A Novel Culprit in a Patient with Budd-Chiari Syndrome.

Budd-Chiari syndrome (BCS) is an uncommon illness that is characterized by obstruction of hepatic venous outflow. Patients typically present with nausea, vomiting, and abdominal pain, which can further progress into signs associated with liver failure, including jaundice, encephalopathy, and coagulopathy. The most common causes of BCS include pathologies that induce portal vein thrombosis, such as myeloproliferative disorders, malignancy, and acquired hypercoagulable states. In this case report, a patient who presented with abdominal pain and distention is diagnosed with BCS caused by an unusual etiology. He was found to have significant eosinophilia, prompting additional evaluation for parasitic infections. Using stool diagnostics/studies, he was found to have Dientamoeba fragilis trophozoites. The patient was treated with enoxaparin, warfarin, and metronidazole with a resolution of his symptoms. This case outlines a novel cause of BCS as well as the proposed mechanism of Dientamoeba fragilis induction of BCS.

An Unexpected Complication of Endoscopic Retrograde Cholangiopancreatography with a Novel Treatment Approach.

Splenic injury after endoscopic retrograde cholangiopancreatography (ERCP) has been documented in less than 30 cases. Here, we present a case that involves a 52-year-old male with choledocholithiasis who developed a splenic injury and major hemorrhage immediately after ERCP. The patient ultimately required splenic artery embolization without splenectomy, a novel treatment approach. The case demonstrates the importance of having a high index of suspicion of this rare complication as well as discusses potential causes of post-ERCP splenic injury and a treatment approach that does not involve splenectomy.

Thermal Destruction of Escherichia coli O157:H7 in Hamburger †.

The inactivation of E. coli O157:H7 in ground beef patties cooked in a skillet was investigated. Ground beef patties inoculated with a mixture of five strains of E. coli O157:H7 were cooked in a Farberware skillet set at a temperature of 275°F (137°C). Eight type K thermocouples connected to a data logger were used to record the temperatures at eight points within the patty. The cooking times studied ranged from 2.25 min to 4 min. Tryptic soy agar plates overlaid with sorbitol MacConkey agar were used for recovery of E. coli O157:H7. Heating of ground beef patties to an internal temperature endpoint of 155°F (68.3°C) resulted in 4-log cycle reductions of the organism. The results of this investigation conducted under conditions simulating those that occur in the retail food industry provide a basis for ensuring safety against E. coli O157:H7 in ground beef patties.

Thermal Resistance of Nonproteolytic Type B and Type E Clostridium botulinum Spores in Phosphate Buffer and Turkey Slurry†.

The heat resistance of nonproteolytic type B and type E Clostridium botulinum spores in phosphate buffer and turkey slurry was determined from 70 to 90°C. Thermal-death times were determined in vials heated using a water bath. Recovery of heat-injured spores was on reinforced clostridial medium (RCM) and tryptic soy agar (TSA) with and without added lysozyme (10 µg/ml). Decimal-reduction times (D-values) were determined by fitting a survival model to the data using a curve-fitting program. The apparent or measured heat resistance was maximum with RCM supplemented with lysozyme. The D-values at 80°C for type E spores in buffer ranged from 1.03 min for strain Whitefish to 4.51 min for strain Saratoga. The D-value for the most heat-resistant nonproteolytic type B strain KAP B5 in buffer was 4.31 min at 80°C. The z-values in buffer for all strains were very similar, ranging from 8.35 to 10.08°C.Turkey slurry offered protection to the spores with a concomitant increase in heat resistance. The D-values in turkey slurry ranged from 51.89 min at 70°C to 1.18min at 85°C for type E strain Alaska (z = 9.90°C) and from 32.53 min at 75°C to 0.80 min at 90°C for nonproteolytic type B strain KAP B5 (z = 9.43°C). Thermal-death-time values from this study will assist food processors to design thermal processes that ensure safety against nonproteolytic C. botulinum in cook/chill foods.

Minimum and Maximum Temperatures for Growth and Verotoxin Production by Hemorrhagic Strains of Escherichia coli.

