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First reported foodborne outbreak associated with microsporidia, Sweden, October 2009

V Decraene1, M Lebbad, S Botero-Kleiven

  • 1Department of Analysis and Prevention, Swedish Institute for Communicable Disease Control, Solna, Sweden. valerie.decraene@smi.se

Epidemiology and Infection
|July 8, 2011
PubMed

Insights

A foodborne outbreak of microsporidiosis, caused by Enterocytozoon bieneusi, occurred in Sweden. Cheese sandwiches and salad containing contaminated cucumber slices were linked to the illness in hotel guests.

Area of Science:

  • Parasitology
  • Infectious Diseases
  • Food Safety

Background:

  • Microsporidia are opportunistic intracellular parasites.
  • Gastrointestinal infections are common, but microsporidiosis is rarely reported in immunocompetent individuals.
  • Foodborne outbreaks are a significant public health concern.

Purpose of the Study:

  • To report the first documented foodborne outbreak of microsporidiosis.
  • To identify the causative agent and source of the outbreak.
  • To determine risk factors associated with the illness.

Main Methods:

  • Case-control study and retrospective cohort analysis.
  • Microscopic examination and genetic sequencing of stool samples.
  • Identification of Enterocytozoon bieneusi genotype C.

Main Results:

  • Enterocytozoon bieneusi was identified in 7/11 case-patients.
  • Consumption of cheese sandwiches and salad were significantly associated with illness.
  • The median incubation period was 9 days, with an attack rate of 30%.

Conclusions:

  • Microsporidia can cause significant gastrointestinal outbreaks.
  • Ready-to-eat produce, such as pre-washed cucumber slices, can be a vehicle for transmission.
  • Microsporidia should be considered in foodborne and waterborne outbreak investigations.

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