Kolavic S A, Kimura A, Simons S L, Slutsker L, Barth S, Haley C E
State Branch, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
JAMA. 1997 Aug 6;278(5):396-8.
Shigella dysenteriae type 2 is rare in the United States, and outbreaks associated with this pathogen are uncommon.
To determine the magnitude and source of an outbreak of S dysenteriae type 2.
Retrospective cohort.
Laboratory of a large medical center.
Case patients were identified as laboratory workers who had diarrhea on or after October 28 and a positive stool culture or temperature greater than 37.8 degrees C. Laboratory workers with diarrhea only were probable case patients.
We interviewed laboratory staff and performed identification, serotyping, and pulsed-field gel electrophoresis on isolates from case patients, implicated food, and laboratory stock culture.
From October 29 through November 1, a total of 12 (27%) of 45 laboratory staff developed severe, acute diarrheal illness; 8 had S dysenteriae isolated from stool and 4 were hospitalized. All case patients reported having eaten muffins or doughnuts placed in the staff break room on October 29. Pulsed-field gel electrophoresis showed stool isolates from 9 case patients were indistinguishable from S dysenteriae type 2 recovered from an uneaten muffin and from the laboratory's stock strain, a portion of which was missing.
The source of the outbreak was most likely the laboratory's stock culture, which was used to contaminate the pastries. Results of this investigation underscore the need for adequate precautions to prevent inadvertent or intentional contamination from highly pathogenic laboratory specimens.
2型痢疾志贺菌在美国较为罕见，与该病原体相关的疫情并不常见。
确定2型痢疾志贺菌疫情的规模和源头。
回顾性队列研究。
一家大型医疗中心的实验室。
病例患者被确定为10月28日及之后出现腹泻且粪便培养呈阳性或体温高于37.8摄氏度的实验室工作人员。仅有腹泻症状的实验室工作人员为疑似病例患者。
我们对实验室工作人员进行了访谈，并对病例患者、可疑食物及实验室储备培养物的分离株进行了鉴定、血清分型和脉冲场凝胶电泳分析。
从10月29日至11月1日，45名实验室工作人员中有12人（27%）出现严重急性腹泻疾病；8人的粪便中分离出2型痢疾志贺菌，4人住院治疗。所有病例患者均报告在10月29日食用了放置在员工休息室的小松饼或甜甜圈。脉冲场凝胶电泳显示，9例病例患者的粪便分离株与从一个未食用的小松饼及实验室储备菌株中分离出的2型痢疾志贺菌无法区分，而实验室储备菌株的一部分已缺失。
此次疫情的源头很可能是实验室的储备培养物，它被用于污染糕点。本次调查结果强调了采取充分预防措施以防止高致病性实验室标本意外或故意污染的必要性。
