Three dead, 40+ ill due to CLOSTRIDIUM PERFRINGENS FOOD INTOXICATION at Central State Hospital - food poisoning suspected

[alert]

http://www.thetowntalk.com/article/...in-deaths-of-3-patients-in-Pineville-hospital

Food poisoning suspected in deaths of 3 patients in Pineville hospital
By Abbey Brown Doyle ? abrown@thetowntalk.com ? May 9, 2010

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Buzz up!Twitter FarkIt Type Size A A A Next Page1| 2Previous PagePINEVILLE -- State health officials suspect food poisoning caused the deaths of three patients this weekend at Pineville's Central State Hospital.



Forty patients at the behavioral health hospital showed signs of gastrointestinal stress beginning around 6:30 a.m. Friday with the three deaths -- a 43-year-old woman, 41-year-old man and 52-year-old man -- happening late Friday night or early Saturday morning, officials said.


Two patients of the state hospital remain hospitalized Saturday night at Huey P. Long Medical Center in Pineville. A total of 11 patients and four staff members were treated at Huey P. Long for possible food-poisoning symptoms.
In a news conference in front of the facility's gates Saturday afternoon, Department of Health and Hospitals Secretary Alan Levine said autopsies of the three victims are scheduled for Monday and results from lab tests already sent to a state lab in New Orleans are expected in a few days.
"At the moment our hearts and our prayers go out to the three folks that we've lost," Levine said. "Our mission and our goal is that we want to serve people and make their lives better. Obviously, we are all heartbroken when you have an outcome like this."
Officials did not release the identities of the patients.
When DHH was notified of the deaths early Saturday, a Rapid Response Team was deployed. The team shut down food-service operations at most of the department's institutions throughout the state.
The team is comprised of epidemiologists, nurses, technicians and members from the U.S. Centers for Disease Control and Prevention.
By around noon, DHH determined that the statewide shutdown wasn't necessary and reopened all facilities but those at Central State.
Levine said DHH sent epidemiology staff to hospitals in the area to determine if they had seen an increase in patients with gastrointestinal issues, but nothing out of the ordinary was reported.
"We think it is isolated to this facility," he said. "That's good news. The public has no need to be concerned about anything in the community. We feel very confident that it is isolated and localized here at Central

Levine said staff at Central State reported that the symptoms were minor. But sometime later Friday, the symptoms of the two men worsened. They were taken to Huey P. Long, where they died.




The woman who died was found unresponsive in her room early Saturday, Levine said. She hadn't reported any symptoms.
The three patients' families were notified Saturday morning, and Gov. Bobby Jindal has been briefed of the situation, Levine said.
"The governor's primary directive to me was to, number one, do everything we can to protect the people here and in our state institutions, and number two, to determine exactly what happened, how it happened and why it happened so we can prevent it from happening again," Levine said. "And number three, in the event that we determine it was not simply a food-borne illness that -- in the hopefully unlikely event -- it was something other than that, that we certainly engage State Police and local police to help us with any investigation."
Levine said it has not been determined whether this was an accident or intentional. Officials are awaiting test results that will show toxicity in the bodies and food, and if there is a presence of a food-borne pathogen.


The kitchen at Central State was cordoned off and is being preserved by police in case the case is determined to be criminal, officials said.
Food for the 126 patients at the hospital is being provided by the Veteran's Affairs Medical Center and Pinecrest Support and Services Center, both in Pineville.
Meanwhile, officials are assessing patients. Those exhibiting any symptoms are being taken to Huey P. Long for an examination.
"Everyone's focus is to make sure the people here are both well emotionally and physically," Levine said.

 

[alert]

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

http://www.usatoday.com/news/health/2010-05-09-hospital-deaths_N.htm

3 die at Pineville hospital, 40 ill
Posted 52m ago | Comments 1 | Recommend 1 E-mail | Save | Print |


PINEVILLE, La. (AP) ? State officials say they suspect food poisoning as the cause behind the weekend deaths of three patients at Pineville's Central State Hospital.
Forty patients at the behavioral health hospital showed signs of gastrointestinal stress beginning around 6:30 a.m. Friday with the three deaths a 43-year-old woman, 41-year-old man and 52-year-old man happening late Friday night or early Saturday morning.

