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<I>Vibrio</I> <I>Mimicus</I> Infection Associated With

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<I>Vibrio</I> <I>Mimicus</I> Infection Associated With 762 Journal of Food Protection, Vol. 75, No. 4, 2012, Pages 762–764 doi:10.4315/0362-028X.JFP-11-410 Research Note Vibrio mimicus Infection Associated with Crayfish Consumption, Spokane, Washington, 2010 MEAGAN K. KAY,1,2* EMILY J. CARTWRIGHT,1 DOROTHY MACEACHERN,3 JOEL MCCULLOUGH,3 EZRA BARZILAY,4 ERIC MINTZ,4 JEFFREY S. DUCHIN,2 KATHRYN MACDONALD,5 MARYANN TURNSEK,4 CHERYL TARR,4 DEBORAH TALKINGTON,4 ANNA NEWTON,4 AND ANTHONY A. MARFIN5 Downloaded from http://meridian.allenpress.com/jfp/article-pdf/75/4/762/1682662/0362-028x_jfp-11-410.pdf by guest on 28 September 2021 1Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30333; 2Public Health - Seattle & King Co., 401 5th Avenue Suite 900, Seattle, Washington 98104; 3Spokane Regional Health District, 1101 West College Avenue, Spokane, Washington 99201; 4Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30333; and 5Washington State Department of Health, 1610 N.E. 150th Street, Shoreline, Washington 98155, USA MS 11-410: Received 13 September 2011/Accepted 4 December 2011 ABSTRACT We report a cluster of severe diarrheal disease caused by Vibrio mimicus infection among four persons who had consumed leftover crayfish the day after a private crayfish boil. Gastrointestinal illness caused by Vibrio mimicus has not been reported previously in Washington State. Three cases were laboratory confirmed by stool culture; using PCR, isolates were found to have ctx genes that encode cholera toxin (CT). Two of the cases were hospitalized under intensive care with a cholera-like illness. The illnesses were most likely caused by cross-contamination of cooked crayfish with uncooked crayfish; however, V. mimicus was not isolated nor were CT genes detected by PCR in leftover samples of frozen crayfish. Clinicians should be aware that V. mimicus can produce CT and that V. mimicus infection can cause severe illness. Vibrio mimicus is a bacterium in the same genus as that residence on 19 June 2010, and leftover crayfish had which causes cholera (Vibrio cholerae), and its disease can been consumed by eight persons at a potluck the following mimic symptoms of cholera, specifically watery diarrhea day. We investigated to identify the outbreak source and (5). V. mimicus is found naturally in freshwater and additional cases, describe the spectrum of illnesses, and seawater. Infections with this organism have been associ- characterize risk factors for illness. ated with gastroenteritis after seafood ingestion and with otitis media after exposure to seawater (9). Reported cases MATERIALS AND METHODS are usually sporadic, but outbreaks have been attributed to The party host provided an attendee list, a menu for both consumption of crayfish in Louisiana (9), raw turtle eggs in events, and a description of food handling and meal preparation. Costa Rica (2), and seafood soup in Thailand (4). No prior Party and potluck attendees were surveyed in person or by telephone outbreaks attributed to V. mimicus have been reported to the with a standardized questionnaire about food and environmental Foodborne Disease Outbreak Surveillance System main- exposures. Respondents were asked about their medical history, tained by the Centers for Disease Control and Prevention including recent diarrheal illnesses, chronic medical conditions, and (CDC) since this system’s inception in 1973, and no cases medications or surgeries that could result in hypochloridia and make them more susceptible to Vibrio species infection. of gastrointestinal illness caused by V. mimicus have been A case was defined as diarrheal illness (more than three stools reported previously in Washington State. per day) #5 days after the event in a party or potluck attendee. We On 24 June 2010, Spokane Regional Health District reviewed patient medical charts, using a standardized form, and was notified of two cases of V. mimicus infection among interviewed ill persons about their symptoms. Clinical isolates persons hospitalized under intensive care who had con- were sent to CDC, and PCR was used to identify the isolates (10) sumed crayfish on 20 June 2010. Spokane Regional Health and to test for the presence of cholera toxin (CT) genes (ctxAB) (8). District notified the Washington State Department of Health To identify asymptomatic infections, serum from 17 (77%)of22 on 24 June, and CDC’s assistance with the epidemiologic attendees was collected during 21 July to 1 August and tested at investigation and laboratory testing was requested. On 28 CDC for antibodies to CT by using an indirect enzyme-linked June, a third case was reported in a person who had eaten immunosorbent assay (ELISA) and a purified CT (11). Testing for