By: James Peacock

There are now a dozen people sick in an outbreak linked to a Souplantation restaurant in Camarillo, California. The restaurant was closed late last week, on June 22, for the Shigella contamination. Five out of the twelve people who have been diagnosed with Shigellosis required hospitalization due to the severity of their illness. Ten of those sickened are customers, and one employee tested positive for Shigellosis.  One other illness, rounding out the twelve reported cases of Shigellosis, was the result of coming into contact with an ill individual. Because only a few Shigella bacteria are required to cause a case of Shigellosis, cases of illness due to secondary contact are quite common.  Samples taken from ill individuals were sent to the state laboratories for further testing. Although the completion of those tests has not been announced to the public, once completed they will help investigators figure out what type of Shigella is responsible for the outbreak.

The Investigation Continues

Health officials with the Ventura County Health Care Agency have said that they do not believe that there was a specific food contamination, making it likely that an ill employee was the cause of the outbreak. Even still, investigators continue to run tests on various items in an effort to find some sort of source for the Shigella contamination, as the investigation may still turn up a contaminated food item responsible for the outbreak. The investigation has been progressing in a fairly quick fashion, in no small part because of the swift reaction of Souplantation. As soon as the investigation had been reasonably linked to the restaurant, it was closed for sanitation. The response time of Souplantation has earned the restaurant the praise of health officials, who have stated that the actions of Souplantation have been “exemplary”. Prior to receiving the “OK” from Ventura County officials to reopen their doors, all employees were retrained in food safety. In addition to their retraining, all 47 employees will be tested prior to being allowed to return to work. At the time of the restaurant’s reopening, on June 27, about half of the employees had been tested.  All food in the establishment was replaced prior to the reopening. The entire restaurant was sanitized, and at least two inspections took place during the five days that the restaurant was closed.

Shigella

Shigella bacteria are known to infect a large number of people in a very short amount of time. Shigellosis, the illness caused by Shigella bacteria, is one of the easiest foodborne pathogens to spread to other people, making it a leading cause of outbreaks in crowded places such as daycares, cruise ships, and restaurants. This 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 boydii, Shigella sonnei, Shigella flexneri, and Shigella dysenteriae. Shigella dysenteriae and Shigella boydii are not as common in the United States but remain a large issue in developing countries.  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. Shigellosis is typically only spread from person to person via the fecal-oral route. Improper hygiene is one of the leading reasons for the spread of Shigellosis. This especially applies to handwashing, as improper handwashing is one of the leading ways that Shigella infections are spread. 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. Shigella bacteria are quite fragile and cannot survive high temperatures or acidic environments, making it relatively easy to prevent illness when the proper measures are put into place. 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. Oftentimes, an ill employee will attend work, causing many exposures to the bacteria as they work. With diseases like Shigellosis, an ill person 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. This is why it is important to maintain these health and safety practices even after an illness goes away.

Only a few Shigella cells, between 10 and 200, are required to cause an infection. Shigellosis will begin to show symptoms between eight and fifty hours after exposure to the bacteria. Most cases of illness will present with symptoms including diarrhea that is often bloody, cramps, abdominal pain, fever, and vomiting. Much of the time, Shigellosis is fairly self-limiting. The illness will usually go away on its own within 5 to 7 days after symptoms appear. Some cases of Shigellosis may be more severe and cause complications. Those with certain risk factors, including the elderly, those with suppressed immune systems, and children are at an increased risk of developing a severe case of Shigellosis. Children, especially under the age of five, are at a much greater risk of infection. CDC data shows that children the rate of incidence of Shigella poisoning in children is five times higher than in adults. Complications associated with Shigellosis include mucosal ulceration, dangerous levels of dehydration, reactive arthritis, rectal bleeding, 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. For more information about this dangerous complication, click here. While Shigella poisoning 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.