Department of Bacteria, Parasites and Fungi, Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark.
European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden.
Clin Infect Dis. 2022 Aug 31;75(3):468-475. doi: 10.1093/cid/ciab949.
Microsporidia are rarely reported to cause outbreaks of diarrhea. We describe a foodborne outbreak of microsporidiosis from a workplace canteen in November 2020 in Denmark.
A probable case was defined as any person using the canteen between 4 November and 13 December 2020, reporting at least one gastrointestinal symptom, whereas a confirmed case also had an Enterocytozoon bieneusi positive stool sample. A web-based questionnaire was used to collect clinical, epidemiological, and food exposure data. We performed a retrospective cohort study and tested stool samples from affected individuals for bacterial, viral, and parasitic pathogens, including E. bieneusi.
Altogether, 195 individuals completed the questionnaire. We identified 52 cases (65% male; median age 45 years [range 25-65]). Diarrhea (90%), fatigue (83%), and abdominal pain (79%) were the most commonly reported symptoms. Eight cases were laboratory-confirmed and had E. bieneusi genotype C. The incubation period was between 5 and 12 days, and polymerase chain reaction (PCR)-detectable spore shedding occurred up to 43 days after symptom onset. Disease was associated with consuming food from the workplace canteen on 4 November 2020 (relative risk [RR[, 2.8 [95% confidence interval [CI]: 1.4 - 5.4]) and lunchboxes containing open sandwiches (RR, 3.2 [95% CI: 1.4 - 7.2]) served that day.
This is the second documented foodborne outbreak of E. bieneusi genotype C-associated diarrhea worldwide. Epidemiological findings advocated an open sandwiches lunchbox from 4 November 2020, as a likely source. E. bieneusi may be an under-reported cause of outbreaks of diarrhea, and testing for it might be useful in foodborne outbreak investigations.
微孢子虫很少引起腹泻暴发。我们描述了 2020 年 11 月丹麦一家工作场所食堂发生的一起食源性微孢子虫病暴发。
疑似病例定义为在 2020 年 11 月 4 日至 12 月 13 日期间使用食堂的任何人，报告至少有一个胃肠道症状，而确诊病例还具有肠细胞微孢子虫阳性粪便样本。使用基于网络的问卷收集临床、流行病学和食物暴露数据。我们进行了回顾性队列研究，并测试了受影响个体的粪便样本，以检测细菌、病毒和寄生虫病原体，包括肠细胞微孢子虫。
共有 195 人完成了问卷。我们确定了 52 例病例（65%为男性；中位年龄 45 岁[范围 25-65]）。腹泻（90%）、疲劳（83%）和腹痛（79%）是最常见的症状。8 例为实验室确诊病例，具有肠细胞微孢子虫基因型 C。潜伏期为 5-12 天，症状出现后 43 天PCR 检测到孢子脱落。疾病与 2020 年 11 月 4 日食用工作场所食堂的食物（相对风险[RR]，2.8[95%置信区间[CI]：1.4-5.4]）和当天供应的含有开放式三明治的午餐盒（RR，3.2[95% CI：1.4-7.2]）有关。
这是全球第二起有记录的食源性肠细胞微孢子虫基因型 C 相关腹泻暴发。流行病学发现支持 2020 年 11 月 4 日的开放式三明治午餐盒可能是此次暴发的来源。肠细胞微孢子虫可能是腹泻暴发的一个被低估的原因，在食源性暴发调查中检测它可能是有用的。
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