Yoshida Hisayoshi, Matsuo Mitsuko, Miyoshi Tatsuya, Uchino Kiyoko, Nakaguchi Hiroyuki, Fukumoto Toshio, Teranaka Yoko, Tanaka Tomoyuki
Sakai City Institute of Public Health, Osaka 590-0953, Japan.
Jpn J Infect Dis. 2007 Nov;60(6):405-7.
On October 17, 2006, the Sakai City Public Health Center received a report of acute gastroenteritis among 4 members from the same company who had eaten raw meat dish called "Yukke: Korean-style beef tartar" and raw liver at a rotisserie in Sakai City on October 7. Based on information from interviews, the median incubation period was 5.5 (range, 5-7 days), and the median length of illness was 7 days (range, 4-10 days). The illness was characterized by a prolonged incubation period, non-bloody watery diarrhea, reduced vomiting, and light fever, which led us to suspect an enteric protozoan infection. Stool specimens obtained from 3 of the 4 symptomatic patients were positive for Cryptosporidium oocysts. They, along with 2 food workers, were negative for food poisoning bacteria or Norovirus. Genotyping of the Cryptosporidium isolates by direct sequencing of PCR products revealed that all the isolates were the C. parvum genotype II (bovine) and the subgenotype of IIa with 100 % homology with respective 18S rRNA and Cpgp40/15 genes. Positive implementation of tests for enteric protozoa including Cryptosporidium is necessary in the differential diagnosis of suspected foodborne gastroenteritis, particularly when it is characterized by a prolonged incubation period and severe watery diarrhea. In fact, we were able to diagnose the illness as cryptosporidiosis without waiting for the results of bacteriological and virological examinations, and thus prevented the possible occurrence of a secondary infection through an ill patient who works as cooking personnel in the company.
2006年10月17日，堺市公共卫生中心收到一份报告，称10月7日在堺市一家烤肉店，同一家公司的4名员工食用了名为“Yukke：韩式生牛肉片”的生肉菜肴和生肝脏后，出现了急性肠胃炎症状。根据访谈信息，中位潜伏期为5.5天（范围为5 - 7天），中位病程为7天（范围为4 - 10天）。该病的特点是潜伏期延长、非血性水样腹泻、呕吐减少和低热，这使我们怀疑是肠道原生动物感染。从4名有症状患者中的3人采集的粪便标本中，隐孢子虫卵囊检测呈阳性。他们以及2名食品工作人员的食物中毒细菌和诺如病毒检测均为阴性。通过对PCR产物进行直接测序对隐孢子虫分离株进行基因分型，结果显示所有分离株均为微小隐孢子虫基因型II（牛型），其亚型为IIa，18S rRNA和Cpgp40/15基因的同源性均为100%。在疑似食源性肠胃炎的鉴别诊断中，尤其是当疾病具有潜伏期延长和严重水样腹泻的特点时，对包括隐孢子虫在内的肠道原生动物进行检测的积极实施是必要的。事实上，我们能够在不等待细菌学和病毒学检查结果的情况下将该病诊断为隐孢子虫病，从而防止了在该公司担任烹饪人员的患病患者可能引发的二次感染。
