Detection of Clostridium perfringens and its enterotoxin in cases of sporadic diarrhoea.

AIMS: To determine the incidence of sporadic and apparently non-food related diarrhoea associated with Clostridium perfringens enterotoxin. METHODS: Enzyme linked immunosorbent assay (ELISA) and reversed phase latex agglutination (RPLA) were used to detect C perfringens enterotoxin in faecal specimens from 818 sporadic cases of diarrhoea. RESULTS: C perfringens enterotoxin was identified as a cause of sporadic diarrhoea in 56 of 818 (6.8%) cases. Diarrhoea was prolonged (three days or more) in most cases. Ages ranged from 3 months to 89 years, although most patients were over 60 years of age. CONCLUSIONS: These results suggest that C perfringens may be a cause of sporadic cases of diarrhoea when causes such as food consumption or cross-infection are absent, particularly in the elderly.

Red kidney bean poisoning in the UK: an analysis of 50 suspected incidents between 1976 and 1989.

Between July 1976 and February 1989, 50 incidents of suspected red kidney bean poisoning were reported in the UK. Nine incidents in which nausea, vomiting and diarrhoea developed within 1-7 h of ingestion, were confirmed by the detection of haemagglutinin in the beans. The diagnosis was made on a further 23 incidents on the basis of symptoms, incubation time and the description of preparation of beans prior to consumption. The haemagglutinin (lectin), which occurs naturally in the red kidney bean, is inactivated by thorough cooking of well soaked beans. In many of the outbreaks reported the implicated beans were consumed raw or following an inadequate heat process.

The source of Yersinia spp. in pasteurized milk: an investigation at a dairy.

Pasteurized bottled milk supplied by a single dairy was frequently found to be contaminated with Yersinia spp. Investigations were carried out at the dairy in an effort to pinpoint the source of these organisms. Viable counts obtained from milk bottle rinses indicated that bottle washing was often unsatisfactory, and on one occasion Y. frederiksenii was isolated from the pooled rinse water of six bottles. Samples of milk were taken on arrival at the dairy and at various stages following pasteurization. Heat resistance tests carried out on strains of yersinia isolated from pasteurized milk indicated that they would not survive the pasteurization process. However two strains of yersinia were isolated from a sample of milk taken immediately after pasteurization but before bottling. The thermograph indicated that the time/temperature conditions applied during pasteurization were adequate. The presence of yersinia strains in the milk at this stage therefore suggests that undetectable levels of raw milk were being allowed to contaminate the pasteurized milk. The absence of yersinia in cartoned samples produced on the same day as contaminated bottled samples indicated that environmental contamination of the bottle filler valve also may have occurred at times. Results of this investigation indicate that increased vigilance is required to ensure proper operation of pasteurizers and bottle washers.

An outbreak of foodborne botulism associated with contaminated hazelnut yoghurt.

The largest recorded outbreak of foodborne botulism in the United Kingdom occurred in June 1989. A total of 27 patients was affected; one patient died. Twenty-five of the patients had eaten one brand of hazelnut yoghurt in the week before the onset of symptoms. This yoghurt contained hazelnut conserve sweetened with aspartame rather than sugar. Clostridium botulinum type B toxin was detected in a blown can of hazelnut conserve, opened and unopened cartons of hazelnut yoghurt, and one faecal specimen. Cl. botulinum type B was subsequently cultured from both opened and unopened cartons of the hazelnut yoghurt and from one faecal specimen. Investigations indicated that the processing of the conserve was inadequate to destroy Cl. botulinum spores. Control measures included the cessation of all yoghurt production by the implicated producer, the withdrawal of the firm's yoghurts from sale, the recall of cans of the hazelnut conserve, and advice to the general public to avoid the consumption of all hazelnut yoghurts.

Evaluation of ELISA, RPLA, and Vero cell assays for detecting Clostridium perfringens enterotoxin in faecal specimens.

Three hundred and ninety two faecal specimens from 70 separate outbreaks of suspected Clostridium perfringens food poisoning were examined by enzyme linked immunosorbent assay (ELISA), reversed passive latex agglutination (RPLA), and Vero cell assays for the presence of enterotoxin. Although the most time consuming method, ELISA was the most specific and reproducible. RPLA was slightly more sensitive than ELISA, but it showed some non-specific reactions. The Vero cell assay was the least sensitive and least reproducible method, being affected by some non-specific cytotoxic and cytotonic reactions. Normal rabbit serum should be included in the Vero cell assay as a control for the neutralisation of cytotoxic effects.

Scombrotoxic fish poisoning in Britain: features of over 250 suspected incidents from 1976 to 1986.

Between 1976 and 1986, 258 incidents of suspected scombrotoxic fish poisoning were reported in Britain. Histamine analysis was carried out on 240 fish samples from these incidents, and 101 were found to contain greater than 5 mg histamine/100 g fish. The symptoms most consistently reported were rash, diarrhoea, flushing and headache. In recent years there has been a decrease in the number of confirmed scombrotoxic outbreaks and a trend towards more sporadic incidents. Of fish samples with greater than 20 mg histamine/100 g, 94% were from incidents in which scombrotoxic symptoms were characteristic, but where fish had 5-20 mg/100 g only 38% of incidents were clinically distinctive. Guidelines are presented based on the interpretation of quantitative histamine analysis of fish samples from scombrotoxic poisoning incidents.