J Legal Med. 2000;114:23–8. DOIPubMed

Hyytia-Trees E, Lafon P, Vauterin P, Ribot EM. Multilaboratory validation study of standardized multiple-locus variable-number tandem repeat analysis protocol for Shiga toxin–producing Escherichia coli O157: a novel approach to normalize fragment size data between capillary electrophoresis platforms. Foodborne Pathog Dis. 2010;7:129–36. DOIPubMed

Fischer JR, Zhao T, Doyle MP, Goldberg MR, Brown CA, Sewell CT, et al. Experimental and field studies of Escherichia coli O157:H7 in white-tailed deer. Appl Environ Microbiol. 2001;67:1218–24. DOIPubMed

Keene WE, Sazie E, Kok J, Rice DH, Hancock DD, Balan VK, et al. An outbreak of Escherichia coli O157:H7 infections traced to jerky made from deer meat. JAMA. 1997;277:1229–31. DOIPubMed

Rounds JM, Rigdon CE, Muhl LJ, Forstner M, Danzeisen GT, Koziol BS, et al. Non-O157 Shiga toxin–producing Escherichia coli associated with venison. Emerg Infect Dis. 2012;18:279–82. DOIPubMed

Laidler MR, Tourdjman M, Buser GL, Hostetler T, Repp KK, Leman R, et al. Escherichia coli O157:H7 infections associated with consumption of locally grown strawberries contaminated by deer. Clin Infect Dis. 2013;57:1129–34. DOIPubMed

 Contaminated stream water as source for Escherichia coli O157 illness in children

05.may.17

William S. Probert, Glen M. Miller, and Katya E. Ledin

Emerging Infectious Diseases, vol. 23, no. 7, July 2017

https://wwwnc.cdc.gov/eid/article/23/7/17-0226_article

Food Safety Talk 125: Slapping it on a bun

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Don and Ben talked big concerts, Flaming Lips (the band, not the anatomy) obscure Canadian bands covering Neil Young and then got into some food safety stuff like the particulars of deer antler tea, with some deer penis sprinkled in. The discussion went to the rules around home-based food businesses and how risk-based decisions are made in regulatory choices. The episode finished with some listener feedback on washing produce and mold and whether food employees at Blue Apron (and like mail-order businesses) should have local health department food handler training.

Episode 125 can be found here and on iTunes.

Show notes so you can follow along at home:

Rob Mancini: Why do folks insist on providing bad food safety advice?

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Our resident non-aging television personality and food safety dude, Rob Mancini, writes

Inside Edition’s Chief Investigative Correspondent and food safety expert knocked on the doors of random homes in Los Angeles to conduct surprise kitchen inspections. Homes were graded as either A (good) to C (bad).

They also provided food safety tips for homeowners.

In 2005, as part of my show, Kitchen Crimes for the Food Network (Canada) and HGTV (US), we looked at food safety in residential homes in Canada  and found some pretty incredible things.

While I appreciate the concept of a food safety expert going into peoples’ homes and inspecting for food violations, I’m not sure if I agree with their tips.

Tips below:

1. Check cutting boards for grooves from your knives. Those small crevices can house some dangerous bacteria. If you see grooves, throw it out.

2. To prevent cross-contamination, store raw meat, fish and poultry on the bottom shelf of your fridge, below your prepared and ready-to-eat food.

3. Store food in plastic containers with tight lids or wrap tightly with plastic wrap or aluminum foil to keep out bacteria, both in and out of the refrigerator.

4. Even a dishwasher gets dirty. Keep your dishwasher clean and free of food particles by wiping it down with distilled bleach and occasionally run an empty load with bleach instead of dish soap.

5. Set aside one day of the month to check expiration dates, especially meat, seafood, produce, eggs and dairy – expired foods can contaminate your safe food.

6. After preparing a meal, especially meat, wipe down surfaces with distilled bleach.

7. Regularly empty your refrigerator and wipe down the surfaces with distilled bleach – especially those lower shelves where you store your meats.

When Powell sent me this article last night, one of the first things I did this morning was pass along these tips to some of my fellow homeowner friends to get their thoughts. First thing out of their mouths was “What….distilled bleach, what is a homeowner going to do with this tip?? What does this even mean?  Do I need to wear gloves?  Do I dilute it?”

Precisely… bad food safety tip.  Kinda’ like using the term piping hot for internal food temperatures. Do not use distilled bleach, scrub your food contact surfaces with soap and water and rinse. The trick is to use friction when cleaning to dislodge bacteria and other like organisms off the surface. If you are adamant on using a sanitizer, try vinegar, worked for our ancestors.

Now onto cutting boards, every cutting board has grooves and even if they don’t, bacteria can still be embedded in some sort of fashion. Bacteria are small and even a freshly planed cutting board, whether it is plastic or wood, is not perfectly smooth under a microscope and will cause entrapment.

O. Pete Synder evaluated 3 types of cutting boards, a hard maple cutting board, plastic cutting board, and a stainless steel surface. In his study he found that rinsing a cutting board with a solution of 1 part 5% vinegar to 4 parts water was a more effective sanitizer than using a quaternary ammonium compound solution for removing aerobic bacteria from a food contact surface (1).

ENOUGH WITH THE DISTILLED BLEACH ALREADY, if they are advocating for the use of chlorine, please quantify. Keep in mind, this is not a restaurant and homeowners are not likely to have chlorine test strips to test their solution concentration causing a myriad of other concerns.

Do not pour bleach into your residential dishwasher as this will lead to corrosion of pipes and may damage the machine. If you see residual food particles left after a cycle, this is an indication that your dishwasher is probably working well. Not a food safety concern and bleach will only ruin your machine.

No mention of dishcloths or scrub pads. Results from show have shown that your ordinary dishcloth, scrub pads, and kitchen sinks are the dirtiest things in your kitchen.

Maybe it’s time for a Kitchen Crimes US Edition.

1.     O. Peter Snyder, Jr., Ph.D. 1997.The Microbiology Of Cleaning And Sanitizing A Cutting Board. Hospitality Institute of Technology and Management.