State Department of Health and Hospitals Secretary Alan Levine told reporters Saturday that autopsies of the three patients are scheduled Monday, with lab test results expected in a few days.

Two patients remain hospitalized at Huey P. Long Medical Center in Pineville. A total of 11 patients and four staff members were treated there for possible food-poisoning symptoms.

__

Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

[snip]

JandySays (7 friends, send message) wrote: 38m ago
Ah, so now we know which of the Hospital Staff has been eating patient food.

If they live, they should be fired. Right?

Book-'em, Danno...

 

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Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

http://www.google.com/hostednews/ap/article/ALeqM5g2Yu-2zGPaPFHN6wbOphM4N38x5wD9FJM8DG0

Food poisoning suspected in 3 La. hospital deaths
(AP) ? 4 hours ago

PINEVILLE, La. ? A health official says food poisoning perhaps from an ingredient in chicken salad could be what killed three Louisiana mental health hospital patients and sickened 40 others.

Officials say patients at Pineville's Central State Hospital showed signs of gastrointestinal stress beginning Friday morning. The three deaths ? a 43-year-old woman, 41-year-old man and 52-year-old man ? happened late Friday night or early Saturday morning.

Lisa Faust, a spokeswoman for the state Department of Health and Hospitals, says the patients had chicken salad Thursday night.

She says something bad could have been in the chicken, lettuce or mayonnaise.

Officials say the poisoning appears to be isolated to the hospital in Pineville, located between Shreveport and Baton Rouge.

Copyright ? 2010 The Associated Press. All rights reserved.

 

[Pathfinder]

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

Virus made 40 sick; still question why 3 died

Associated Press - May 10, 2010 4:04 PM ET

PINEVILLE, La. (AP) - Louisiana's state health secretary says it was a virus that made 40 people ill at a state mental hospital, and investigators are still working to find out why 3 of them died.

Doctors first thought that food poisoning had sickened patients and staffers at Central Louisiana State Hospital in Pineville.
Secretary Alan Levine said Monday that it was norovirus, which spreads very fast - explaining how so many people got sick at once. But he says that deaths from norovirus are not that common.

A 41-year-old man, a 43-year-old woman and a 52-year-old man died late Friday or early Saturday.

Levine says lab work, including toxicity screens, and other investigation will help explain whether it was a medical management issue, a bad reaction to the virus, or something else.

http://www.wdam.com/Global/story.asp?S=12458412

 

[alert]

40+ ill due to norovirus, three undiagnosed fatalities

40+ ill due to norovirus, three undiagnosed fatalities

Norovirus is certainly far more consistent with the epidemiology than foodborne bacterial illness, as staff would likely not eat the same meals as the patients.

The three fatalities, though, cannot be caused by norovirus. Norovirus fatalities are exceedingly rare, even among elderly cruise ship passengers, so three among physically healthy behavioral health patients is impossible. Of note, is that post #1 in this thread indicates that one of the three fatalities did not experience any symptoms, so it is possible that something other than infectious disease, such as accidental poisioning or overdose, might be responsible for the deaths.

 

[Vibrant62]

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

I would argue your point that norovirus cannot cause fatalities and that it is 'impossible': - in people who are either old or frail due to illness, norovirus can be quite severe. The numbers of hospital admissions as a direct consequence of Norovirus in the UK bears testament to that - I dont know about the data elsewhere.

Whilst death from viral effects rather than dehydration and sequelae of violent diarhoea and vomiting must be considered to be unlikely, viruses of all types can mutate or become pathogenic. There is also a possiblity here of failure of care (instigation of drips for rehydration) in these mentally ill patients. If staff suddenly were facing 40 cases of extremely unwell mentally ill (we dont know how mentally capable these patients were) it is quite possible they would have been overwhelmed, leading to a care failure - sudden rapid dehydration can be fatal in itself.

