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First reported foodborne outbreak associated with microsporidia, Sweden, October 2009

Epidemiol Infect. 2012 Mar;140(3):519-27. doi: 10.1017/S095026881100077X. Epub 2011 May 9.

Abstract

Microsporidia are spore-forming intracellular parasites that infrequently cause disease in immunocompetent persons. This study describes the first report of a foodborne microsporidiosis outbreak which affected persons visiting a hotel in Sweden. Enterocytozoon bieneusi was identified in stool samples from 7/11 case-patients, all six sequenced samples were genotype C. To confirm that this was not a chance finding, 19 stool samples submitted by healthy persons from a comparable group who did not visit the hotel on that day were tested; all were negative for microsporidia. A retrospective cohort study identified 135 case-patients (attack rate 30%). The median incubation period was 9 days. Consumption of cheese sandwiches [relative risk (RR) 4·1, 95% confidence interval (CI) 1·4-12·2] and salad (RR 2·1, 95% CI 1·1-4) were associated with illness. Both items contained pre-washed, ready-to-eat cucumber slices. Microsporidia may be an under-reported cause of gastrointestinal outbreaks; we recommend that microsporidia be explored as potential causative agents in food- and waterborne outbreaks, especially when no other organisms are identified.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • DNA, Fungal / genetics
  • Disease Outbreaks*
  • Enterocytozoon / classification
  • Enterocytozoon / genetics
  • Enterocytozoon / isolation & purification*
  • Feces / microbiology
  • Female
  • Foodborne Diseases / epidemiology*
  • Genotype
  • Humans
  • Male
  • Microsporidiosis / epidemiology*
  • Middle Aged
  • Retrospective Studies
  • Sweden / epidemiology

Substances

  • DNA, Fungal