An outbreak of febrile gastroenteritis associated with jellied pork contaminated with Listeria monocytogenes

• Published in: Wiener Klinische Wochenschrift Vol. 121; no. 3-4; pp. 149 - 156
• Main Authors: Pichler, Juliane, Much, Peter, Kasper, Sabine, Fretz, Rainer, Auer, Bettina, Kathan, Julia, Mann, Michaela, Huhulescu, Steliana, Ruppitsch, Werner, Pietzka, Ariane, Silberbauer, Karl, Neumann, Christian, Gschiel, Ernst, de Martin, Alfred, Schuetz, Angelika, Gindl, Josef, Neugschwandtner, Ernst, Allerberger, Franz
• Format: Journal Article
• Language: English
• Published: Vienna Springer-Verlag 2009
• Subjects: Adult; Aged; Animals; Austria; Brain - pathology; Cohort Studies; Disease Outbreaks - statistics & numerical data; Endocrinology; Female; Food Microbiology; Foodborne Diseases - diagnosis; Foodborne Diseases - epidemiology; Foodborne Diseases - microbiology; Gastroenteritis - diagnosis; Gastroenteritis - epidemiology; Gastroenteritis - microbiology; Gastroenterology; Humans; Internal Medicine; Listeria monocytogenes - genetics; Listeriosis - diagnosis; Listeriosis - epidemiology; Listeriosis - microbiology; Magnetic Resonance Imaging; Male; Meat Products - microbiology; Medicine; Medicine & Public Health; Meningitis, Listeria - diagnosis; Meningitis, Listeria - epidemiology; Meningitis, Listeria - microbiology; Middle Aged; Original Article; Pneumology/Respiratory System; Polymerase Chain Reaction; Serotyping; Swine; Travel; Young Adult; Austria; Meningitis; Outbreak; Foodborne; Rhombencephalitis; Gastroenteritis
• DOI: 10.1007/s00508-009-1137-3
• EISSN: 1613-7671
• ISSN: 0043-5325

Summary
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 × 10
3
–3 × 10
4
colony forming units/g and was indistinguishable from the clinical outbreak isolates. Symptoms reported by the 12 patients included unspecified fever (12×), diarrhea (9×), headache (5×), vomiting (4×), body aches (2×) and sore throat (1×). 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.