This case of cyclospora may have no relation to the Canadian outbreak; or may.
A 64-year-old French [female] with type 2 diabetes mellitus was referred to our department on [Mon 3 Jul 2017] because she was suffering from protracted diarrhea.
Symptoms began on [Sat 10 Jun 2017] as she was just returning from a touristic trip in Cancun (Quintana Roo State, Mexico) where she stayed from [Mon 29 May to Fri 9 Jun 2017] with her husband.
She acknowledged having moderate watery diarrhea with abdominal discomfort, bloating, transient vomiting, 5 kg weight [approx. 11.02 pounds] loss and fatigue. Empiric therapy with oral Metronidazole 500 mg 3 times a day for 7 days she received previously failed to improve her symptoms. Of note, a 1st microscopic stool examination failed to identify parasites and no enteropathogenic bacteria was found by culture on selective media.
Up to 3 extra stool specimens where sent to the laboratory of clinical parasitology in our hospital.
Oocysts of Cyclospora cayetanensis where evidenced by autofluorescence after Bailenger concentration technique.
Now, a trial has begun for two former executives of French frozen food company SEB, charged with a “deliberate violation of safety obligations” that put customers at risk and caused involuntary injuries. Their trial began on Tuesday, June 6, and the two men face prison if convicted.
SEB has since gone out of business.
According to The Local, in 2011 a two-year-old boy named Nolan Moittie was one of 17 people in France who became seriously ill after eating steak hachés, or chopped steak patties, that were contaminated with E. coli bacteria, and which had been sold frozen at a Lidl grocery store. The illness caused the two-year-old boy to have a heart attack and fall into a coma while in the hospital.
Travel woes en route to an FAO meeting (oh, that is a food safety hook) in Russia resulted in me having 12 hours to kill in Paris. Instead of staying in the city, I did something today that I’ve thought about for a while but had not had the chance- rented the world’s smallest stick shift car and traveled to Normandy. I drove through the French countryside and walked along Juno Beach where many Canadians landed on D-Day.
Most emotional for me was seeing an area of the world that had an impact on my life – the small villages of Le Mesnil-Patry and Norrey-en-Bessin. My grandfather, who Sam is named for, was part of a small group of seven that survived a battle where their company lost 98 soldiers. My grandfather was awarded a Distinguished Conduct Medal. Although we were very close he never spoke about it.
An investigation launched after 300 children fell ill in the town of Rouen named the culprit as gone-off cheese served up by school canteens.
One parent said her child would be avoiding school meals after the scandal, telling local media: “I’d prefer to take them to a fast food place”.
Local authorities inspected the producers of the cheese – a soft, mould-ripened local variety called neufchâtel – but were unable to identify the origin of the contamination.
The children began to suffer headaches, vomiting and stomach aches after eating the cheese at 54 different primary schools and nurseries on 27 April.
A survey of 1,000 parents of children in the region, both those affected and not affected by the outbreak, found a “strong association between the consumption of the cheese and the appearance of digestive symptoms,” according to the local health board.
The aim of this study was to identify and characterise Bacillus cereus from a unique national collection of 564 strains associated with 140 strong-evidence food-borne outbreaks (FBOs) occurring in France during 2007 to 2014.
Starchy food and vegetables were the most frequent food vehicles identified; 747 of 911 human cases occurred in institutional catering contexts. Incubation period was significantly shorter for emetic strains compared with diarrhoeal strains.
A sub-panel of 149 strains strictly associated to 74 FBOs and selected on Coliphage M13-PCR pattern, was studied for detection of the genes encoding cereulide, diarrhoeic toxins (Nhe, Hbl, CytK1 and CytK2) and haemolysin (HlyII), as well as panC phylogenetic classification. This clustered the strains into 12 genetic signatures (GSs) highlighting the virulence potential of each strain. GS1 (nhe genes only) and GS2 (nhe, hbl and cytK2), were the most prevalent GS and may have a large impact on human health as they were present in 28% and 31% of FBOs, respectively.
Our study provides a convenient molecular scheme for characterisation of B. cereus strains responsible for FBOs in order to improve the monitoring and investigation of B. cereus-induced FBOs, assess emerging clusters and diversity of strains.