 

[alert]

40+ ill due to norovirus at Central State Hospital - three deaths under investigation

40+ ill due to norovirus at Central State Hospital - three deaths under investigation

http://www.thetowntalk.com/article/20100511/NEWS01/5110309/1002

Officials suspect norovirus behind Central State Hospital incident
By Abbey Brown Doyle ? abrown@thetowntalk.com ? May 11, 2010

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Buzz up!Twitter FarkIt Type Size A A A Next Page1| 2Previous PageThe source of the illness that led to the deaths of three patients at Central Louisiana State Hospital in Pineville over the weekend is thought to be norovirus, officials said.



The norovirus is a fairly common organism and is the same one that has grounded several cruise ships over the past few years, said Dr. David Holcombe, medical director for Region 6 of the Louisiana Department of Health and Hospitals' Office of Public Health.
While the virus is common, Holcombe said, deaths as a result of having the virus are not. Further tests and an autopsy will hopefully shed light on what led to the deaths of a 43-year-old woman, 41-year-old man and 52-year-old man happening late Friday night or early Saturday morning, officials said.
A total of 40 patients and four staff members became ill. Patients began showing signs of illness -- with gastrointestinal distress -- around 6:30 a.m. Friday. Four staff members and 11 patients were taken to Huey P. Long Medical Center in Pineville for treatment. Two remained hospitalized Saturday, although Holcombe wouldn't say if they remained hospitalized Monday, only noting they are improving and "seem to be out of danger."
Holcombe said the norovirus is very contagious and takes very little to be transmitted from person to person. The virus is found in the stool and vomit of infected people. People can become infected in several ways, including eating food or drinking liquids that are contaminated by infected food handlers, touching surfaces or objects contaminated with norovirus and then touching their mouth before hand washing, or having direct contact with another person who is infected and then touching their mouth before hand washing.
The most common way it is spread, Holcombe said, is through food preparation, but it will be difficult, if not impossible, to narrow the spread down to one particular food because the concentrations of norovirus are so low in food.
Officials are interviewing those who got sick to see what they ate and what they did before getting sick so perhaps they will be able to determine statistically where the virus came from with a high degree of accuracy.

The hospital's kitchen remains closed and sealed off, and it won't reopen until all biological tests have come back. Once they are completed, Holcombe said, the kitchen will undergo a "super cleaning," and the staff will receive food-handling training.



Holcombe said it wouldn't be unusual for there to be one or two more patients to become ill, but that most everyone who gets the virus does just fine a few days later with adequate hydration. Any future cases will most likely be isolated cases, not an outbreak like the institution saw over the weekend, he said.
Norovirus illness usually begins 24 to 48 hours after exposure, but can appear as early as 10 hours after exposure. Symptoms usually include nausea, vomiting, diarrhea and stomach cramping. Sometimes people have a low-grade fever, chills, headache, muscle aches and a general sense of tiredness. The illness is usually brief, with symptoms lasting only one or two days.
Fortunately, the prevention of norovirus is very easy, Holcombe said. Strict hand washing rules -- similar to those prescribed for most virus outbreaks -- of warm water and soap for at least 20 seconds and adequate hand sanitizer are to be used. The virus is very sensitive to water and alcohol.
"It is important for people to not panic," Holcombe said. "This is not an unusual or unknown agent. What is unusual is the intensity and the numbers involved."

 

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Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

http://www.thetowntalk.com/article/20100512/NEWS01/5120317

Central deaths probe continues; virus ebbing
Town Talk staff ? May 12, 2010

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Buzz up!Twitter FarkIt Type Size A A A Authorities still are looking into the details of what killed three Central Louisiana State Hospital patients and sent more than a dozen other patients and staff members to the hospital for treatment over the weekend.




Though two patients went to the emergency room Monday, the suspected norovirus infection appears to be subsiding as expected in those already infected, officials said.
The results of the autopsies are pending, and toxicology reports could take up to a week to complete.
The virus usually stays in someone's system for a few days, but officials are looking into what made the infection intense enough to kill a 43-year-old woman, a 41-year-old man and a 52-year-old man between late Friday and early Saturday.
Kitchen facilities at the hospital, suspected to be the source of the infection, remain closed for inspection, cleaning and staff training, Department of Health and Hospital officials said.

