Gastroenteritis outbreak at holiday resort, central Italy.

During the summer of 2003, a gastroenteritis outbreak spread throughout a holiday resort in central Italy. Fecally contaminated groundwater and seawater were leaking into the non-drinking-water system, which was found to be connected to the drinking-water system of a large resort. This contamination had a primary role in the onset of the outbreak and spread of the infection.

Investigation of an outbreak of Salmonella enterica subsp. enterica serovar Hadar food illness in the Abruzzi region of Italy.

A comparative study was made of 22 strains of Salmonella Hadar isolated from victims of an outbreak of food illness in the Abruzzi region of Italy in 2000 and 21 strains of the same serotype isolated from poultry meat and human stool samples in the Abruzzi and Molise regions between 2000 and 2001. The aim of the investigation was to provide an epidemiological interpretation of the food illness outbreak to establish the degree of similarity between the S. Hadar strains isolated from victims of the outbreak and those isolated from poultry meat (identified but unconfirmed as the possible source of infection) and from other human samples received in the laboratory. Pulsed-field gel electrophoresis (PFGE) and random amplified polymorphic DNA (RAPD) were used to identify the genotypes and antimicrobial resistance patterns were determined. PFGE analysis of the restriction patterns obtained with XbaI and BlnI led to the identification of 12 pulsotypes in three groups. RAPD did not provide any information, as it was unable to differentiate between the strains isolated from food illness victims with gastroenteritis. Antimicrobial resistance tests revealed multiple resistance patterns and no strains were found to be resistant to ciprofloxacin or to the other quinolones tested. The poultry strains were found to be resistant to nalidixic acid, while the resistance in human strains was 31.8%. A combined analysis of resistance patterns and pulsotypes revealed four resistance patterns; the pattern associated with the outbreak was not correlated with the others present in the same period. This work suggests that a study of the relationship between different strains of the same serovar requires the implementation of different analytical methods.

Two cases of methemoglobinaemia caused by suspected sodium nitrite poisoning.

Among the causes of acute methemoglobinaemia are the ingestion and inhalation of over 40 oxidising substances, including nitrite, nitrate, carbon monoxide, some medicines, chlorine. The authors describe a case of acute methemoglobinaemia in two people that most probably suffered from food poisoning resulting from the consumption of a preparation of a dish called turkey alla canzanese that contained significant amounts of sodium nitrite. Both subjects who were treated promptly with methylene blue and hyperbaric oxygen therapy room recovered fully. Epidemiological investigations performed to clarify the dynamics of the episode suggested that among the causes of contamination were the swapping of products at the time of sale and the non-compliance to rules for the preparation of foods for human consumption.

An outbreak of gastroenteritis in a holiday resort in Italy: epidemiological survey, implementation and application of preventive measures.

A major gastroenteritis outbreak was reported in a vacation resort in Central Italy in 2003. A total of 183 cases were identified. The case-control study identified a statistically significant correlation between the disease and sea bathing, use of sanitary facilities in bungalows and of common showers. Stool samples taken from people affected were found positive for Norovirus (68%, 13 of 19 samples), Rotavirus (38%, 1 of 14 samples) and Campylobacter (7%, 3 of 8 samples). Environmental investigations revealed serious faecal contamination of the groundwater and the presence of Norovirus in the seawater near the resort. The mixing of groundwater and seawater with the non-drinking water system - which was also found to be connected to the drinking water system - had a primary role in the onset and spread of infection within the village. The complete absence of any gastroenteritis epidemics among the site guests since 2006 demonstrates the effectiveness of the environmental corrective measures taken.