Baccillus cereus-induced food-borne outbreaks in France, 2007 to 2014: Epidemiology and genetic characteristics
Eurosurveillance, Vol 21, Issue 48, 01 December 2016
Thanks to my French friend, Albert Amgar, for sending this along.
Between Tuesday 1 September 2015 and Wednesday 2 September 2015, the health monitoring and emergency platform of the Regional Health Agency (ARS) of Haute-Normandie received reports of three suspected cases of collective food poisoning due to Salmonella.
These foodborne outbreaks were reported by local laboratories in the same geographical area of the Seine-Maritime (76) district. The first investigative elements contributed to identify that each of the three families had consumed traditionally-prepared ham purchased from the same delicatessen butcher within the 24 to 48 hours preceding the date of symptoms onset among the reported cases.
The epidemiological, microbiological and environmental investigations performed following this report identified a total of 68 cases, including 6 biologically confirmed cases. The results of the cohort study that followed indicated an association between the consumption of prepared meals which were purchased from a delicatessen butcher, and the risk of occurrence of salmonellosis.
Bacteriological analyses identified a strain of Salmonella typhimurium 4,12: i: – with the same Crispol type (CT 797), rarely identified until now. The veterinary survey highlighted several dysfunctions explaining a diffuse contamination of surfaces and tools in the premises and in the food produced by the butcher.
Investigation of a cluster of salmonellosis in the Seine-Maritime district linked to the attendance of a delicatessen butcher in September 2015
Rapport d’investigation. Saint-Maurice : Santé publique France ; 2016. 16 p.
Epidemiological investigations following the initial notification on 30 December 2014 of five cases of salmonellosis (two confirmed S. Enteritidis) in young children residing in the Somme department revealed that all cases frequented the same food bank A. Further epidemiological, microbiological and food trace-back investigations indicated frozen beefburgers as the source of the outbreak and the suspected lot originating from Poland was recalled on 22 January 2015. On 2 March 2015 a second notification of S. Enteritidis cases in the Somme reinitiated investigations that confirmed a link with food bank A and with consumption of frozen beefburgers from the same Polish producer. In the face of a possible persistent source of contamination, all frozen beefburgers distributed by food bank A and from the same origin were blocked on 3 March 2015. Microbiological analyses confirmed contamination by S. Enteritidis of frozen beefburgers from a second lot remaining in cases’ homes. A second recall was initiated on 6 March 2015 and all frozen beefburgers from the Polish producer remain blocked after analyses identified additional contaminated lots over several months of production.
Outbreak of Salmonella Enteritidis linked to the consumption of frozen beefburgers received from a food bank and originating from Poland: Northern France, December 2014 to April 2015
Eurosurveillance, Volume 21, Issue 40, 06 October 2016
During phase 1, a message on Facebook asked the racers to report by email any symptoms. In phase 2, a retrospective study was conducted through an interactive questionnaire for all participants. Cross-sectional descriptive studies were conducted, completed by an analytical study of the potential risks factors. Microbiological and environmental investigations were conducted in order to identify the responsible agent. An analysis of antidiarrhoeal drugs reimbursements was conducted with data from the French national health insurance to confirm the epidemiological investigation.
During phase 1, on 8229 registered participants, at least 1001 adults reported an AG, which was resolved in 48H.
In phase 2, the risks factors of AG identified were due to: younger participants, first hour of departure time and ingestion of mud. Twenty stool specimens traced were negative for bacteriological research. Only 4 stool specimens were sent to the CNR of enteric viruses. They were all positive for Norovirus genogroup1 and genotype 2 (GI.2), strain of human origin.
Indicator bacteria were negative in the drinking water and positive in the muddy water. Outbreak origin was due to human transmission: a norovirus possibly introduced by stools or vomiting from one or more persons infected, transmitted through contaminated muddy water.
For the future, recommendations for the organisation of such events should be proposed. The risks related to these races should be assessed to guide health authorities and to guide organizers in their awareness of potential risks factors.
