title: Outbreak of Salmonella braenderup gastroenteritis due to contaminated meat pies: clinical and molecular epidemiology.
abstract: OBJECTIVE
  To determine the epidemiologic, clinical and molecular characteristics of an outbreak of severe gastroenteritis due to the ingestion of meat pies highly contaminated with Salmonella braenderup.
  
  
  METHODS
  In October 1993, we observed an outbreak of Salmonella braenderup gastroenteritis that occurred in the Lausanne area, Canton de Vaud, Switzerland. Cultures of suspected food products, of samples at the incriminated food factory and from workers, as well as a case-control study, were used to determine the source of the epidemics. Ribotyping of representative Salmonella braenderup strains was performed to define the molecular epidemiology. The clinical characteristics of this infection were determined by using a standardized interview performed during and 6 months after the outbreak in 156 of 215 identified patients.
  
  
  RESULTS
  The outbreak resulted from the ingestion of pies, heavily contaminated (> 106 CFU/g) with a strain of Salmonella braenderup. The contamination was due to mishandling and recycling of jelly poured on top of the products. According to its ribotype and plasmid characteristics, this strain had not been isolated previously in Switzerland. Ten of the 24 workers of the incriminated food factory were shedding the epidemic strain in their stools, and one of them reported gastroenteritis 3 weeks before the beginning of the outbreak. The estimated attack rate in the exposed population was 7.5%. The median incubation time was 18 h. Among 127 adult patients studied, 98% had diarrhea, 95% abdominal pain, 74% fever > or = 38.5 degrees C, 69% nausea and 35% vomiting. One patient developed prosthetic valve endocarditis, and one reactive arthritis. Long-term complications were not identified, although 12 patients complained of irritable bowel syndrome and 24 of unusual asthenia lasting for more than 6 weeks after infection. Children had more severe signs and symptoms compared to adults, and six of 29 needed hospitalization.
  
  
  CONCLUSIONS
  This study showed that ingestion of food highly contaminated with Salmonella braenderup resulted in severe but typical gastroenteritis and indicated mishandling of food during manufacture as the cause of this outbreak.
authors.affiliation: Department of Medecine, Hôpital de zone St-Loup Orbe, Pompaples, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Urfer
authors.forename: P
authors.initials: P
authors.lastname: Rossier
authors.forename: F
authors.initials: F
authors.lastname: Méan
authors.forename: M J
authors.initials: MJ
authors.lastname: Krending
authors.forename: A
authors.initials: A
authors.lastname: Burnens
authors.forename: J
authors.initials: J
authors.lastname: Bille
authors.forename: P
authors.initials: P
authors.lastname: Francioli
authors.forename: A
authors.initials: A
authors.lastname: Zwahlen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015169:Colony Count, Microbial; D004196:Disease Outbreaks; D005260:Female; D005511:Food Handling; D005759:Gastroenteritis / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008461:Meat Products / Q000382:microbiology*; D008875:Middle Aged; D012335:RNA, Ribosomal / Q000032:analysis; D021521:Ribotyping; D012475:Salmonella; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000209:etiology; D013557:Switzerland / Q000453:epidemiology
chemical_list: D012335:RNA, Ribosomal