[Diagnosis and epidemiological investigation of an outbreak of Clostridium perfringens food poisoning].
OBJECTIVE
Clostridium perfringens is a classical agent of food-borne disease but because of the mildness and self-limiting nature of the illness, many cases are undiagnosed. This study describes the investigation of an outbreak of diarrhea due to C. perfringens in a public restaurant.


METHODS
An epidemiological survey was performed and the restaurant was inspected. The specific attack rates for the items on the menu were calculated. Odds ratios were calculated to investigate the independent association between each item and the disease using a logistic regression model. Investigation of C. perfringens toxin in the feces of four symptomatic subjects and one exposed but asymptomatic subject was performed by the reverse passive latex agglutination test.


RESULTS
The overall attack rate was 70.8%. The main symptoms were diarrhea (100%) and abdominal pain (94%). Significant differences were found in specific attack rates for consumption of different menu items. However, the independent contribution of each item was significant only for consumption of "ravioli with cheese sauce". Fecal detection of C. perfringens enterotoxin was positive in the four symptomatic subjects and negative in the exposed but asymptomatic subject.


CONCLUSIONS
The overall attack rate in this outbreak was high. The clinical symptomatology was similar to previously published data. The epidemiological analysis revealed "ravioli with cheese sauce" to be responsible for transmission of the disease and clinical investigation together with the fecal enterotoxin detection established C. perfringens as the etiological agent.
Sanz
Juan Carlos
JC
Laboratorio Regional de Salud Pública. Dirección General de Salud Pública. Consejería de Sanidad Comunidad de Madrid, España.
Domínguez
María Felicitas
MF
Sagües
María Jesús
MJ
Fernández
Marisa
M
Feito
Ricardo
R
Noguerales
Rosa
R
Asensio
Angel
A
Fernández De La Hoz
Karoline
K
D000293:Adolescent; D000328:Adult; D000818:Animals; D001427:Bacterial Toxins / Q000009:adverse effects* / Q000302:isolation & purification; D002135:Calcium-Binding Proteins; D002417:Cattle; D002611:Cheese / Q000382:microbiology; D002648:Child; D003016:Clostridium perfringens / Q000302:isolation & purification*; D004196:Disease Outbreaks; D005243:Feces / Q000737:chemistry; D005260:Female; D005506:Food Contamination; D005511:Food Handling / Q000379:methods / Q000592:standards; D005516:Food Microbiology; D005517:Foodborne Diseases / Q000453:epidemiology / Q000382:microbiology*; D005759:Gastroenteritis / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007841:Latex Fixation Tests; D008460:Meat / Q000382:microbiology; D016017:Odds Ratio; D012147:Restaurants; D013030:Spain / Q000453:epidemiology; D010738:Type C Phospholipases / Q000009:adverse effects* / Q000302:isolation & purification
D001427:Bacterial Toxins; D002135:Calcium-Binding Proteins; D010738:Type C Phospholipases; C040649:alpha toxin, Clostridium perfringens