By: James Peacock

A restaurant in Camarillo, California, reopened on the morning of June 27, 2017 after being closed for the weekend. The restaurant, Souplantation, was connected to an outbreak of Shigella poisoning in the area. There have now been ten cases of illness connected to the restaurant, including one employee. Bacterial samples taken from ill persons were sent to the California State laboratory for further analysis. Not all cases of illness were started by eating at Souplantation. At least one person, the eighth reported case of Shigella poisoning in this outbreak, was the product of coming into to contact with an ill individual in a household. Souplantation is a restaurant chain based out of San Diego, California, and includes 97 different locations. Only the Camarillo location, which is a city outside of Los Angeles, has been connected to the outbreak.

The Investigation

The Camarillo location of Souplantation was implicated in the outbreak quickly after the investigation began. Health officials, as is common to every foodborne illness outbreak, conducted interviews with ill individuals. When a surge in infections was noticed on June 20, interviews began to be conducted. Out of the first four people interviewed, three said that they had eaten at Souplantation prior to their illnesses. When a pattern of illnesses was established, Souplantation closed its doors. At the time, the closing was labeled as a precautionary measure. Further investigation revealed that the closing of the restaurant was the correct move. The quick response of the restaurant earned the praise of Public Health Officer Dr. Robert Levin, who said, “Souplantation’s actions have been exemplary. This is the kind of swift and decisive action, which leads to a collaboration with public Health that results in a rapid resolution of the problem.”

After the restaurant was closed, the Chief Operating Officer, a vice president with the company, and the quality assurance manager all came to Camarillo to oversee the cleaning process. The restaurant was thoroughly cleaned, and all of the food was thrown out and replaced. All forty-seven of the restaurant’s employees were given sanitary training refresher courses and were tested for illness prior to being allowed to return to work. At the time of reopening, more than half of the employees had been cleared. Only cleared employees will be allowed to work after the restaurant reopens. The reopening of the restaurant was originally slated for Monday night, but that time was pushed back to lunchtime on Tuesday. According to Greg Keller, the corporate Chief Operating Officer, “We have to literally, as you can imagine, restock the whole restaurant.”

Shigella

Shigella bacteria are known to infect a large number of people in a very short amount of time. It can be transmitted from person to person with relative ease, making it a leading cause of outbreaks in crowded places such as daycares, cruise ships, and restaurants. The ease of transmission has placed Shigella bacteria among the most common forms of foodborne illness, causing a CDC-estimated 500,000 cases of illness per year. Shigella bacteria represent a genus of several different bacterial species. Most of these Shigella bacteria can cause illness in humans, including Shigella sonnei, Shigella boydii, Shigella flexneri, and Shigella dysenteriae. Shigella sonnei is typically the mildest of the Shigella bacteria, causing only watery diarrhea. S. flexneri and S. boydii can cause mild to severe infections depending on the person. S. dysenteriae often causes the most severe infections and can produce Shiga toxins. Shigella dysenteriae and Shigella boydii are not as common in the United States but remain a large issue in developing countries.  Shigella bacteria are quite fragile and cannot survive high temperatures or acidic environments. Shigellosis, the illness caused by Shigella bacteria, is typically only spread from person to person. This is mainly via the fecal-oral route. Improper hygiene, most specifically related to hand washing, is one of the leading reasons for the spread of Shigellosis. Shigellosis is also spread when food is prepared by someone who has a Shigellosis infection. Practicing proper hygiene, proper cooking techniques, and other preventative measures can help limit the risk for a Shigellosis infection. Outbreaks caused by Shigella bacteria have been connected to lettuce, potato salad, milk, tuna salad, dairy products, shrimp salad, poultry, chicken salad, and macaroni salad. It is important to maintain these health and safety practices even after becoming sick. This is especially important with diseases like Shigellosis, because it can still be contagious even after the illness has subsided. Shigella bacteria can remain in the stool for up to two weeks after the symptoms of infection go away.

Only a few Shigella cells, between 10 and 200, are required to cause an infection. Shigellosis will begin to show symptoms eight to fifty hours after exposure to the bacteria. Most cases of illness will present with symptoms including diarrhea that is often bloody, abdominal pain, cramps, fever, and vomiting. Much of the time, Shigellosis is self-limiting and can resolve itself in around 5 to 7 days. Some cases of Shigellosis may be more severe and cause complications. Those with certain risk factors, including the elderly, children, and those with suppressed immune systems are at an increased risk of developing a severe case of Shigellosis. Complications associated with Shigellosis include mucosal ulceration, rectal bleeding, reactive arthritis, dangerous levels of dehydration, and hemolytic uremic syndrome (HUS). HUS is caused by Shiga toxins and can damage red blood cells. These blood cells are then sent to the kidneys in order to be filtered out. The attempted removal of these damaged blood cells can damage the kidneys. The damage from the filtration process, coupled with the increased rate of damage inflicted on the kidneys by Shiga toxins, can lead to serious kidney damage and even kidney failure. If a case of Shigellosis has progressed to HUS, symptoms such as decreased frequency in urination, fatigue, and loss of color in the eyes and cheeks will be present. HUS is a very serious complication that needs to be treated as quickly as possible. While Shigellosis may go away on its own, antibiotics are often prescribed to limit and end the infection. If you or a loved one begins to show the symptoms of Shigellosis, monitor their condition closely and take them to a health professional if necessary.

Sources:

https://www.cdc.gov/shigella/resources.html

https://www.cdc.gov/shigella/fast-facts.html

https://www.cdc.gov/shigella/general-information.html

http://www.vcstar.com/story/news/local/2017/06/24/surge-infectious-illness-brings-temporary-restaurant-closure-camarillo/425299001/

http://www.vcstar.com/story/news/local/2017/06/26/closed-after-shigella-surge-souplantation-reopen-tuesday/428572001/

http://www.vchca.org/images/2017_Press_Releases/Shigella-Cases-2017.pdf