Sodium nitrite food poisoning in one family.

Sodium nitrite is used as a coloring agent or preservative in food, as well as an antimicrobial agent in meat and fish and some cheeses. In high amounts it can be toxic for humans, causing methemoglobinemia. This is an unusual and potentially fatal condition in which hemoglobin is oxidized to methemoglobin (MHb), reducing the amount of oxygen that is released from hemoglobin, similar to carbon monoxide poisoning. MHb levels of 70% are generally lethal, but the existence of underlying anemia, acidosis, respiratory compromise, and cardiac disease may exacerbate the toxicity of MHb. We present a case of poisoning with sodium nitrite in three family members after eating homemade sausages given to them by their neighbor who was a butcher. According to the findings of the veterinary inspectorate in charge of food control in this case, the concentration of sodium nitrite in the homemade sausages was about 3.5 g per 1 kg of meat, almost 30 times higher than allowed according to legislation. In this case report, a 70-year-old man died about 7 h after consuming the meal, while two women, 53 and 67 years of age, respectively, were admitted to a toxicology clinic the following day due to food poisoning, with the maximum concentration of MHb in blood of 33.7 and 20.4%, respectively. They were discharged 3 days later. The autopsy of the deceased man showed sodium nitrite poisoning with a relatively low concentration of MHb in his blood - 9.87%. Death was attributed to the exacerbation of hypertensive and ischemic heart disease, resulting from accidental sodium nitrite poisoning. The presented cases illustrate the necessity of close cooperation between the authorities, medical staff, veterinary inspectorate, and forensic pathologists in determining the source of poisoning, the cause of death of the victim, and preventing the outbreak of poisoning among a greater number of consumers.

A large outbreak of Campylobacter jejuni infection in a university college caused by chicken liver pâté, Australia, 2013.

In October 2013, public health authorities were notified of a suspected outbreak of gastroenteritis in students and guests following a catered function at a university residential college. A retrospective cohort study was undertaken to examine whether foods served at the function caused illness. A total of 56 cases of gastroenteritis, including seven laboratory-confirmed cases of Campylobacter jejuni infection, were identified in 235 eligible respondents. Univariate analysis showed a significant association with a chicken liver pâté entrée [relative risk (RR) 3·64, 95% confidence interval (CI) 2·03-6·52, P < 0·001], which retained significance after adjustment for confounding via multivariable analysis (adjusted RR 2·80, 95% CI 1·26-6·19, P = 0·01). C. jejuni and C. coli were also isolated in chicken liver pâté recovered from the college's kitchen. Subsequent whole genome multilocus sequence typing (wgMLST) of clinical and food-derived C. jejuni isolates showed three genetically distinct sequence types (STs) comprising ST528, ST535 (both clinically derived) and ST991 (food derived). The study demonstrates the value of utilizing complementary sources of evidence, including genomic data, to support public health investigations. The use of wgMLST highlights the potential for significant C. jejuni diversity in epidemiologically related human and food isolates recovered during outbreaks linked to poultry liver.

Detection of hepatitis E virus RNA in raw sausages and liver sausages from retail in Germany using an optimized method.

Hepatitis E virus (HEV) is a pathogen of increasing importance, which can be zoonotically transmitted from domestic pigs, wild boar, and deer to humans. Foodborne transmission by consumption of raw and undercooked liver, meat, or sausages prepared from infected animals has been documented. The aim of this study was to investigate the distribution of HEV in different types of sausages sold in Germany. As no standardized methods for HEV detection in food exist, several techniques of sample homogenization, virus concentration and nucleic acid extraction followed by real-time RT-PCR were compared using artificially contaminated sausages. A method using TRI Reagent® Solution showed the best efficacy of matrix disruption and a treatment with chloroform followed by a silica-based RNA extraction method resulted in the highest HEV detection rates. The detection limit of the method was 2.9 × 10(3) and 5.3 × 10(4) genome equivalents per 5 g raw sausage and 2 g liver sausage, respectively. Application of the method to raw and liver sausages from retail in Germany resulted in the HEV genome detection in 14 out of 70 (20%) raw sausages and in 11 out of 50 (22%) liver sausages. The detected HEV sequences showed a high diversity and belonged to different subtypes of HEV genotype 3. The results indicate a broad distribution of HEV-RNA in meat products sold in Germany; however, the infectivity of the detected virus remains to be assessed in future.

Foodborne botulism in Poland in 2013.