antibodies to the lipopolysaccharide of the V. mimicus strain the same crayfish. The initial investigation revealed that isolated from the clinically ill persons was also performed at CDC freshly boiled crayfish had been served at a party at a private by using an indirect ELISA (unvalidated assay). Samples of leftover frozen crayfish were sent to the Food and Drug * Author for correspondence. Tel: 206-263-8277; Fax: 206-296-4803; Administration’s Gulf Coast Seafood Laboratory for culture and E-mail: [email protected]. PCR testing on 20 July 2010 (1, 6). J. Food Prot., Vol. 75, No. 4 CRAYFISH-ASSOCIATED VIBRIOSIS 763 TABLE 1. Crayfish exposure, clinical illness, stool culture, and serologic testing results among party and potluck attendees, Spokane, Washington, 2010 Consumed freshly boiled Consumed leftover Cholera toxin Attendeea Age (y) crayfish crayfish Clinical illnessb Stool culturec antibody 1 48 Yes Yes Yes Positive No 2 49 No Yes Yes Positive No 3 57 No Yes Yes Positive No 4 13 No Yes Yes ND Yes 5 50 Yes No No ND Yes 6 81 No No No ND Yes 7 41 Yes No No ND Yesd 8 5 Yes No No ND Yesd 9 9 No No No ND Yesd Downloaded from http://meridian.allenpress.com/jfp/article-pdf/75/4/762/1682662/0362-028x_jfp-11-410.pdf by guest on 28 September 2021 10 12 No No No ND Yesd 11 85 Yes No No ND No 12 70 No No No ND No 13 46 Yes No No ND No 14 64 Yes No No ND No 15 21 Yes Yes No ND No 16 45 Yes Yes No ND No 17 17 No Yes No ND No 18 19 Yes Yes No ND ND 19 21 Yes No No ND ND 20 71 No No No ND ND 21 19 Yes No No ND ND a n ~ 21. b Yes indicates that the person had gastrointestinal illness compatible with the case definition and with onset within 5 days of crayfish consumption. c ND indicates sample not collected or testing not performed. d All members of the same family; none reported international travel, seafood handling, or other common Vibrio species exposures. Proportions were calculated and compared by using the 2 | 2 Three of four persons meeting the case definition table in OpenEpi version 2.3 (http://www.openepi.com/Menu/ provided stool samples; PCR assays identified all isolates OpenEpiMenu.htm). from the stool as V. mimicus and determined that the strains carried the ctxAB genes that encode CT. V. mimicus was not RESULTS isolated, nor were CT genes detected by PCR in leftover samples of frozen crayfish. Fourteen persons attended the party only, four persons Serologic results for antibodies to CT did not correlate attended the potluck only, and four persons attended both with clinical illness or consumption of crayfish; however, three events. Twenty-one (95%) of 22 attendees completed a of four ill persons had measurable antibody reactivity to the questionnaire. The median age of respondents was 45 years lipopolysaccharide of V. mimicus. Of those persons without (range, 5 to 85 years). Twelve (57%) respondents were clinical illness, 6 (46%)of13,4fromthesamefamily,had male, and all were non-Hispanic white. positive anti-CT immunoglobulin G antibodies (Table 1). Of 21 respondents, 8 (38%) consumed freshly cooked crayfish only, 4 (19%) ate leftover crayfish only, and 4 Case description 1. A man, aged 57 years, with a respondents ate both types. Four persons had illness meeting history of gastroesophageal reflux disease requiring antacid the case definition. Of the eight persons who consumed therapy experienced vomiting, profuse watery diarrhea, and leftover crayfish, four (50%) experienced illness; none of 13 fever 36 h after consumption of leftover crayfish. He was who did not consume leftover crayfish became ill (Table 1). admitted to the intensive care unit and experienced metabolic No other common food or environmental exposures were acidosis (pH 7.12) and acute renal failure (peak creatinine, identified among all ill persons. 7.3 mg/dl). He was treated with rehydration (23 liters over The host ordered 120 lb (54.4 kg) of pond-raised, live 6 days), a bicarbonate infusion, a single dose of doxycycline crayfish from an online company. Crayfish were shipped cold orally, and intravenous azithromycin for 2 days. in three burlap sacks and stored in the sacks on ice in coolers overnight. The host combined the crayfish into one cooler Case description 2. A woman, aged 49 years, with a before boiling them in batches for 20 min. After cooking each history of gastric bypass surgery experienced fever, batch, he immediately served them from a cooler that had vomiting, and profuse watery diarrhea 42 h after consuming contained raw crayfish previously and had not been cleaned. leftover crayfish. She was admitted to the intensive care Leftover crayfish were stored in different containers in a unit and treated for metabolic acidosis (pH 7.1) and acute refrigerator and served cold the next day at the potluck. renal failure (peak creatinine, 8.0 mg/dl). She received a 764 KAY ET AL.
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