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Clostridium Welchii and Bacillus Cereus Infection and Intoxication BETTY C

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Clostridium Welchii and Bacillus Cereus Infection and Intoxication BETTY C Postgrad Med J: first published as 10.1136/pgmj.50.588.597 on 1 October 1974. Downloaded from Postgraduate Medical Journal (October 1974) 50, 597-602. Clostridium welchii and Bacillus cereus infection and intoxication BETTY C. HOBBS O.St.J., D.Sc., F.R.C.Path., Dip.Bact. Food Hygiene Laboratory, Central Public Health Laboratory, Colindale Avenue, London NW9 5HT Summary 1948, there was a large outbreak of intestinal disease Clostridium welchii type A is a common agent of food described as enteritis necroticans in Hamburg, poisoning when allowed to proliferate to large numbers Germany; it was reported in a number of papers in cooked foods, usually meat and poultry. The main (Ernst, 1948; Schutz, 1948; Marcuse and Konig, factors of importance are survival of the spores, 1950). The clinical and bacteriological findings were frequently found on raw products, through the cooking clarified in papers by Zeissler and Rassfeld-Sternberg process, and possible contamination of cooked meats (1949), Oakley (1949) and Hain (1949). These workers transferred to unclean containers; subsequent germina- described a small outbreak of haemorrhagic enteritis tion ofspores and rapid multiplication ofthe vegetative in a family who had eaten tinned rabbit meat or fish; cells during long slow cooling and non-refrigerated the outbreak was thought to be part of the much Protected by copyright. storage lead to heavy contamination. The toxin re- larger episode. The strain of Cl. welchii isolated from sponsible is different from the soluble antigens, and its food and patients survived 1000C for 1-4 hr and formation in the intestine is associated with sporulation. produced much 3-toxin. This strain was given the Large numbers of Cl. welchii of the same sero- new type letter F; later it was described as a sub- logical types in food and faeces is the main diagnostic group (heat-resistant) of type C (Brooks, Sterne and factor. Important preventive measures are rapid cooling Warrack, 1957; Warrack, 1963; Sterne and Warrack, and cold storage to prevent growth. 1964). Hobbs et al. (1953) established Cl. welchii Bacillus cereus is an aerobic sporulating organism type A as a major cause of gastro-enteritis of a much commonly found in cereals. Outbreaks described from milder nature than that described as enteritis necro- Europe have a different aetiology with regard to food ticans by the German workers. The outbreaks re- vehicles, incubation period and symptoms from those ported in this paper were due to heat-resistant 'non- that have been reported recently in the U.K. from fried or oc-haemolytic Cl. welchii'. Later McKillop (1959), and boiled rice. The spores survive through cooking Hall et al. (1963), Taylor and Coetzee (1966), and procedures and grow out to cells which sporulate Sutton and Hobbs (1968) showed that the so-called http://pmj.bmj.com/ readily in the cooked food and which are assumed to 'heat-sensitive' strains, mostly P-haemolytic on horse produce toxin in the food. Large numbers of B. cereus blood agar, were also responsible for outbreaks. are found in foods causing illness and, as with Cl. Although the spores of these strains are less resistant welchii, the main preventive measure is inhibition of to heat, nevertheless they can survive cooking. growth by quick cooling and cold storage of foods Many other papers have been written on Cl. welchii cooked ahead of requirements. A comparative table of food poisoning up to the present day, when the the characteristics and clinical symptoms of Cl. means by which the organism causes symptoms is welchii and B. cereus is given. described. on September 29, 2021 by guest. Of the five types of Cl. welchii A to E differen- Clostridium welchil tiated on the proportion of soluble antigens in each, There were early reports of intestinal disturbances types A, C and D are pathogenic for man and types due to Cl. welchii in 1895 (Klein, 1895) and 1899 B, C, D and E affect animals. Type A is further (Andrewes, 1899). In 1943 Knox and MacDonald divisible into serological types; sera are obtained by described outbreaks of food poisoning in children inoculation of the whole organism into rabbits. after eating school meals. Gravy prepared in bulk on Cl. welchii type A may be isolated in small num- the previous day was heavily contaminated with bers from many foods both raw and cooked, and it anaerobic sporulating bacilli including Cl. welchii. forms a minor component of the faecal flora in most McClung (1945) in the U.S.A. was definite in his if not all healthy adults, occurring in numbers of assertion that certain food poisoning outbreaks after about 104/g of faeces. When it becomes established meals of cooked poultry were