The influence of temperature on growth and verotoxin production by Escherichia coli strains was studied in brain heart infusion (BHI) broth both in shake cultures at various temperatures and in a temperature-gradient incubator. All strains of E. coli surveyed grew from at least 10 to 45°C, with some strains growing at 8° C. Verotoxin production (determined using the Vero cell-assay system) was a function of both temperature and time, with the highest titers produced at temperatures supporting the fastest growth (based on days to visible turbidity) and highest viable cell counts. However, for strains producing verotoxin, toxin production was detected at any temperature supporting growth. Three strains (of 16 tested) increased 1000-fold in viable count in 4 to 6 days at 10°C. The data presented here indicate that most E. coli strains surveyed can easily grow at ca. 10°C and thus suggest the potential for growth in temperature-abused refrigerated foods.

Model for the Anaerobic Growth of Aeromonas hydrophila K144.

The combined effects of temperature (5 to 42°C), NaCl (0.5 to 4.5%), pH (5.3 to 7.3), and NaNO2 (0 to 200 µg/ml) on the anaerobic growth of Aeromonas hydrophila K144 were studied in brain heart infusion broth using a modified central composite design. Variable combinations were tested in triplicate anaerobic flasks (nitrogen atmosphere in sealed trypsinizing flasks); viable cell counts were made at intervals during incubation by surface plating on tryptic soy agar. Growth curves were generated using the Gompertz equation in conjunction with a nonlinear regression analysis program. Values for the four Gompertz parameters (A, C, B, and M) were obtained for the variable combinations tested. Using response surface techniques, regressions were performed on Ln (B), Ln (M), Sqrt (B), and Sqrt (1/M); quadratic and cubic equations containing the four variables of temperature, NaCl, pH, and NaNO2 were developed to yield predictive values for the B and M Gompertz values. Goodness of fit evaluation of the models was determined by R2 values. Comparison of predicted and observed values of B and M and evaluation of predicted lag and generation times indicated that the quadratic model gave the best fit. Overall, the variable combinations interacted to affect the generation and lag times. The results indicate that pH, salt level, and nitrite level can be manipulated to decrease the growth of A. hydrophila when combined with low temperature incubation and anaerobic conditions.

Model for the Aerobic Growth of Aeromonas hydrophila K144.

The combined effects of temperature (5 to 42°C), NaCl (0.5 to 4.5%), pH (5.3 to 7.3), and NaN02 (0 to 200 µg/ml) on the aerobic growth of Aeromonas hydrophila K144 were studied in brain heart infusion (BHI) broth using a modified central composite design. Variable combinations were tested in triplicate aerobic flasks; viable cell counts were made at intervals during incubation by surface plating on tryptic soy agar. Growth curves were generated using the Gompertz equation in conjunction with a nonlinear iterative regression analysis. Values for the four Gompertz parameters (A, C, B, and M) were obtained for the variable combinations tested. Using response surface techniques, quadratic and cubic equations containing the four variables of temperature, pH, NaCl, and NaN02 were developed to yield predictive values for the B and M Gompertz values. Goodness of fit evaluation of the models was by R2 values. Comparison of predicted and observed values of B and M and evaluation of predicted lag times and generation times indicated that the quadratic model gave a better fit. Overall, the variable combinations interacted to decrease the generation time and increase the lag time. The results indicate that pH, salt, and nitrite can decrease the growth of A. hydrophila when combined with low temperature incubation.

Effect of Temperature, Relative Humidity, and Suspending Menstrua on the Resistance of Listeria monocytogenes to Drying.

The ability of Listeria monocytogenes to survive dehydrated storage at different temperatures (5 vs. 25°C) and relative humidities (75, 59, 35, 14, and 1%) when suspended in different menstrua was studied. L. monocytogenes survived longer when held at 5°C compared to 25°C, and when suspended in beef extract, glycerol, Karo syrup, skim milk, and canned milk compared to distilled water. The contribution of relative humidity to survival was less clear, though survival tended to be longer at the lower relative humidities. At 5°C when suspended in beef extract and held at relative humidities of 59% and below, there was less than a 2 log10 decline in the viable population (starting count ca. 105/coverslip). L. monocytogenes was not injured during drying or storage at the various relative humidities. In addition, based on the Listeria selective media evaluated, these Listeria media permitted quantitative recovery of the organism dried on surfaces. These results suggested that once L. monocytogenes has contaminated a food processing plant, it can persist for long periods in the plant environment if the temperature is low and the organism is protected by various food components.