From October 15, to October 21, 1983, 28 cases of foodborne
botulism occurred in Peoria, Illinois. All 28 persons had eaten at
the same restaurant from October 14 to October 16; all were
hospitalized. Twelve patients required ventilatory support, and no
deaths have been reported. Botulinal type A toxin was detected in
serum and/or stool specimens in 13 patients. The epidemiologic
investigation implicated sauteed onions served on a patty-melt
sandwich as the source of the botulinal toxin.
The patients were 20-72 years of age, and 20 were female.
Detailed food histories were obtained from the patients and from
groups of well persons who had consumed food at the restaurant
during
the same 3-day period. Each of these comparisons showed a highly
significant association between eating a patty-melt sandwich and
developing botulism (p 0.001). Of the 28 patients, 24 recalled
eating the patty-melt, which consisted of toasted rye bread, sliced
American cheese, one-half or one-third pound hamburger patty, and
sauteed onions. The remaining four patients recalled eating a
variety
of food items, none of which were implicated by epidemiologic data.
Review of the serving practices in the restaurant indicated that
the
same utensils were used in serving multiple food items, including
the
patty-melt.
An additional case-control study was conducted to determine
which
items on the patty-melt were associated with illness. Eighteen
persons who had eaten the patty-melt during the 3-day period and
remained well were identified through repeated news media
announcements. These 18 controls, plus the 24 patients who ate
patty-melts, represented 42 of the estimated maximum of 45
patty-melts
served over the 3-day period. All 24 patients, but only 10 of 18
controls, reported eating the sauteed onions (p = 0.0004). The
onions
were said to have been prepared daily with fresh whole onions,
margarine, paprika, garlic salt, and a chicken-base powder; they
were
held uncovered in a pan with a large volume of melted margarine on
a
warm stove (below 60 C (140 F)) and were not reheated before
serving.
The original batch of sauteed onions was not available for
culture
or toxin testing, but type A botulinal toxin was detected in an
extract made from washings of a discarded foil wrapper used by one
of
the patients to take a patty-melt home. Type A botulinal spores
were
cultured from five of 75 skins of whole onions taken from the
restaurant. No other ingredients of the sauteed onions contained
botulinal toxin or spores. Additional laboratory tests are
pending.
Reported by SC Doughty, MD, RP O'Connor, MD, St. Francis
Hospital-Medical Center and Methodist Medical Center, J Alexander,
MD,
GJ Sidler, MD, St. Francis Hospital-Medical Center, Peoria, S
Churchill, JW Parker, PhD, R Tarter, T Woods, TF Jackamore, Jr,
Staff,
Peoria City/County Health Dept, JC Bhalerao, MD, Cottage Hospital,
Galesburg, EJ Menamin, MD, Hindsdale Hospital, Hindsdale, P Hays,
MD,
Riverside Medical Center, Kankakee, M McVay, MD, Community Hospital
of
Ottawa, C Gibson, C Langkop, RJ Martin, DVM, BJ Francis, MD, State
Epidemiologist, Illinois Dept of Public Health; US Food and Drug
Administration--Chicago District Office, Chicago, Emergency and
Epidemiology Operations Br, Rockville, Maryland, Region V
Microbiology
Laboratory, Cincinnati, Ohio, Food and Cosmetic Microbiology Br,
Washington, DC; MA Malik, DVM, Epidemiology Br, J Damare,
Microbiology
Br, US Dept of Agriculture, Beltsville, Maryland; Div of Field
Svcs,
Epidemiology Program Office, Enteric Diseases Br, Div of Bacterial
Diseases, Center for Infections Disease, CDC.
Editorial Note
Editorial Note: This is the third largest foodborne botulism
outbreak
reported in the United States since 1899 (1). The two larger
outbreaks occurred in 1977 in Michigan, when 58 people became ill
after eating home-canned peppers at a restaurant (2), and in 1978
in
New Mexico, when 34 people became ill after eating potato salad or
bean salad at a restaurant (3). Botulism outbreaks are usually
isolated incidents involving small numbers of people who have
consumed
improperly preserved home-canned or home-processed foods (4).
Epidemiologic evidence implicated the sauteed onions as the
source
of this outbreak. Recent investigations of pot pies (5) and baked
potatoes (6) have demonstrated the ability of C. botulinum to grow
and
produce toxin in cooked foods held at temperatures below 60 C (140
F). Sauteed onions have never before been associated with
botulism.
References
CDC. Botulism in the United States, 1899-1977. Handbook for
epidemiologists, clinicians, and laboratory workers. Issued
May
1979.
Terranova WA, Breman JG, Locey RP, Speck S. Botulism type B:
epidemiologic aspects of an extensive outbreak. Am J Epidemiol
1978;108:150-6.
CDC. Botulism--New Mexico. MMWR 1978;27:138.
Smith LDS. Botulism: the organism, its toxins, the disease.
Springfield, Illinois: Charles C. Thomas, 1977.
California State Department of Health Services. Botulism and
commercial pot pie. California Morbidity, November 12, 1982
(44).
Sugiyama H, Woodburn M, Yang KH, Movroydis C. Production of
botulism toxin in inoculated pack studies of foil-wrapped baked
potatoes. J Food Protection 1981;44:896-8.
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