Investigation of an outbreak of acute gastroenteritis among participants of an Obstacle Adventure Race Alpes-Maritimes
Methods – A questionnaire was administered to 98 wedding participants who were asked to give a blood sample. Cases were identified by RT-PCR and anti-HEV serological tests. A retrospective cohort study was conducted among 38 blood sampled participants after the exclusion of participants with evidence of past HEV immunity. Relative risks (RR) with their 95% confidence intervals were calculated based on foods consumed at the wedding meal using univariate and multivariable Poisson regressions.
The human HEV strains were compared with the strains detected in the liquid manure sampled at the farm where the piglet was born and at the inlet of the island wastewater treatment plants.
Results – 17 cases, including 3 confirmed cases, were identified and 70.6% were asymptomatic. Acute HEV infection was independently associated with piglet stuffing consumption (RR=1.69 [1.04-2.73]). Human strains from the index cases, veterinary and environmental HEV strains were identical.
Discussion – The outbreak was attributable to the consumption of an undercooked pig liver-based stuffing. After infection, the cases have probably become a temporary reservoir for HEV, which was detected in the island’s untreated wastewater.
Hepatitis E outbreak associated with the consumption of a spit-roasted piglet, Brittany (France), 2013
Épidémie d’hépatite E associée à la consommation d’un porcelet grillé à la broche, Bretagne, 2013. Bull Epidémiol Hebd. 2016;(26-27):444-9
Y Guillois, F Abravanel, T Miura, N Pavio, V Vaillant, S Lhomme, et al.
Jenina Pellegren of Contagion Live writes that Enterohemorrhagic Escherichia coli (EHEC) are a subset of Shiga toxin–producing E. coli (STEC) that cause diarrhea and hemorrhagic colitis. The illness can progress to hemolytic uremic syndrome (HUS) in 5%-10% of cases.
In France between 2005 – 2014, a total of 54 patients were infected with EHEC O80:H2; 91% had HUS. Two patients had invasive infections and 2 died. Similar strains were found in Spain with all isolates belonging to the same clonal group.
“Azithromycin decreased Shiga toxin in subinhibitory concentrations significantly. Ciproflaxacin increased it substantially and ceftriaxone had no major effect. The occurrence of bacteremia during EHEC infections warranted antibiotic treatment. However, antibiotics are not usually recommended because of the risk for worsening HUS, notably by the secretion of Shiga toxin (Stx). This represents a therapeutic challenge.”
In 2011, an outbreak in Germany linked to EHEC O104:H4 underscored the potential benefit of certain antibiotics when HUS occurs, making the use of antibiotics a source of debate. To determine the incidence rate of HUS cases associated with the singular EHEC O80:H2, a study examined the effects of different antibiotics on Stx production in representative strains.
During January 2005 – October 2014 The Centre National de Reference Associe Escherichia coli, in France, collected 57 different strains of EHEC O80:H2. Isolated from stool specimens of over 54 patients; 2 and 3 isolates each were recovered from 2 patients.
According to the Center for Disease Control and Prevention (CDC) “Among the 53 patients for whom clinical data were available, 49 (91%) had HUS; 27 (51%) were male. Median age for these 48 patients was 1.2 years (range 0.2–39 years, interquartile range [IQR] 0.7–1.6 years). Only 1 adult HUS patient (a 39-year-old) was reported. The 5 (9%) non-HUS patients were largely older (1, 2, 6, 21, and 40 years old). Among HUS patients, fever was present in 45%; median leukocyte count was 13,000 cells/mm3 (data were not available for 14 patients), and 56% had leukocytosis (>11,500 leukocytes/mm3).”
Several studies demonstrated that the effect of antibiotics on HUS depends on their class. Ciprofloxacin raises the production and release of Stx in vitro and is associated with a higher mortality rate in pigs. Yet, other studies indicate azithromycin might decrease the production and release of Stx. However, during a 2011 outbreak of EHEC O104 infection in Germany, a patient treated by ciprofloxacin plus imipenem unexpectedly had a better prognosis.
Despite promising in vitro results, the authors of the study could not advocate the use of these antibiotics for treatment of patients infected with EHEC O80:H2. While potentially promising, these findings are preliminary and require confirmation.