 

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Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

http://www.thetowntalk.com/article/20100513/NEWS01/5130319/1002/Central-deaths---probe-continues

Central deaths probe continues
Town Talk staff ? May 13, 2010

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Twitter FarkIt Type Size A A A There is no new information in the deaths of three patients of Pineville's Central Louisiana State Hospital.



Dr. David Holcombe, medical director for Region 6 of the Louisiana Department of Health and Hospitals' Office of Public Health, said the investigation into the deaths continues, although the norovirus is the suspected culprit. Lab tests and interviews continue to try to determine how the outbreak started at the hospital over the weekend.
At least 40 people became ill beginning Friday morning. Holcombe said there have been a few isolated instances of sickness since then, but all have been minor.

 

[alert]

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

I knew norovirus alone wasn't likely to cause this outbreak. It appears to be a compound outbreak of some kind. And the fact that one of the fatalities did not report any gastrointestinal symptoms might be an important clue.

http://www.thetowntalk.com/article/20100518/NEWS01/5180322

Norovirus may not be cause of Central deaths
By Abbey Brown Doyle • abrown@thetowntalk.com • May 18, 2010

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Twitter FarkIt Type Size A A A Next Page1| 2Previous PageNew test results may point to another cause for the deaths of three Central Louisiana State Hospital patients earlier this month.



Initial test results led investigators with the Department of Health and Hospitals to believe the common norovirus is what led to more than 40 patients and staff at the Pineville facility getting sick and three patients dying. But while some patients' stools tested positive for the virus, many did not.
Now it is thought that norovirus isn't an "adequate explanation" for the illnesses and deaths, said Dr. David Holcombe, medical director for the Alexandria-based Region 6 of the DHH's Office of Public Health.
Because of that doubt, a Centers for Disease Control team came to the Pineville behavioral health hospital to intensify the investigation.
They stayed through Monday, working with local staff, collecting new samples, re-interviewing patients and staff, re-examining medical records and re-analyzing epidemiological data, Holcombe said.
"We identified norovirus, the agent that causes nausea, vomiting and diarrhea -- all the symptoms these folks had," he said. "You would expect the vast majority of stool samples would come back positive for the agent. And while we had some that were positive, we felt it was not an adequate explanation for the whole thing."
New samples will be sent off to be tested for even more agents along with samples of all of the food in the kitchen that had been carefully saved and preserved, Holcombe said.
Norovirus is a fairly common organism -- the same one that has grounded several cruise ships over the past few years -- but is not typically fatal.
A 43-year-old woman, 41-year-old man and 52-year-old man -- all Central patients -- died late May 7 or early May 8, officials said.
More than 40 patients and staff members became ill beginning to show signs of illness around 6:30 a.m. May 7. Four staff members and 11 patients were taken to Huey P. Long Medical Center in Pineville for treatment. Holcombe said all signs of sickness seem to have subsided, with the last instance of diarrhea occurring four days ago.




"Clearly norovirus was there," he said. "The problem is there are a lot of causes of food poisoning. Some are bacterial, some are viral. And norovirus is nearly at the top of this list. But it does not seem to explain all of the cases and is not present enough to feel that it is 100 percent sure the cause of everything."



There are about 10 other bacterial or viral agents that can cause a similar picture to what investigators and doctors are looking at right now, Holcombe said. Further tests, which they hope to receive results of in the near future, should give them a better look at what they are dealing with.
Holcombe was unable to give specifics, but did say that not all of the patients who died tested positive for norovirus.
While it looks as if norovirus alone may not be the only culprit in the deaths and sickness, it still doesn't seem likely that foul play was a factor, he said.
The hospital's kitchen remains closed, and it won't reopen until all tests have come back.
Once they are completed, Holcombe said, the kitchen will undergo a "super cleaning."
The hospital's staff has already begun to receive food-handling training.

 

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Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - clostridium perfringens confirmed

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - clostridium perfringens confirmed

And we finally get a diagnosis. Clostridium perfringens confirmed.

http://www.thetowntalk.com/article/...-deadly-outbreak-at-hospital-in-Pineville--La.

Tainted chicken salad linked to deadly outbreak at hospital in Pineville, La.
By David Dinsmore ? ddinsmore@thetowntalk.com ? May 29, 2010

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Buzz up!Twitter FarkIt Type Size A A A The outbreak of illnesses that sickened more than 40 people and killed three patients at Central Louisiana State Hospital in Pineville appears to be connected to bacteria from chicken salad served at the facility, a health official reported Friday.



