Outbreak of group A streptococcal throat infection: don't forget to ask about food

Abstract

We report a large foodborne outbreak due to group A streptococci (GAS), which caused acute tonsillo-pharyngitis in 200-250 patrons of a company canteen in Copenhagen, Denmark, in June 2006. A retrospective cohort study of canteen users showed that consumption of cold pasta was associated with an increased risk of illness (attack rate 68%, risk ratio 4.1, P<0.0001). Indistinguishable GAS strains (emm89, T-type 3/13/B3264) were cultured from three cases and a cook, who had prepared the pasta. To our knowledge, pasta has previously only twice been incriminated as the source of a GAS outbreak. Only six foodborne GAS outbreaks have been reported in Europe since 1970, four of them in Sweden or Denmark. This geographical clustering suggests that foodborne GAS outbreaks are probably under-recognized elsewhere.

Brote de faringoamigdalitis de origen alimentario por estreptococo betahemolítico A

“…Los controles se seleccionaron entre los acompañantes de los enfermos en la consulta y entre asistentes a la comunión que no enfermaron. Para completar el resto de casos se localizaron a través de bús-queda activa en el Centro de Salud (historia de salud) [4][5][6][7][8][9][10][11][12] aunque solo se pudo recoger posible diagnóstico y día de presentación de síntomas.…”

“…En nuestro medio la notificación es escasa encontrando solo una referencia al respecto publicada en 1999 5 . Alimentos como ensaladas, pasta fría y preparaciones con huevo o sus derivados son los implicados generalmente y notificados como vehícu-los de transmisión [6][7][8][9] .…”

“…Las características de la presentación, tipo de alimento, período de incubación y tipo de curva epidémica nos orientaría hacia una exposición a fuente común y en la posibilidad de contemplar su origen alimentario [4][5][6][7][8][9][10]12 .…”

Antistreptolysin O (ASO) titers and beta-haemolytic streptococcus (BHS) in Children in Calabar, Nigeria.

“…GAS infection is spread by droplets, thus accounting for it high transmissibility in such situations [11]. Most outbreaks are associated with respiratory tract infection, but food-borne outbreaks often with dairy products and eggs have been documented [12,13,14].…”

Genome-wide analysis of Streptococcus pyogenes associated with pharyngitis and skin infections. (c2015)

“…Interestingly, S. pyogenes infections are associated with foodborne transmission, often causing foodborne streptococcal pharyngitis and more sparingly scarlet fever (Wong & Yuen, 2012). The main routes for such infective cases are unpasteurized milk, eggs, and salads (Falkenhorst et al, 2008). Amongst all the pathogenic species of the GAS, S. pyogenes is the most frequently attributed to outbreaks occurring in families, schools, day care centers, prisons, and even in hospitals.…”