NCJ Number
191281
Journal
Journal of American Medical Association Volume: 278 Issue: 5 Dated: August 6, 1997 Pages: 396-398
Date Published
August 1997
Length
3 pages
Annotation
This document describes the findings of an investigation of an outbreak of shigella dysenteriae Type 2.
Abstract
From October 29 through November 1, 1996, 12 laboratory workers at a large medical center in Texas experienced severe gastrointestinal illness after eating muffins and doughnuts left in their break room. Stool cultures from these persons revealed S dysenteriae. The workers who ate muffins or doughnuts reported diarrhea with fever, headache, or vomiting. The mean incubation period until onset of diarrhea was 25 hours and was preceded by nausea, abdominal discomfort, and bloating. Patients were treated with ciprofloxacin. No deaths occurred among the ill workers. Investigation of the storage freezer in the laboratory suggested that the reference culture of S dysenteriae type 2 had been disturbed. There was a strong epidemiologic link between the ill persons, the uneaten food, and the laboratory’s stock culture of this rare pathogen. Although the motive and method of contamination are still unknown, the most likely hypothesis is that it was done by someone who had access to the freezer, had the laboratory skills to culture the organism and inoculate the pastries, and had access to the locked break room. A criminal investigation is ongoing. The medical center has implemented security measures to safeguard against future incidents of this type. The laboratory freezer is now secured and must be unlocked by a supervisor to gain entry. Stock culture labels no longer identify microorganisms by name and have been replaced by a numerical identification system. 18 references