Test results found the third most common cause of food poisoning -- clostridium perfringens -- was to blame for the outbreak at Central earlier this month, said Dr. David Holcombe, medical director for Region 6 of the Louisiana Department of Health and Hospitals' Office of Public Health.
The C. perfringens bacterium appears to have come from the chicken salad served before patients and staff members began getting sick, Holcombe said.
Those who had the chicken salad at that time were 23 times more likely to show symptoms, which is a good indicator that the dish was the culprit.
C. perfringens is a naturally occurring organism, but it can spread to unsafe levels with improper food storage and handling, Holcombe said.
The bacteria explain the cause of sickness in the patients, Holcombe said, but the test results do not fully spell out the causes of death for three patients.
Autopsy and toxicology reports still pending will help determine what, if any, other factors caused their illnesses to be fatal.
Starting the morning of May 7, patients at Central Louisiana State Hospital began showing symptoms of gastrointestinal problems.
By that night and into the next morning, a 43-year-old woman, 41-year-old man and 52-year-old man died.
C. perfringens often is found in beef and poultry that has been boiled, stewed or roasted or meats used in sauces, gravies, pies, salads, casseroles and
dressings, according to information from the Office of Public Health.
It's a heat-resistant species of bacterium that can cause gastrointestinal problems like those experienced by Central patients and staff members.
It cannot be transmitted from person to person.
The bacteria form spores that spread through food that has not been properly stored and become hard to completely cook away, Holcombe said, and they begin producing a toxin that makes people sick once they enter the lower intestine.
Food-borne disease was immediately suspected, and kitchen services were shut down for investigation, Holcombe said.
Food re-education was conducted with the kitchen staff in the time between then and announcement of the test results Friday.

 

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Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

http://www.foodpoisonjournal.com/20...-central-louisianna-hospital-what-went-wrong/

Clostridium perfringens at Central Louisianna Hospital: what went wrong?
Posted on May 29, 2010 by Drew Falkenstein

The Clostridium perfringens outbreak that occurred in early May at Central Louisianna State Hospital was recently linked to contaminated chicken salad. 40 people were sickened in the outbreak, and three people died. So what went wrong? Environmental health findings--i.e. the investigation at the hospital's kitchen--have not yet been released, but the outbreak almost certainly occurred as a result of improper food handling procedures.

Clostridium perfringens is a very common pathogen in foodpoisoning outbreaks; some estimates set clostridium perfringens as the third most common cause of foodpoisoning illnesses. Most clostridium perfringens outbreaks are ultimately linked to contaminated meat, and many such outbreaks occur after holiday meals. The reason? The cooking of whole fowl species, such as chicken and turkeys, that are cooled improperly after cooking. For instance, the CDC reported on a clostridium perfringens outbreak in 2008 that occurred at a Wisconsin jail, stating as follows regarding the environmental investigation at the jail's kitchen:

On August 8, the environmental health sanitarian from the local health department met with jail kitchen supervisors and employees of the food distribution company to assess food preparation and employee health and hygiene practices. The macaroni and ground beef in the implicated casserole were cooked the day before. The sanitarian determined that food temperatures had not been obtained or recorded consistently, and documentation of cooling temperatures for both the ground beef and macaroni, where cooling from 70?F to 41?F (39?C to 23?C) is a vital step, could not be provided. An inspection of the cooler revealed improper handling and cooling of taco meat, which was being prepared for a future meal and was not implicated in this outbreak; some containers of meat were cooled with ice paddles and other containers were not.

It has not yet been publicly disclosed how the chicken in the chicken salad at the Louisianna hospital was prepared . . . or cooled. It is possible that the chickens were cooked whole, and cooled improperly, or that the chicken salad was cooled improperly after it was assembled. It is unlikely that the mayonnaise, vegetables, or spices that were included in the chicken salad were contaminated prior to assembly.

