Journal Article

An Outbreak of Enterotoxigenic <i>Escherichia coli</i> Associated with Sushi Restaurants in Nevada, 2004

Seema Jain, Lei Chen, Amy Dechet, Alan T. Hertz, Debra L. Brus, Kathleen Hanley, Brenda Wilson, Jaime Frank, Kathy D. Greene, Michele Parsons, Cheryl A. Bopp, Randall Todd, Michael Hoekstra, Eric D. Mintz and Pavani K. Ram

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 47, issue 1, pages 1-7
Published in print July 2008 | ISSN: 1058-4838
Published online July 2008 | e-ISSN: 1537-6591 | DOI:
An Outbreak of Enterotoxigenic Escherichia coli Associated with Sushi Restaurants in Nevada, 2004

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Background. In August and November 2004, 2 clusters of diarrhea cases occurred among patrons of 2 affiliated sushi restaurants (sushi restaurant A and sushi restaurant B) in Nevada. In August 2004, a stool sample from 1 ill sushi restaurant A patron yielded enterotoxigenic Escherichia coli (ETEC). In December 2004, we investigated a third cluster of diarrhea cases among sushi restaurant B patrons.

Methods. We defined a case as diarrhea in a person who ate at sushi restaurant B from 3 December through 13 December 2004. Control subjects were individuals who dined with case patients but did not become ill. Duplex polymerase chain reaction was used to detect genes coding for heat-stable and heat-labile enterotoxins of ETEC.

Results. One-hundred thirty patrons of sushi restaurant B reported illness; we enrolled 36 case patients and 29 control subjects. The diarrhea-to-vomiting prevalence ratio among patients was 4.5. Illness was associated with consumption of butterfly shrimp (estimated odds ratio, 7.2; 95% confidence interval, 1.1 to infinity). The implicated food was distributed to many restaurants, but only sushi restaurant B patrons reported diarrhea. We observed poor food-handling and hand hygiene practices at sushi restaurant B. Stool samples from 6 of 7 ill patrons and 2 of 27 employees who denied illness yielded ETEC.

Conclusions. ETEC was identified as the etiologic agent of a large foodborne outbreak at a sushi restaurant in Nevada. Poor food-handling practices and infected foodhandlers likely contributed to this outbreak. Although ETEC is a well-documented cause of domestic foodborne outbreaks, few laboratories can test for it. Earlier recognition of ETEC infections may prevent subsequent outbreaks from occurring.

Journal Article.  3840 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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