Published Date: 2012-05-14 17:58:19
Subject: PRO/EDR> Foodborne illness - USA (04): (NY) Bacillus cereus susp.
Archive Number: 20120514.1132522
FOODBORNE ILLNESS - USA (04): (NEW YORK) BACILLUS CEREUS SUSPECTED
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Mon 14 May 2012
Source: WABC-TV [edited]
About 150 Mother's Day [13 May 2012] celebrators suffered terribly from a massive case of food poisoning on Sunday night, 13 May 2012, according to authorities. So many people got sick at the same time that officials report the patients had to be rushed to hospitals in several different counties -- from Putnam to Westchester to Rockland.
Eyewitness News is told that it all began with a beautiful serene trip to the Chuang Yen Monastery in Kent about 55 miles [89 km] outside of New York City. There were 700 celebrators attending the Buddhist garden festival, 500 of them from Chinatown. They took buses up for the day, and by mid-afternoon, they boarded the same buses to go shopping at Woodbury Commons. That's when they were hit by diarrhea and vomiting.
Authorities say it was so severe, ambulances had to be called. One published report says that authorities are looking into sticky rice balls served at the festival to see if that is what made everyone sick. The temple website says that the food it served was vegetarian. On Sunday night, 13 May 2012, they released a statement saying that "the dishes were provided by volunteers" and that everything "is being investigated by event organizers who are cooperating with the local authorities."
Since most of the patients came up on buses, it us not clear how they will get back home once they are discharged.
[The short incubation period suggesting a pre-formed enterotoxin and the suspected vehicle, rice, implicates _Bacillus cereus_ as the etiology of this dramatic outbreak.
_Bacillus cereus_ food poisoning is the general name used for the illness. However, the organism has 2 recognized types of foodborne illness: diarrheal and emetic. The emetic syndrome is caused by cereulide, a heat- and pH-stable peptide toxin. Consumption of food contaminated with this toxin may lead to emesis between 0.5 and 5 hours after ingestion. The symptoms of this illness mimic those of _Staphylococcus aureus_ food poisoning.
The diarrheal illness (more common in North America and Europe) is caused by a high molecular weight protein while the emetic or vomiting type (commoner in Japan than the diarrheal type) of food poisoning is caused by a low molecular weight and heat-stable protein. In some outbreaks there seems to be an overlap between the diarrheal and the emetic types of illness [as in the above report].
The symptoms of _B. cereus_ diarrheal type food poisoning include abdominal pain, watery diarrhea, rectal tenesmus, moderate nausea that may accompany diarrhea, seldom vomiting, and no fever. Symptoms develop within 6-15 hours and can persist for 24 hrs. This syndrome is rather mild, and tends to mimic the symptoms of _Clostridium perfringens_ food poisoning. The diarrheal syndrome is caused by enterotoxins that are produced during growth of _B. cereus_ in the small intestine.
Generally, symptoms are transient and mild possibly contributing to underreporting. Large numbers of cells are needed to cause illness and can occur when the food product (often rice) is held at a temperature inadequate to prevent growth. Despite the illness's usual mild symptoms, fatalities have been described associated with liver failure (Mahler H, Pasi A, Kramer JK, et al: Fulminant liver failure in association with the emetic toxin of _Bacillus cereus_. N Engl J Med 1997; 336(16): 1142-8; available at http://www.nejm.org/doi/full/10.1056/NEJM199704173361604). - Mod.LL]
[Sticky (glutinous) rice balls: