Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento.
Sacramento County Department Public Health, Mather.
Clin Infect Dis. 2020 Apr 10;70(8):1695-1700. doi: 10.1093/cid/ciz479.
Botulism is a rare and potentially fatal paralytic disease caused by botulinum neurotoxin (BoNT). In April 2017, 4 California residents from 2 adjacent counties were hospitalized with suspected foodborne botulism, precipitating an investigation by state and local public health departments in California.
We interviewed suspected botulism patients and their families, inspected the suspect establishment, and collected suspect food. We tested patient sera, stool, and gastric aspirates using mouse bioassay for BoNT and/or culture for Clostridium botulinum. We tested suspect food and environmental samples for BoNT and confirmed presumptive positives using direct mouse bioassay and culture. We performed whole-genome sequencing on food and clinical isolates.
From April 2017 through May 2017, 10 patients in the Sacramento area were hospitalized with laboratory-confirmed botulism; 7 required mechanical ventilation, and 1 died. Of 9 patients with information, all had visited Gas Station X before illness onset, where 8 reported consuming a commercial cheese sauce. BoNT/A and/or BoNT/A-producing C. botulinum were detected from each patient and from leftover cheese sauce. Clostridium botulinum isolates from 4 patients were closely related to cheese sauce isolates by whole-genome high-quality single-nucleotide polymorphism analysis. No other botulism cases associated with this cheese sauce were reported elsewhere in the United States.
This large foodborne botulism outbreak in California was caused by consumption of commercial cheese sauce dispensed at a gas station market. The epidemiologic and laboratory evidence confirmed the cheese sauce as the outbreak source. The cheese sauce was likely locally contaminated, although the mechanism is unclear.
肉毒中毒是一种罕见的、潜在致命的麻痹性疾病，由肉毒神经毒素（BoNT）引起。2017 年 4 月，加利福尼亚州 2 个相邻县的 4 名居民因疑似食源性肉毒中毒住院，促使加利福尼亚州州和地方公共卫生部门展开调查。
我们对疑似肉毒中毒患者及其家属进行了访谈，检查了可疑场所，并采集了可疑食物。我们使用小鼠生物测定法检测 BoNT 和/或培养梭菌肉毒杆菌对患者血清、粪便和胃液抽吸物进行了检测。我们对可疑食物和环境样本进行了 BoNT 检测，并使用直接小鼠生物测定法和培养法对推定阳性结果进行了确认。我们对食物和临床分离株进行了全基因组测序。
2017 年 4 月至 5 月，萨克拉门托地区有 10 名患者因实验室确诊的肉毒中毒住院；7 人需要机械通气，1 人死亡。9 名有信息的患者均在发病前去过 X 加油站，其中 8 人报告食用了一种商业奶酪酱。从每个患者和剩余的奶酪酱中均检测到 BoNT/A 和/或 BoNT/A 产生的梭菌肉毒杆菌。通过全基因组高质量单核苷酸多态性分析，从 4 名患者中分离出的梭菌肉毒杆菌与奶酪酱分离株密切相关。在美国其他地方没有报告与这种奶酪酱相关的其他肉毒中毒病例。
加利福尼亚州的这次大型食源性肉毒中毒暴发是由在加油站市场购买的商业奶酪酱消费引起的。流行病学和实验室证据证实了奶酪酱是此次暴发的源头。尽管机制尚不清楚，但奶酪酱可能是本地污染的。
