An outbreak of food poisoning occurred, affecting half the members of five famil

Question

An outbreak of food poisoning occurred, affecting half the members of five families who ate at a restaurant in San Francisco at 3 p.m. on June 20.

On June 20, a woman was admitted to a hospital with “chilliness,” nausea, abdominal cramps, and watery diarrhea. The next morning, she complained of limb numbness and
difficulty swallowing and breathing. Examination was unremarkable except for slight
weakness of the upper extremities and diminished deep tendon reflexes. Laboratory
analysis yielded no viral or bacterial infection.

An investigation was started to trace her contacts. During the investigation, it became
apparent that the symptoms were due to a meal shared by 32 persons on June 20. The
restaurant purchased rice from a produce market in a 50-kg bag. The rice was boiled the morning of the dinner and kept warm in foil-covered pots. Chicken was purchased from a
supermarket. The chicken was cut up, browned in oil, and boiled for 2 hours; the flesh was pulled from the bones. The chicken was mixed with rice noodles. A whole, gutted pig was roasted in a conventional hot-air oven until the meat was white. Rice noodles were purchased from a supermarket, boiled, and pan-fried. Whole, ungutted jackfish were purchased from a seaman who caught the fish at Midway Island. The fish were frozen in the ship’s freezer until return to the Port of Oakland on June 19; they were gutted and cut into steaks, which were deep-fried and served in vinegar/herb sauce. The fish heads and viscera were boiled with vegetables for 15 minutes to make chowder (escabeche).

Questions

   1.   Identify the etiologic agent of this outbreak of food poisoning.

   2.   Was it food infection or intoxication?

   3.   How did the food get contaminated, and what item was contaminated?

   4.   Briefly explain how you arrived at your conclusion. How did you eliminate the other
major causes of food poisoning?

Explanation / Answer

1. Ciguatera poisoning.
2. Intoxication.
3. Ciguatera toxin is derived from the dinoflagellate Gambierdiscus toxicus, which herbivorous coral reef fish consume. Jackfish eat the herbivorous fish.
4. Diagnosis is clinical, based on the mixture of gastrointestinal and neurological indications. The disease is endemic in many areas of the Caribbean and South Pacific.

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