Is There Something Fishy about Campylobacteriosis?

BACKGROUND: In October 2013, the Los Angeles County Department of Public Health (LAC-DPH) received a report of several persons ill with diarrhea, vomiting, abdominal cramps, fever, and nausea after attending a fundraising dinner for a private club.   

METHODS:   A partial list of attendees was obtained during the facility inspection conducted by LAC-DPH Environmental Health Services. A list of club employees was not provided. The Acute Communicable Disease Control Program (ACDC) interviewed persons on the list using a standardized questionnaire. Additional attendees were found through interviewees and by contacting campylobacteriosis cases (reported October 12-28, 2013) residing in the same geographic area. ACDC reviewed symptoms of cases and performed an analysis of food items. Cases were defined as persons eating at the fundraising dinner who: 1)had a positive culture for Campylobacter, 2)became ill with diarrhea and abdominal cramps, or 3)became ill with diarrhea AND two other symptoms (nausea, fatigue, headache, body aches, chills, or fever). A control was a non-ill person who ate at the fundraising dinner.

RESULTS:   Approximately 150 persons attended the fundraising dinner. Food was prepared in the club kitchen. Interviews were completed on 31 attendees(21%): 21 cases, 7 controls, and 3 ill persons who did not meet the case definition (excluded from the analysis). Median age of cases was 68 years. Primary symptoms included diarrhea, abdominal cramps, chills, body aches. Median incubation period was 33 hours. Median duration of illness was 72 hours. Five cases had positive stool cultures for Campylobacter jejuni. Dried cod was eaten by all cases and was the only food item significantly associated with illness(p<0.001). Health inspectors were denied entrance to the kitchen until after all food preparation and cleanup had occurred from a subsequent meal. Therefore, no food safety violations were discovered. The facility kitchen, operating without a license, was closed.

CONCLUSIONS: Although symptoms and durations reported by cases were consistent with campylobacteriosis, foods eaten and incubation periods were not. Shorter incubation periods may have been due to the victims’ advanced age and/or underlying health conditions. C.jejuni infection is usually associated with raw or undercooked poultry. Dried fish is an unusual primary source of Campylobacter and was most likely contaminated during preparation.  The short incubation periods and unusual food source make it unlikely that Campylobacter would have been identified as the etiologic agent without cultures. It is likely that the short incubation period was due to the cases’ advanced age expediting the infection.