Update: Gastrointestinal Illness Associated with Imported
Semi-Soft Cheese
In September 1983, three clusters of gastrointestinal illness
associated with eating imported French Brie cheese occurred in the
District of Columbia (1). All three outbreaks involved one lot of
cheese and one distributor in the Washington, D.C., area. Cases of
similar clinical illness have subsequently been identified in four
states (Colorado, Georgia, Illinois, and Wisconsin) associated with
eating the same brand of semi-soft cheese (either Brie or
Camembert).
The lots implicated in these states included at least one lot
produced
approximately 40 days after the cheese that caused the District of
Columbia cases. Stool specimens were collected in Illinois and
Wisconsin from ill individuals and from well family members who did
not eat the cheese. Escherichia coli serotype O27:H20 producing a
heat-stable toxin was identified in stool specimens from seven of
15
recently ill persons and from none of eight controls. E. coli
O27:H20
organisms were also isolated from single cases in Washington, D.C.,
and Atlanta, Georgia. Plasmid analysis of the organisms from
patients
who lived in different locations and who ate different lots of
cheese
revealed an identical plasmid profile. Attempts to isolate the
organism from the cheese are in progress. Control measures
included
recalling the cheese nationwide and instituting a program of
regulatory sampling in cooperation with the French government for
the
importation of semi-soft cheeses.
Reported by BJ Francis, MD, State Epidemiologist, Illinois Dept of
Public Health; JP Davis, MD, State Epidemiologist, Wisconsin Dept
of
Health and Social Svcs; Emergency and Epidemiology Operations Br,
US
Food and Drug Administration; Div of Field Svcs, Epidemiology
Program
Office, Enteric Diseases Br, Div of Bacterial Diseases, Center for
Infectious Diseases, CDC.
Editorial Note
Editorial Note: Enterotoxigenic E. coli organisms commonly cause
diarrhea in developing countries (2), and they have also been
implicated as a common cause of travelers' diarrhea (3). They are
rarely associated with illness acquired in the United States,
Canada,
or Europe (4-6). This represents the third foodborne outbreak
caused
by enterotoxigenic E. coli and the first common-source outbreak due
to
a strain producing heat-stable enterotoxin reported in the United
States (7,8).
The association of a single pathogen with illness caused by
eating
semi-soft cheeses from at least two lots manufactured 1 month apart
suggests a continuing common source of contamination; however, no
information is yet available from the manufacturing plant in
France.
In a 1971 diarrheal-disease outbreak in the United States caused by
enteroinvasive E. coli contaminating Brie, Camembert, or Coulomiers
cheese produced by another French manufacturer, a contaminated
water
supply was implicated as the source of pathogenic organisms (9).
References
CDC. Gastrointestinal illness associated with imported Brie
cheese--District of Columbia. MMWR 1983;32:533.
Ryder RW, Sack DA, Kapikian AZ, et al. Enterotoxigenic
Escherichia coli and reovirus-like agent in rural Bangladesh.
Lancet 1976;I;659-62.
Merson MH, Morris GK, Sack DA, et al. Travelers' diarrhea in
Mexico. A prospective study of physicians and family members
attending a congress. N Engl J Med 1976;294:1299-305.
Brunton J, Hinde D, Langston C, Gross R, Rowe B, Gurwith M.
Enterotoxigenic Escherichia coli in central Canada. J Clin
Microbiol 1980;11:343-8.
Back E, Blomberg S, Wadstrom T. Enterotoxigenic Escherichia
coli
in Sweden. Infection 1977;5:2-5.
Gangarosa EJ. Epidemiology of Escherichia coli in the United
States. J Infect Dis 1978;137:634-8.
Taylor WR, Schell WL, Wells JG, et al. A foodborne outbreak of
enterotoxigenic Escherichia coli diarrhea. N Engl J Med
1982;306:1093-5.
Wood LV, Wolfe WH, Ruiz-Palacios G, et al. An outbreak of
gastroenteritis due to a heat-labile enterotoxin-producing
strain
of Esherichia coli. Infection and Immunity 1983;41:931-4.
Marier R, Wells JG, Swanson RC, Callahan W, Mehlman IJ. An
outbreak of enteropathogenic Escherichia coli foodborne disease
traced to imported French cheese. Lancet 1973;II:1376-8.
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