Whatever the case, somehow the clostridium perfringens bacteria--more specifically, the bacterial spores that release the illness-causing toxins--in the bad chicken was allowed to grow or replicate, leading to the bacterial proliferation that was surely the cause of this widespread outbreak. An abstract from a recent article on the growth of clostridium perfringens bacteria during improper cooling states as follows:

Many meat-based food products are cooked to temperatures sufficient to inactivate vegetative cells of Clostridium perfringens, but spores of this bacterium can survive, germinate, and grow in these products if sufficient time, temperature, and other variables exist. Because ingestion of large numbers of vegetative cells can lead to concomitant sporulation, enterotoxin release in the gastrointestinal tract, and diarrhea-like illness, a necessary food safety objective is to ensure that not more than acceptable levels of C. perfringens are in finished products. As cooked meat items cool they will pass through the growth temperature range of C. perfringens (50 to 15 degrees C). Therefore, an important step in determining the likely level of C. perfringens in the final product is the estimation of growth of the pathogen during cooling of the cooked product.

 

[alert]

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

Re: Three dead, 40+ ill due to undiagnosed outbreak at Central State Hospital - food poisoning suspected

While both C. perfringens and norovirus have low mortality rates, compund infections could cause the three deaths.

This thread should likely be renamed and moved now.

http://promedmail.org/pls/apex/f?p=..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,82986

Archive Number 20100530.1799
Published Date 30-MAY-2010
Subject PRO/AH/EDR> C. perfringens food intoxication, fatal - USA: (LA) nosocomial


CLOSTRIDIUM PERFRINGENS FOOD INTOXICATION, FATAL - USA: (LOUISIANA) NOSOCOMIAL
******************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 29 May 2010
Source: The Town Talk [edited]
<http://www.thetowntalk.com/article/20100529/NEWS01/5290331/1002>


The outbreak of illnesses that sickened more than 40 people and killed
3 patients at Central Louisiana State Hospital in Pineville appears to
be connected to bacteria from chicken salad served at the facility, a
health official reported Fri 28 May 2010.

Test results found the 3rd most common cause of food poisoning,
[toxin-producing] _Clostridium perfringens_, was to blame for the
outbreak at Central earlier in May 2010, said Dr. David Holcombe,
medical director for Region 6 of the Louisiana Department of Health
and Hospitals' Office of Public Health.

The _C. perfringens_ bacterium appears to have come from the chicken
salad served before patients and staff members began getting sick,
Holcombe said. Those who had the chicken salad at that time were 23
times more likely to show symptoms, which is a good indicator that the
dish was the culprit.

_C. perfringens_ is a naturally occurring organism, but it can spread
to unsafe levels with improper food storage and handling, Holcombe said.

The bacterium explains the cause of sickness in the patients, Holcombe
said, but the test results do not fully spell out the causes of death
for 3 patients. Autopsy and toxicology reports still pending will help
determine what, if any, other factors caused their illnesses to be
fatal.

Starting the morning of 7 May 2010, patients at Central Louisiana
State Hospital began showing symptoms of gastrointestinal problems. By
that night and into the next morning, a 43-year-old woman, 41-year-old
man and 52-year-old man died.

It cannot be transmitted from person to person. Spores of the organism
are heat-resistant and may germinate into the vegetative form of the
bacterium in food that has not been properly stored, Holcombe said,
and they begin producing a toxin that makes people sick once they
enter the lower intestine.

[Byline: David Dinsmore]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The following discussion on _C. perfringens_ associated foodborne
illness is from the FDA's "Bad Bug Book: Foodborne Pathogenic
Microorganisms and Natural Toxins Handbook"
<http://www.fda.gov/Food/FoodSafety/Foodborneillness/FoodborneillnessFoodbornePathogensNaturalToxins/BadBugBook/>

"1. The Organism:
-----------------
_Clostridium perfringens_ is an anaerobic, Gram-positive, sporeforming
rod (anaerobic means unable to grow in the presence of free oxygen).
It is widely distributed in the environment and frequently occurs in
the intestines of humans and many domestic and feral animals. Spores
of the organism persist in soil, sediments, and areas subject to human
or animal fecal pollution.

