Dohtsu Y, Kanda T, Kusumoto Y, Ishizaki T, Tomimasu K, Kohno S
Department of Medicine, Nagasaki Municipal Hospital.
Kansenshogaku Zasshi. 2001 Feb;75(2):110-5. doi: 10.11150/kansenshogakuzasshi1970.75.110.
We experienced a hospital outbreak of salmonella food poisoning after ingestion of omelet which was the hospital evening meal on August 8, 1999. Total number of patients was sixty-two (Male 25: female 37) and the mean age was 52.1 years old. Salmonella Enteritidis was isolated from the stool in 59 cases. Twenty-one of them were associated with the immunosuppression (12 with malignancy, 6 with DM, one with nephrotic syndrome, one with chronic nephritis and one with allergic purpura). Clinical symptoms of the patients were composed of watery diarrhea (100%), fever (88.7%), abdominal pain (82.3%), nausea (45.2%) and vomiting (25.8%). The laboratory data revealed leukocytosis (15/47 = 31.9%), increased CRP (44/46 = 95.7%), elevated creatinin (1/37 = 2.7%) and hypokalemia (5/42 = 11.9%). MICs of 20 strains isolated in our laboratory almost coincided with each other indicating that the source of bacteria was probably the same. In vitro, S. Enteritidis were sensitive to OFLX, TFLX, FOM, most of PCs, CEPs, AGs but resistant to MPIPC, CAM, CLDM, VCM. Therefore we administered LVFX to 59 cases (alone in 45cases, combination with FOM in 6 cases), NFLX to two children and FMOX to one pregnant woman. Lactobacillus was administered to 28 cases (45.2%) and antidiarrhetics were given to 6 cases (9.7%). Finally all patients improved within two weeks. We suspect that the salmonella food poisoning was due to infected egg. The partially cooked omelet would permit the growth of a sufficient inoculum to cause disease. To prevent food poisoning, we have to be consistent in cooking the food well (at 75 degrees C, for more than 1 minute) and should not have omelets during the hot summer season.
1999年8月8日晚,我院食用煎蛋后爆发了沙门氏菌食物中毒事件。患者总数为62人(男性25人,女性37人),平均年龄52.1岁。59例患者粪便中分离出肠炎沙门氏菌。其中21例与免疫抑制有关(12例患有恶性肿瘤,6例患有糖尿病,1例患有肾病综合征,1例患有慢性肾炎,1例患有过敏性紫癜)。患者的临床症状包括水样腹泻(100%)、发热(88.7%)、腹痛(82.3%)、恶心(45.2%)和呕吐(25.8%)。实验室数据显示白细胞增多(15/47 = 31.9%)、CRP升高(44/46 = 95.7%)、肌酐升高(1/37 = 2.7%)和低钾血症(5/42 = 11.9%)。我院实验室分离出的20株菌株的最低抑菌浓度几乎一致,表明细菌来源可能相同。体外实验中,肠炎沙门氏菌对氟氧沙星、妥舒沙星、磷霉素、大多数青霉素类、头孢菌素类、氨基糖苷类敏感,但对美洛培南、头孢噻肟、氯碳头孢、万古霉素耐药。因此,我们对59例患者使用了左氧氟沙星(45例单独使用,6例与磷霉素联合使用),对2名儿童使用了诺氟沙星,对1名孕妇使用了磷莫西沙星。28例患者(45.2%)使用了乳酸菌,6例患者(9.7%)使用了止泻药。最终,所有患者在两周内康复。我们怀疑沙门氏菌食物中毒是由受感染的鸡蛋引起的。煎蛋未完全煮熟会使足够数量的细菌繁殖从而致病。为预防食物中毒,我们必须始终将食物煮熟(75摄氏度以上,持续1分钟以上),并且在炎热的夏季不应食用煎蛋。