title: Verotoxinogenic Citrobacter freundii associated with severe gastroenteritis and cases of haemolytic uraemic syndrome in a nursery school: green butter as the infection source.
abstract: A summer outbreak of severe gastroenteritis followed by haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura in a nursery school and kindergarten is described. Sandwiches prepared with green butter made with contaminated parsley were the likely vehicle of infection. The parsley originated from an organic garden in which manure of pig origin was used instead of artificial fertilizers. Clonally identical verotoxinogenic Citrobacter freundii were found as causative agents of HUS and gastroenteritis and were also detected on the parsley.
authors.affiliation: Robert Koch Institut, Wernigerode, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Tschape
authors.forename: R
authors.initials: R
authors.lastname: Prager
authors.forename: W
authors.initials: W
authors.lastname: Streckel
authors.forename: A
authors.initials: A
authors.lastname: Fruth
authors.forename: E
authors.initials: E
authors.lastname: Tietze
authors.forename: G
authors.initials: G
authors.lastname: Böhme
mesh_terms: D000328:Adult; D002079:Butter / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D016971:Citrobacter freundii / Q000302:isolation & purification*; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D004756:Enterobacteriaceae Infections / Q000453:epidemiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D005516:Food Microbiology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology; D005858:Germany / Q000453:epidemiology; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D016133:Polymerase Chain Reaction; D012578:Schools, Nursery; D014675:Vegetables / Q000382:microbiology
chemical_list: D002079:Butter