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Update: Gastrointestinal Illness Associated with Imported Semi-Soft Cheese

In September 1983, three clusters of gastrointestinal illness associated with eating imported French Brie cheese occurred in the District of Columbia (1). All three outbreaks involved one lot of cheese and one distributor in the Washington, D.C., area. Cases of similar clinical illness have subsequently been identified in four states (Colorado, Georgia, Illinois, and Wisconsin) associated with eating the same brand of semi-soft cheese (either Brie or Camembert). The lots implicated in these states included at least one lot produced approximately 40 days after the cheese that caused the District of Columbia cases. Stool specimens were collected in Illinois and Wisconsin from ill individuals and from well family members who did not eat the cheese. Escherichia coli serotype O27:H20 producing a heat-stable toxin was identified in stool specimens from seven of 15 recently ill persons and from none of eight controls. E. coli O27:H20 organisms were also isolated from single cases in Washington, D.C., and Atlanta, Georgia. Plasmid analysis of the organisms from patients who lived in different locations and who ate different lots of cheese revealed an identical plasmid profile. Attempts to isolate the organism from the cheese are in progress. Control measures included recalling the cheese nationwide and instituting a program of regulatory sampling in cooperation with the French government for the importation of semi-soft cheeses. Reported by BJ Francis, MD, State Epidemiologist, Illinois Dept of Public Health; JP Davis, MD, State Epidemiologist, Wisconsin Dept of Health and Social Svcs; Emergency and Epidemiology Operations Br, US Food and Drug Administration; Div of Field Svcs, Epidemiology Program Office, Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Enterotoxigenic E. coli organisms commonly cause diarrhea in developing countries (2), and they have also been implicated as a common cause of travelers' diarrhea (3). They are rarely associated with illness acquired in the United States, Canada, or Europe (4-6). This represents the third foodborne outbreak caused by enterotoxigenic E. coli and the first common-source outbreak due to a strain producing heat-stable enterotoxin reported in the United States (7,8).

The association of a single pathogen with illness caused by eating semi-soft cheeses from at least two lots manufactured 1 month apart suggests a continuing common source of contamination; however, no information is yet available from the manufacturing plant in France. In a 1971 diarrheal-disease outbreak in the United States caused by enteroinvasive E. coli contaminating Brie, Camembert, or Coulomiers cheese produced by another French manufacturer, a contaminated water supply was implicated as the source of pathogenic organisms (9).

References

  1. CDC. Gastrointestinal illness associated with imported Brie cheese--District of Columbia. MMWR 1983;32:533.

  2. Ryder RW, Sack DA, Kapikian AZ, et al. Enterotoxigenic Escherichia coli and reovirus-like agent in rural Bangladesh. Lancet 1976;I;659-62.

  3. Merson MH, Morris GK, Sack DA, et al. Travelers' diarrhea in Mexico. A prospective study of physicians and family members attending a congress. N Engl J Med 1976;294:1299-305.

  4. Brunton J, Hinde D, Langston C, Gross R, Rowe B, Gurwith M. Enterotoxigenic Escherichia coli in central Canada. J Clin Microbiol 1980;11:343-8.

  5. Back E, Blomberg S, Wadstrom T. Enterotoxigenic Escherichia coli in Sweden. Infection 1977;5:2-5.

  6. Gangarosa EJ. Epidemiology of Escherichia coli in the United States. J Infect Dis 1978;137:634-8.

  7. Taylor WR, Schell WL, Wells JG, et al. A foodborne outbreak of enterotoxigenic Escherichia coli diarrhea. N Engl J Med 1982;306:1093-5.

  8. Wood LV, Wolfe WH, Ruiz-Palacios G, et al. An outbreak of gastroenteritis due to a heat-labile enterotoxin-producing strain of Esherichia coli. Infection and Immunity 1983;41:931-4.

  9. Marier R, Wells JG, Swanson RC, Callahan W, Mehlman IJ. An outbreak of enteropathogenic Escherichia coli foodborne disease traced to imported French cheese. Lancet 1973;II:1376-8.



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