due to Cl. welchii. In in the large gut, where toxin is produced, large Postgrad Med J: first published as 10.1136/pgmj.50.588.597 on 1 October 1974. Downloaded from 598 B. C. Hobbs numbers appear in the faecal flora. Outbreaks of less than 4%/ of spores of the more heat-resistant enteritis necroticans due to the type C strains are strains grew without heating, and activation was uncommon; they have been reported from New usually detected at 75-80°C. The heat resistance, Guinea by Murrell et al. (1966a, b); Collee (1973) heat activation and rapid generation time are the describes similar enterotoxaemic diseases produced factors which predispose this organism to survival by various types of Cl. welchii in animals; the type C followed by rapid multiplication in slowly cooling strains in pigs show evidence of bacterial adhesion to masses of meat and poultry. The organism is intestinal epithelial cells, which may explain the anaerobic, but not to a marked degree, nevertheless, more serious nature of the disease caused by type C its growth depends on anaerogenic conditions within strains in humans as well as in animals. a mass of cooked food. Large numbers (millions per The annual statistics for Cl. welchii food poisoning gram) of viable Cl. welchii cells in cooked foods is in England and Wales record 47 outbreaks and indicative of a health hazard. approximately 1534 cases in 1969 and 32 outbreaks The toxin of Cl. welchii responsible for the food and 1263 cases in 1970. The symptoms of abdominal poisoning symptoms is produced in the large intes- pain, nausea and acute diarrhoea occur 8-24 hr after tine during sporulation. The potential for sporula- eating food, such as cooked meat and poultry, which tion in cooked foodstuffs is poor and if the toxin is has become grossly contaminated with the organism formed at all it is unlikely to be detected. In the during long slow cooling periods and storage at intestine, spores are readily formed and the toxin ambient temperatures. Roast, boiled, steamed, also. Ingestion of a large dose of Cl. welchii and and stewed meats and poultry, and pies and gravies sporulation of the organism in vivo are important are the predominant vehicles of infection, whether factors in the production and release of the entero- eaten cold or reheated. When meat is cooked in bulk, toxin. Ligated gut experiments in rabbits and lambs, the heat gain is slow and subsequent cooling is slow. those with monkeys (Duncan and Strong, 1969; Protected by copyright. The heat drives off dissolved oxygen and the meat Hauschild, Niilo and Dorward, 1970; Duncan and maintains an anaerobic environment. The heat- Strong, 1971) and volunteer experiments in man shocked spores are activated to germinate and when (Strong, Duncan and Perna, 1971) have confirmed the temperature drops to below 50°C the out- the association between sporulation and enterotoxin growths of vegetative cells multiply rapidly. The production. so-called heat-sensitive strains of Cl. welchii type A, Hauschild (1973) refers to the toxin as enterotoxin, usually P-haemolytic on horse blood agar and more and he gives an excellent summary of the properties active in production of a, 0 and x toxins, require less of the substance in his review. After precipitation heat shock for germination. Spores of these strains with ammonium sulphate the toxin may be purified present on the inside of containers may grow in by gel filtration and ion exchange chromatography. cooked meat foods poured into the containers. The purified preparation is free of nucleic acids, The spores of the organisms Cl. welchii, Cl. fatty acids, phosphatides and reducing sugars. The botulinum and B. cereus can survive in food after u.v. absorption spectrum is maximum at 278-280 cooking, they can be activated to germinate by the nm and minimum at 250 nm. By hydrolysis, 19 http://pmj.bmj.com/ heat treatment and grow at various rates in slowly amino-acids have been demonstrated, amongst which cooling food. Large numbers are assumed to be re- aspartic acid, serine, leucine and glutamic acid are quired to initiate toxin production in the intestine predominant. The substance is probably a protein of or to produce toxin in the foodstuff before consump- mol. wt. 36,000 ± 4000 with an iso-electric point of tion. 4-3. The toxin is inactivated by pronase and B. The characteristics of Cl. welchii are important in subtilis protease but not by trypsin, chymotrypsin or relation to the food poisoning. Temperature limits papain. It is heat labile with a D,o° of 4 min. The for the growth of Cl. welchii are about 250C and MLD for mice (i.v.) is 2000/mgN and lethal doses of on September 29, 2021 by guest. 50°C and the optimum temperature for growth in toxin caused death within 20 min (Hauschild and cooked meat is between 43°C and 47°C (Collee, Hilsheimer, 1971). The enterotoxin may be isolated Knowlden and Hobbs, 1961).
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