2. Nature of Acute Disease:
---------------------------
Perfringens food poisoning is the term used to describe the common
foodborne illness caused by _C. perfringens_ type A. A more serious
but rare illness is also caused by ingesting food contaminated with
Type C strains. The latter illness is known as enteritis necroticans
or pig-bel disease.

3. Nature of Disease:
--------------------
The common form of perfringens poisoning is characterized by intense
abdominal cramps and diarrhea which begin 8-22 hours after consumption
of foods containing large numbers of those _C. perfringens_ bacteria
capable of producing the food poisoning toxin. The illness is usually
over within 24 hours but less severe symptoms may persist in some
individuals for 1 or 2 weeks. A few deaths have been reported as a
result of dehydration and other complications.

Necrotic enteritis (pig-bel) caused by _C. perfringens_ is often
fatal. This disease also begins as a result of ingesting large numbers
of the causative bacteria in contaminated foods. Deaths from necrotic
enteritis (pig-bel syndrome) are caused by infection and necrosis of
the intestines and from resulting septicemia. This disease is very
rare in the USA.

Infective dose - The symptoms are caused by ingestion of large numbers
(greater than 10 to the 8th) [100 million] vegetative cells. Toxin
production in the digestive tract (or in test tubes) is associated
with sporulation. This disease is a food infection; only 1 episode has
ever implied the possibility of intoxication (i.e., disease from
preformed toxin).

4. Diagnosis of Human Illness:
------------------------------
Perfringens poisoning is diagnosed by its symptoms and the typical
delayed onset of illness. Diagnosis is confirmed by detecting the
toxin in the feces of patients. Bacteriological confirmation can also
be done by finding exceptionally large numbers of the causative
bacteria in implicated foods or in the feces of patients.

5. Associated Foods:
--------------------
In most instances, the actual cause of poisoning by _C. perfringens_
is temperature abuse of prepared foods. Small numbers of the organisms
are often present after cooking and multiply to food poisoning levels
during cool down and storage of prepared foods. Meats, meat products,
and gravy are the foods most frequently implicated.

6. Relative Frequency of Disease:
---------------------------------
Perfringens poisoning is one of the most commonly reported foodborne
illnesses in the USA. There were 1162 cases in 1981, in 28 separate
outbreaks. At least 10-20 outbreaks have been reported annually in the
USA for the past 2 decades. Typically, dozens or even hundreds of
person are affected. It is probable that many outbreaks go unreported
because the implicated foods or patient feces are not tested routinely
for _C. perfringens_ or its toxin. The Centers for Disease Control and
Prevention (CDC) estimates that about 10 000 actual cases occur
annually in the USA.

7. Course of Disease and Complications:
---------------------------------------
The disease generally lasts 24 hours. In the elderly or infirm,
symptoms may last 1-2 weeks. Complications and/or death only very
rarely occur.

8. Target Populations:
----------------------
Institutional feeding (such as school cafeterias, hospitals, nursing
homes, prisons, etc.) where large quantities of food are prepared
several hours before serving is the most common circumstance in which
perfringens poisoning occurs. The young and elderly are the most
frequent victims of perfringens poisoning. Except in the case of
pig-bel syndrome, complications are few in persons under 30 years of
age. Elderly persons are more likely to experience prolonged or severe
symptoms.

9. Food Analysis:
----------------
Standard bacteriological culturing procedures are used to detect the
organism in implicated foods and in feces of patients. Serological
assays are used for detecting enterotoxin in the feces of patients and
for testing the ability of strains to produce toxin. The procedures
take 1-3 days."

[As noted in the text, this illness is usually related to _in situ_
production of the enterotoxin rather than (as with the more common
staphylococcus-associated foodborne illness) the ingestion of
preformed toxin. The staphylococcal illness usually presents with
vomiting and little if any diarrhea with an incubation period of 4-6
hours, whereas _C. perfringens_ food poisoning causes diarrhea without
much vomiting. Neither illness usually causes significant fever.
Mortality rates in perfringens food poisoning are quite low and
fatalities are very unusual in the non-elderly. Reports are pending on
what co-existing illnesses were present in the decedents. - Mod.LL]

[The interactive HealthMap/ProMED map for Louisiana is available at:
<http://healthmap.org/r/01pT> - CopyEd.EJP]