Published Date: 2005-05-31 23:50:00
Subject: PRO/AH/EDR> Food poisoning, wedding - India (Karnataka): staph. susp.
Archive Number: 20050531.1506
FOOD POISONING, WEDDING - INDIA (KARNATAKA): STAPHYLOCOCCUS SUSP.
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Tue, 31 May 2005
From: ProMED-mail <email@example.com>
Source: Star of Mysore [edited]
More than 100 guests take ill after wedding lunch
More than 100 guests, including women and children, took ill after lunch
following a marriage ceremony on Sun, 29 May 2005, in Basallihundi village
in Mysore Taluk. They have been admitted to Cheluvamba Hospital, KR
Hospital, Government Epidemic Diseases Hospital on KRS Road and Sita Ranga
Polyclinic, on Narayana Sastry Road.
A large number of people had come from Hebya village in Nanjangud Taluk to
attend the marriage ceremony. 3 guests, who had lunch in the function on
Sun afternoon, 29 May 2005, started vomiting, villagers disclosed. The
number of guests in the wedding who took ill rose by the evening, and the
affected were treated by ayurvedic practitioners in the village.
As their number did not abate, a 6-member team of doctors from the KR
Hospital rushed to the village immediately. Although first aid was
rendered, the situation did not improve, as the number of sick persons
continued to rise, leaving the doctors helpless. As the condition of the
children among the ill turned serious, they were shifted to Mysore and
admitted to KR Hospital as well as Cheluvamba Hospital Children's ward.
Further, 43 persons were admitted to the Epidemic Diseases Hospital on KRS
Road, apart from 30 to Cheluvamba and 17 to K.R. Hospital. Another 10 were
admitted into JSS Hospital and Sitaranga Polyclinic. While 11 children out
of 30 in Cheluvamba Hospital are in Intensive Care Unit, the remaining 19
are in wards.
Doctors at the Epidemic Diseases Hospital Road on KRS Road are treating 28
female and 17 male patients. The condition of a 53-year-old is critical.
He is being kept in the Intensive Care Unit of KR Hospital.
Medical Superintendent of Cheluvamba Hospital Dr. H.R. Damayanti told Star
of Mysore that the children are running fever and experiencing fatigue. The
illness was due to food poisoning. Since more than 600 guests at lunch
after the wedding, the number of affected is likely to rise. Neither the
bride nor the groom was affected.
[The explosive nature of a primarily vomiting-associated illness after a
large gathering beginning within hours is suggestive of staphylococcal food
poisoning, a self-limited illness caused by a pre-formed enterotoxin. The
degree of illness with a substantial number of patients in intensive care
is disconcerting and may suggest either another illness or a large toxin
burden. Another concern is the comment in the last paragraph regarding
fever. 2 reports from MMWR (1, 2) report 11 and 34 percent of affected
individuals with fever; however, pyrexia is not a prominent feature of the
illness nor is the degree of fever generally high.
1. CDC: Outbreak of Staphylococcal Food Poisoning Associated with
Precooked Ham -Florida, 1997. Morbid Mortal Week Rep 1997;46:1189-91.
2. CDC: Staphylococcal Food Poisoning from Turkey at a County Club Buffet.
Morbid Mortal Week Rep 1986; 35:715-6, 721-2.
The following is extracted from the USA FDA's Bad Bug Book regarding
staphylococcal food poisoning:
"In the diagnosis of staphylococcal foodborne illness, proper interviews
with the victims, and the gathering and analyzing of epidemiological data,
are essential. Incriminated foods should be collected and examined for
staphylococci. The presence of relatively large numbers of enterotoxigenic
staphylococci is good circumstantial evidence that the food contains toxin.
The most conclusive test is the linking of an illness with a specific food,
or, in cases where multiple vehicles exist, the detection of the toxin in
the food sample(s).
In cases where the food may have been treated to kill the staphylococci, as
in pasteurization or heating, direct microscopic observation of the food
may be an aid in the diagnosis. A number of serological methods for
determining the enterotoxigenicity of _S. aureus_ isolated from foods, as
well as methods for the separation and detection of toxins in foods, have
been developed, and used successfully, to aid in the diagnosis of the
illness. Phage typing may also be useful when viable staphylococci can be
isolated from the incriminated food, from victims, and from suspected
carriers, such as food handlers.
A toxin dose of less than 1.0 microgram in contaminated food will produce
symptoms of staphylococcal intoxication. This toxin level is reached when
_S. aureus_ populations exceed 100 000 per gram.
Foods that are frequently incriminated in staphylococcal food poisoning
include meat and meat products; poultry and egg products; salads such as
egg, tuna, chicken, potato, and macaroni; bakery products such as
cream-filled pastries, cream pies, and chocolate eclairs; sandwich
fillings; and milk and dairy products. Foods that require considerable
handling during preparation, and that are kept at slightly elevated
temperatures after preparation, are frequently involved in staphylococcal