METHODS: The initial case was interviewed on August 21. On August 24 DCDOH inspected the kitchen of the law firm cafeteria, where the catered lunch had been prepared. After the inspection, an electronic survey was sent to luncheon attendees and a traceback investigation was conducted to determine the source and distributor of the fish served at the lunch.
RESULTS: Seven of the eight law firm partners who attended the August 18 lunch experienced symptoms; all 7 reported consuming fish. The remaining asymptomatic partner did not consume the fish. All ill persons were White, non-Hispanic males, with a median age of 57 years (range: 33–73). The most common symptoms included diarrhea (7/7), itching (5/7), muscle aches (5/7), and abnormal sensations when touching hot or cold items (4/7). Symptoms began as early as 2.6 hours after the meal for one ill person. Symptoms persisted for more than a week after the meal. One ill person sought medical attention and 2 spoke with a health care provider by telephone. No one was hospitalized. The fish was delivered fresh the morning of the luncheon; leftover fish was discarded at the end of that day. Initially, due to staff termination and deceptive actions taken by the chef, we were unable to get information on what type of fish was served or how it was prepared at the time of the inspection. Discussions with the distributor revealed that amberjack fish had been served, had been sourced from Florida, and no other clients had reported illnesses associated with the fish. There was no remaining fish from the lot that was served, but samples of amberjack from an adjacent lot obtained. An Epi-X was sent out about the investigation, but no additional cases of illness associated with amberjack were identified.
CONCLUSIONS: The results of our investigation demonstrate that the illness is consistent with either ciguatera poisoning or histamine toxicity due to the type of fish served and the temperature issues observed during the inspection. Unfortunately, because testing for marine toxins is not performed by our public health lab we were unable to determine the specific cause of illness.