title: An outbreak of febrile gastroenteritis associated with jellied pork contaminated with Listeria monocytogenes.
abstract: In September 2008, the Austrian Agency for Health and Food Safety (AGES) learned of an outbreak of diarrheal illness that included a 71-year-old patient hospitalized for gastroenteritis with a blood culture positive for Listeria monocytogenes. Three stool specimens provided by seven of 19 persons attending a day trip to a foreign city, including a final break at an Austrian tavern, yielded L. monocytogenes. All isolates were of serovar 4b and had fingerprints indistinguishable from each other. A cohort study revealed that the outbreak of gastroenteritis occurred among 16 persons who had eaten dinner at the wine tavern on September 6. Of the 15 persons who ate from platters of mixed cold-cuts, 12 (80%) developed symptoms of febrile gastroenteritis within 24-48 h. The median age of those who became ill was 62 years. A 72-year-old patient recovered from gastroenteritis but was hospitalized with bacterial meningitis on day 19 after the dinner. The epidemiological investigation identified the consumption of mixed cold-cuts (including jellied pork) at the wine tavern as the most likely vehicle of the foodborne outbreak (P = 0.0015). This hypothesis was confirmed by microbiological investigation of jellied pork produced by the tavern owner on September 3. L. monocytogenes was isolated from leftover food in numbers of 3 x 10(3)-3 x 10(4) colony forming units/g and was indistinguishable from the clinical outbreak isolates. Symptoms reported by the 12 patients included unspecified fever (12x), diarrhea (9x), headache (5x), vomiting (4x), body aches (2x) and sore throat (1x). Active case finding identified one case of rhombencephalitis (female, age 48) among another group of four guests, among whom only the patient and her asymptomatic husband had eaten jellied pork on September 6. This is the first outbreak of L. monocytogenes-associated gastroenteritis reported in Austria. The occurrence of a secondary case of meningitis (diagnosed on day 19 after consumption of jellied pork) indicates a significant risk of systemic listeriosis among elderly patients with febrile gastroenteritis caused by L. monocytogenes; antibiotic therapy should therefore be considered in such cases of documented listerial gastroenteritis.
authors.affiliation: Osterreichische Agentur für Gesundheit und Ernährungssicherheit (AGES), Wien, Austria.
authors.forename: Juliane
authors.initials: J
authors.lastname: Pichler
authors.forename: Peter
authors.initials: P
authors.lastname: Much
authors.forename: Sabine
authors.initials: S
authors.lastname: Kasper
authors.forename: Rainer
authors.initials: R
authors.lastname: Fretz
authors.forename: Bettina
authors.initials: B
authors.lastname: Auer
authors.forename: Julia
authors.initials: J
authors.lastname: Kathan
authors.forename: Michaela
authors.initials: M
authors.lastname: Mann
authors.forename: Steliana
authors.initials: S
authors.lastname: Huhulescu
authors.forename: Werner
authors.initials: W
authors.lastname: Ruppitsch
authors.forename: Ariane
authors.initials: A
authors.lastname: Pietzka
authors.forename: Karl
authors.initials: K
authors.lastname: Silberbauer
authors.forename: Christian
authors.initials: C
authors.lastname: Neumann
authors.forename: Ernst
authors.initials: E
authors.lastname: Gschiel
authors.forename: Alfred
authors.initials: A
authors.lastname: de Martin
authors.forename: Angelika
authors.initials: A
authors.lastname: Schuetz
authors.forename: Josef
authors.initials: J
authors.lastname: Gindl
authors.forename: Ernst
authors.initials: E
authors.lastname: Neugschwandtner
authors.forename: Franz
authors.initials: F
authors.lastname: Allerberger
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001317:Austria; D001921:Brain / Q000473:pathology; D015331:Cohort Studies; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D005516:Food Microbiology; D005517:Foodborne Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D005759:Gastroenteritis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008089:Listeria monocytogenes / Q000235:genetics; D008088:Listeriosis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008461:Meat Products / Q000382:microbiology; D008584:Meningitis, Listeria / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012703:Serotyping; D013552:Swine; D014195:Travel; D055815:Young Adult