OBJECTIVES: The aim of the study is to assess the epidemiology of foodborne botulism in Poland in 2013. MATERIALS AND METHODS: We reviewed surveillance data published in the annual bulletin "Infectious diseases and poisonings in Poland in 2013" and in previous publications, and botulism case reports for 2013 sent to the Department of Epidemiology NIPH-NIH by Sanitary-Epidemiological Stations. RESULTS: In 2013, a total of 24 foodborne botulism cases (including 8 laboratory confirmed cases) was reported, corresponding to the lowest annual incidence rate (0.06 per 100,000 population) since the introduction of botulism as mandatory notifiable disease. The highest incidence in the country was reported in Kujawsko-Pomorskie (0.19). Incidence in rural areas (0.09 per 100,000 population) was more than 2-fold higher than the incidence in urban areas (0.04). Men, had more than 3 times higher incidence than women; the highest incidence rate (0.29 per 100,000 population) was observed among men in the age group of 40-49 years. Most cases were associated with consumption of different types of commercially canned meat. Commercially canned fish was also a common vehicle. All cases were hospitalized. No deaths related to the disease were reported. CONCLUSIONS: In 2013, in Poland a downward trend in the incidence of foodborne botulism was maintained. Insufficient laboratory capacity remains a major weakness in national surveillance resulting in disproportionate reporting of cases meeting only clinical criteria and an epidemiological link. This situation clearly speaks for the need to improve laboratory capacity for surveillance.

Transient renal Fanconi syndrome in a Chihuahua exposed to Chinese chicken jerky treats.

Transient Fanconi syndrome without azotemia was diagnosed in a dog and was associated with ingestion of Chinese chicken jerky treats. Fanconi syndrome is a proximal renal tubular defect and a diagnosis was made based upon severe glucosuria with normoglycemia, and severe generalized aminoaciduria. The clinical signs of polyuria and polydipsia as well as the massive urinary metabolic abnormalities resolved after jerky treat withdrawal. While frequently seen in North America and Australia, this is the first report of jerky treat induced Fanconi syndrome in continental Europe. Clinicians should be aware of this potential intoxication and be vigilant for a history of jerky treat consumption in a dog with glucosuria.

A time-resolved fluorescence immunoassay for the ultrasensitive determination of diethylstilbestrol based on the double-codified gold nanoparticles.

An ultrasensitive and selective method is presented for the determination of diethylstilbestrol (DES) using time-resolved fluorescence immunoassay (TRFIA) based on double-codified gold nanoparticles (DC-AuNPs). In this system, the DC-AuNPs, that are gold nanoparticles (AuNPs) modified with anti-DES antibody and SH-dsDNA-biotin, was regarded as signal amplifier. A competitive immunoreaction was performed on polystyrene microtitration plates, where the DES compete with the immobilized DES-ovalbumin on polystyrene microtitration plates to bind to anti-DES antibodies on DC-AuNPs, and the europium(III)-labeled streptavidin was added to link to the SH-dsDNA-biotin as a tracer. Fluorescence signal was amplified via the AuNPs and the biotin-streptavidin double amplification systems. Under the optimized condition, DES can be quantified by TRFIA. The linear range and the limit of detection of DES were 1.0×10(-6)-10ngmL(-1) and 0.4fgmL(-1), respectively. This method was applied to determine DES in beef sample, with the recoveries ranging from 88% to 105%.

Foodborne botulism in Poland in 2111.

OBJECTIVES: The main objective of this article is to assess the epidemiology of foodborne botulism in Poland in 2011, using national surveillance data. MATERIALS AND METHODS: We reviewed surveillance data published in the annual bulletin "Infectious diseases and poisonings in Poland" from 2005 to 2011, and botulism case reports from 2011 sent to the Department of Epidemiology NIPH-NIH by Sanitary-Epidemiological Stations. RESULTS: In 2011, a total of 35 foodborne botulism cases (including 21 laboratory confirmed cases) was reported, corresponding to the one of the lowest annual incidence rate (0.09 per 100,000 population) since the introduction of botulism as mandatory notifiable disease. The higher incidence rates compared to the previous year were in the Warminsko-Mazurskie, Kujawsko-Pomorskie, Lubelskie, Podkarpackie, Mazowieckie and Dolnoslaskie. Incidence in rural areas (0.13 per 100,000 population) was higher than the incidence in urban areas (0.07). Men, had more than 3,5 times higher incidence than women; the highest incidence rate (0.23 per 100,000 population) was observed among men in the age group of 60 + years. Most cases were associated with consumption of commercially canned meat (including pork and other types of meat). Home canned foods containing meats or vegetables and meats were also a common vehicle. Almost all cases were hospitalized (33 cases). One death related to the disease was reported. CONCLUSIONS: In 2011, in Poland epidemiology of the foodborne botulism remains stable. From the point of view of national surveillance, it is necessary to increase the percentage of cases investigated with laboratory tests.

[Autochtonous hepatitis E, an emerging infection: case report]. / Hépatite E autochtone, une pathologie émergente: à propos d'un cas.

