JACKSON COUNTY, Okla. - Enteritis was the special of the day on one Oklahoma restaurant menu as several patrons fell ill after eating salads and lasagna contaminated with Campylobacter.
Campylobacter is one of the most common causes of foodborne disease in the United States, causing some 2 million cases of gastroenteritis annually. Most illnesses associated with the bacteria are usually mild and sporadic, but some can be fatal. Guillain-Barré syndrome, a demyelinating disorder resulting in acute neuromuscular paralysis, is a potentially serious consequence of Campylobacter infection.
Common source outbreaks have occurred in the past with most traced to unpasteurized milk and contaminated drinking water. The incubation period for waterborne Campylobacter seems to be longer than the foodborne variety, according to health officials. But in comparison, most sporadic cases, like those in this particular restaurant outbreak, are associated with improper handling and preparation of poultry.
The outbreak occurred among 14 lunch customers who had consumed garden salads and plates of lasagna served by a small, southwestern Oklahoma family restaurant. Several were Air Force personnel from a nearby military base who were giving a going-away party for three servicemen being transferred. When the diners began showing up in the county hospital's emergency room complaining of identical symptoms, health officials from the Oklahoma State Department of Health (OSDH) and Jackson County Health Department (JCHD) were quickly notified and began their investigation.
Inspection of the restaurant indicated the countertop surface area of the kitchen was too small to separate raw poultry from other foods adequately during their preparation. The cook reported to health inspectors that she usually cut up raw chicken parts for dinner before preparing salads, lasagna and sandwiches for the daily luncheon menu. The lettuce for the salads was shredded with a common knife, and the cook wore a towel around her waist that she frequently used to dry her hands.
Bleach solution at the appropriate temperature and concentration was present to sanitize table surfaces, but health officials could not determined whether the cook had actually cleaned the countertop after cutting the chicken. Although health officials could not determine the original source of the bacteria, the lettuce and lasagna were probably contaminated with C. jejuni from raw chicken through unwashed or inadequately washed hands, cooking utensils or the countertop.
The OSDH and JCHD implemented a case-control study of the 14 victims to identify their risk factors for illness. All of the victims reported diarrhea, 13 reported a fever, another 13 reported abdominal cramps, 11 had nausea, five were vomiting and three had visible blood in their stools. The median incubation period was three days. Stool cultures taken from 10 of the victims yielded C. jejuni. one of the suspected contaminated food was available for testing, said state health officials.
"This type of outbreak is pretty uncommon since almost 95% of all Campylobacter infections occur inside the home," said Penny Adcock, MD, medical investigator at the National Center for Infectious Diseases at the Centers for Disease Control and Prevention (CDC). "However, these types of outbreaks can be much easier to study."
The CDC recommends cooking chicken at a temperature of 170° F for 15 minutes to kill Campylobacter. Ingestion of 500 organisms, the amount that can be present in just one drop of chicken juice, can result in illness.
For more information:
- CDC. Outbreak of Campylobacter enteritis associated with cross-contamination of food - Oklahoma, 1996.MMWR.1998;47;7;129-31.
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