title: First Report of a Foodborne Providencia alcalifaciens Outbreak in Kenya.
abstract: Providencia alcalifaciens is an emerging bacterial pathogen known to cause acute gastroenteritis in children and travelers. In July 2013, P. alcalifaciens was isolated from four children appearing for diarrhea at Kiambu District Hospital (KDH) in Kenya. This study describes the outbreak investigation, which aimed to identify the source and mechanisms of infection. We identified seven primary and four secondary cases. Among primary cases were four mothers who had children and experienced mild diarrhea after eating mashed potatoes. The mothers reported feeding children after visiting the toilet and washing their hands without soap. P. alcalifaciens was detected from all secondary cases, and the isolates were found to be clonal by random amplified polymorphic DNA (RAPD) fingerprinting. Our study suggests that the outbreak was caused by P. alcalifaciens, although no fluid accumulation was observed in rabbit ileal loops. The vehicle of the outbreak was believed to be the mashed potato dish, but the source of P. alcalifaciens could not be confirmed. We found that lack of hygiene, inadequate food storage, and improper hand washing before food preparation was the likely cause of the current outbreak. This is the first report of a foodborne infection caused by P. alcalifaciens in Kenya.
authors.affiliation: Centre for Infectious Disease Research in Asia and Africa, Institute of Tropical Medicine Nagasaki University, Nagasaki, Japan; Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute Project, Nairobi, Kenya; Department of Tumor and Diagnostic Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan shah@nagasaki-u.ac.jp ichinose@nagasaki-u.ac.jp.
authors.forename: Mohammad Monir
authors.initials: MM
authors.lastname: Shah
authors.affiliation: Centre for Infectious Disease Research in Asia and Africa, Institute of Tropical Medicine Nagasaki University, Nagasaki, Japan; Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute Project, Nairobi, Kenya; Department of Tumor and Diagnostic Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Erick
authors.initials: E
authors.lastname: Odoyo
authors.affiliation: Centre for Infectious Disease Research in Asia and Africa, Institute of Tropical Medicine Nagasaki University, Nagasaki, Japan; Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute Project, Nairobi, Kenya; Department of Tumor and Diagnostic Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Larson
authors.affiliation: Centre for Infectious Disease Research in Asia and Africa, Institute of Tropical Medicine Nagasaki University, Nagasaki, Japan; Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute Project, Nairobi, Kenya; Department of Tumor and Diagnostic Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Ernest
authors.initials: E
authors.lastname: Apondi
authors.affiliation: Centre for Infectious Disease Research in Asia and Africa, Institute of Tropical Medicine Nagasaki University, Nagasaki, Japan; Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute Project, Nairobi, Kenya; Department of Tumor and Diagnostic Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Kathiiko
authors.affiliation: Centre for Infectious Disease Research in Asia and Africa, Institute of Tropical Medicine Nagasaki University, Nagasaki, Japan; Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute Project, Nairobi, Kenya; Department of Tumor and Diagnostic Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Miringu
authors.affiliation: Centre for Infectious Disease Research in Asia and Africa, Institute of Tropical Medicine Nagasaki University, Nagasaki, Japan; Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute Project, Nairobi, Kenya; Department of Tumor and Diagnostic Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakashima
authors.affiliation: Centre for Infectious Disease Research in Asia and Africa, Institute of Tropical Medicine Nagasaki University, Nagasaki, Japan; Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute Project, Nairobi, Kenya; Department of Tumor and Diagnostic Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan shah@nagasaki-u.ac.jp ichinose@nagasaki-u.ac.jp.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ichinose
mesh_terms: D000293:Adolescent; D002648:Child; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D004196:Disease Outbreaks; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D011532:Providencia / Q000302:isolation & purification; D011198:Solanum tuberosum / Q000382:microbiology