Hepatitis E is rare in France but its increasing frequency makes it an emerging infection. Autochtonous hepatitis E is prevalent, largely confined to older men and currently caused by gentotype 3f. Patients with unexplained hepatitis should be tested by hepatitis E, even in the absence of travel from endemic areas. The diagnosis is based on serological testing (including detection of specific antibodies IgM and IgG, and sometimes by determination of antibody avidity) and nucleic acid amplification techniques which might used first.

A long-lasting outbreak of Salmonella Typhimurium U323 associated with several pork products, Denmark, 2010.

This paper shows that control of foodborne disease outbreaks may be challenging even after establishing the source of infection. An outbreak of Salmonella Typhimurium U323 infections occurred in Denmark from March to September 2010, involving 172 cases. Before the detection of human cases, several positive isolates of the outbreak strain had been found in a particular pig slaughterhouse and thus early traceback, investigation and control measures were possible. Several batches of pork and pork products were recalled and the slaughterhouse was closed twice for disinfection. No single common food item was identified as the outbreak source, but repeated isolation of the outbreak strain from the slaughterhouse environment and in pork and products as well as patient interviews strongly suggested different pork products as the source of infection. Furthermore, a matched case-control study identified a specific ready-to-eat spreadable pork sausage (teewurst) as the source of a sub-outbreak (matched odds ratio 17, 95% confidence interval 2·1-130).

[Botulism in Poland in 2010]. / Zatrucia jadem kielbasianym w Polsce w 2010 roku.

OBJECTIVE: The main objective of this article is to assess the epidemiology of foodborne botulism in Poland in 2010, using national surveillance data. In Poland, botulism is a mandatory notifiable disease based on the European Union case definition (probable or confirmed), however given limited laboratory capacity, in national surveillance we also use "possible" case definition for cases reported by physicians based on clinical symptoms (with no laboratory confirmation). RESULTS: The number of botulism cases reported has decreased over the past years. Between 2004-2008 the median annual number of cases in years 2004-2008 was 49, whereas in 2009 alone, was only 31 cases. In 2010 a total 32 botulism cases (0.08 per 100,000 inhabitants)--including 22 confirmed cases (in 20 cases--toxin type B, and in 2 -toxin type B / E was found) were reported. There was only one--'probable case'--reported on the basis of clinical symptoms and the presence of an 'epidemiological link' (exposure from the same source). Other cases (9 patients) were reported, on the basis of clinical diagnosis without laboratory confirmation and registered as 'possible cases'. Incidence in rural areas (0.18) was 9-fold higher than the incidence in urban areas. Men had higher (0.12) incidence than women (0.05); the highest incidence (0.17) was observed among people aged 50-59 years. All cases were people aged over 25 years of age. In 28% of all cases--homemade canned pork was implicated. Canned fish were also a common vehicle. All patients were hospitalized--for between 5 and 35 days (median 11 days). No deaths related to the disease were reported. CONCLUSIONS: Botulism in Poland is still an important epidemiological problem. A large number of poisonings is primarily due to consumption of homemade canned foods.

Epidemiological and microbiological investigation of a large outbreak of monophasic Salmonella Typhimurium 4,5,12:i:- in schools associated with imported beef in Poitiers, France, October 2010.

An outbreak due to the emerging monophasic Salmonella Typhimurium 4,5,12:i:- occurred in four schools in Poitiers in October 2010. Food trace-back investigation led to the identification of beef burgers as the cause of the outbreak and their subsequent withdrawal. The Institute for Public Health Surveillance conducted a retrospective epidemiological investigation to assess the extent of the outbreak and describe cases. Self-administered questionnaires were completed by students and personnel attending each of the four schools affected. Clinical cases were defined as anyone having eaten at the school when the beef burgers were served and reporting diarrhoea or fever with at least one digestive symptom (nausea, vomiting or abdominal pain), within five days after the incriminated school meal or with unknown date of onset within a 15-day period after the incriminated school meal. Of 1,559 persons exposed, 554 clinical cases were identified corresponding to an overall attack rate of 35.5%. Of 554 clinical cases, a total of 286 (53%) sought medical care and 31 (6%) were hospitalised for more than 24 hours. This multi-school outbreak is one of the biggest food-borne outbreaks of monophasic Salmonella Typhimurium 4,5,12:i:- described in France. Prompt notification of cases and rapid identification and withdrawal of the incriminated batch of beef burgers was crucial to limit the extension of this outbreak.

Development of an algorithm for assessing the risk to food safety posed by a new animal disease.

