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Toxic alimentary
Shigella flexneri infection in a fire fighting unit |
Cahiers d'études et de recherches francophones / Santé . Volume 7, Number 5, 295-9, Septembre-Octobre 1997, Étude originale
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 Résumé
 Summary
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Author(s) : Éric Cheftel, Alain Spiegel, Guy Bornert, Éric Morell, Alain Michel, Yves Buisson, Brigade de sapeurs-pompiers de Paris, 55, boulevard de Port-Royal, 75013 Paris, France, Hôpital d’Instruction des Armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France, Groupe de secteurs vétérinaires de Paris, 1, boulevard Louis-Loucheur, 92211 Saint-Cloud, France, Laboratoire de biologie clinique, Hôpital du Val-de-Grâce, 74, boulevard de Port-Royal, 75013 Paris, France.. |
Summary : Food borne disease outbreaks have increased in France, but outbreaks caused by Shigella are rare, accounting for only 73 cases (1.62%) in 1993. We report a food borne outbreak of Shigella flexneri strain 3 infection in a fire fighting unit in Paris between July 13th and 17th 1995. Forty of the 127 firemen suffered symptoms including acute diarrhea (80%), fever (50%) and blood and mucus in stools (1 case, 2.5%). Epidemiological investigation generated an unimodal epidemic curve suggesting a single source of contamination with no secondary cases. The median incubation period was between 43 hours 30 minutes and 51 hours 30 minutes. This is consistent with food borne Shigella infection. Statistical analysis of a case-control study implicated a mixed salad containing frozen shellfish from Asia (shrimps and mussels), served at lunch and dinner on July 13th 1995. Shigella was not detected in this salad by microbiological methods. However, inoculation with as little as 100 organisms can cause symptoms. There was low-level contamination with Escherichia coli (940 cfu/g) due to cross-contamination. Shigella flexneri strain 3 was isolated from 11 of 18 stool cultures, but was never isolated from cultures of stools provided by the cooks. All isolates had identical antibiotic resistance profiles. They were resistant to ampicillin and ticarcillin, moderately sensitive to amoxicillin-clavulanic acid, highly sensitive to aminosides, erythromycin and quinolones. This identical pattern in all isolates suggests a common source of contamination. Plasmid-based multiple resistance is common in this organism. Therefore, antibiotics should only be given to patients with evident clinical signs of infection.
Treatment was symptom-based in all but 4 patients, who had acute diarrhea and were treated with ciprofloxacin. This antibiotic is well tolerated, has rapid bactericidal action and significantly reduces the duration of the symptoms and excretion of Shigella, thus preventing secondary contamination with this highly infectious bacterium.
Thus, food borne outbreaks of Shigella can occur in countries with a high standard of living because of the increase in mass catering (e.g. fast food restaurants) and importation of foodstuffs from developing countries with endemic shigellosis. This is a public health problem because of the morbidity and absenteeism due to illness, particularly when the patients are firemen responsible for emergency management.
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