An algorithm was developed as a tool to rapidly assess the potential for a new or emerging disease of livestock to adversely affect humans via consumption or handling of meat product, so that the risks and uncertainties can be understood and appropriate risk management and communication implemented. An algorithm describing the sequence of events from occurrence of the disease in livestock, release of the causative agent from an infected animal, contamination of fresh meat and then possible adverse effects in humans following meat handling and consumption was created. A list of questions complements the algorithm to help the assessors address the issues of concern at each step of the decision pathway. The algorithm was refined and validated through consultation with a panel of experts and a review group of animal health and food safety policy advisors via five case studies of potential emerging diseases of cattle. Tasks for model validation included describing the path taken in the algorithm and stating an outcome. Twenty-nine per cent of the 62 experts commented on the model, and one-third of those responding also completed the tasks required for model validation. The feedback from the panel of experts and the review group was used to further develop the tool and remove redundancies and ambiguities. There was agreement in the pathways and assessments for diseases in which the causative agent was well understood (for example, bovine pneumonia due to Mycoplasma bovis). The stated pathways and assessments of other diseases (for example, bovine Johne's disease) were not as consistent. The framework helps to promote objectivity by requiring questions to be answered sequentially and providing the opportunity to record consensus or differences of opinion. Areas for discussion and future investigation are highlighted by the points of diversion on the pathway taken by different assessors.

[Botulism in Poland in 2009]. / Zatrucia jadem kielbasianym w Polsce w 2009 roku.

Atotal number of 31 foodborne botulism cases were registered in Poland in 2009 (incidence rate 0.08 per 100,000 population), in rural areas--22 cases (incidence 0.15) and in urban areas--9 cases (incidence 0.04). There were 22 sporadic cases (71%), 3 outbreaks of two persons and 1 outbreak involving three persons. Tinned pork meat (especially homemade) was the main vehicle of infection botulin toxin. One death due to foodborne botulism was reported.

Outbreak of invasive listeriosis associated with the consumption of hog head cheese--Louisiana, 2010.

During January-June 2010, a total of 14 cases of laboratory-confirmed invasive listeriosis were reported to the Louisiana Office of Public Health (OPH). Isolates of Listeria monocytogenes from the blood samples of eight patients were identified as serotype 1/2a and had pulsed-field gel electrophoresis (PFGE) pattern combinations that were indistinguishable from one another. The detection of this cluster prompted an investigation in coordination with CDC, the Louisiana Department of Agriculture and Forestry (LDAF), and the U.S. Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS). In-depth epidemiologic and environmental investigations of the cluster were initiated on July 26, including food history interviews of four patients. Three patients reported eating hog head cheese (a meat jelly made from swine heads and feet); the product was purchased at two grocery stores in Louisiana. A traceback investigation determined that a single brand of hog head cheese was common between the two grocery stores. L. monocytogenes serotype 1/2a was cultured from one of three product samples and from two of 16 environmental samples collected by LDAF at the processing establishment; the product and one of the two environmental samples yielded isolates with PFGE pattern combinations that were indistinguishable from the patient isolates. On August 14, LDAF coordinated a voluntary recall of approximately 500,000 pounds of hog head cheese and sausage because of possible contamination with L. monocytogenes. This is the first published report of an invasive listeriosis outbreak associated with hog head cheese, which is a ready-to-eat (RTE) meat. USDA-FSIS has a "zero tolerance" policy for L. monocytogenes contamination of RTE food products, requesting recall of such products at any detectable level of L. monocytogenes contamination. LDAF imposes and enforces equivalent requirements in state-inspected establishments.

Cohort study of a campylobacteriosis outbreak associated with chicken liver parfait, United Kingdom, June 2010.

In an outbreak of 24 cases of gastroenteritis among guests at a wedding reception, 13 cases had confirmed Campylobacter infection. In a cohort study, univariate analysis revealed a strong association with consumption of chicken liver parfait: risk ratio (RR): 30.08, 95% confidence interval (CI): 4.34-208.44, p<0.001, which remained after adjustment for potential confounders in a multivariable model: RR=27.8, 95% CI=3.9-199.7, p=0.001. These analyses strongly support the hypothesis that this outbreak was caused by the consumption of chicken liver parfait.

[Botulism in Poland in 2008]. / Zatrucia jadem kielbasianym w Polsce w 2008 roku.

A total number of 46 foodborne botulism cases were registered in Poland in 2008 (incidence rate 0.12 per 100,000 population), in rural areas--28 cases (incidence 0.19) and in urban areas--18 cases (incidence 0.08). There were 36 sporadic cases (78%), 2 outbreaks of two persons and 2 outbreaks involving three persons. Tinned meat (especially home made) was the main vehicle of infection botulin toxin. There were no deaths reported due to botulism.

[Botulism in Poland in 2007]. / Zatrucia jadem kielbasianym w Polsce w 2007 roku.

A total number of 49 foodborne botulism cases were registered in Poland in 2007 (incidence rate 0.13 per 100,000 population), in rural areas--37 cases (incidence 0.25) and in urban areas--12 cases (incidence 0.05). There were 31 sporadic cases (60%), 6 outbreaks of two persons and 2 outbreaks involving three persons. Tinned meat (especially home made) was the main vehicle of botulin toxin. One death from foodborne botulism was registered.