Repeated food poisoning episodes, help n

Sunil Khemaney syama at delphi.com
Wed Aug 2 20:41:18 EST 1995


We are in need of assistance of determining the cause of repeated
food poisoning episodes.  Specifically, we are seeking the
assistance of any doctors, chemists or microbiologists who might
be able to shed some light on the cause and cure for our problem,
and we are willing to hire an expert in this area.  Any help
would be much appreciated.  The details are as follows:

John has had food poisoning on three occasions recently with
different food preparations, each time suffering the same
symptoms.  Others who ate those preparations also experienced the
same or similar symptoms.  These same foods have been eaten in
the same combinations on other occasions without causing problems
which would seem to rule out food allergies.  We know which
preparations are the cause of the problems because on each
occasion, those were the only dishes consumed at the particular
meal and others eating those same preparations suffered
similarly.

We had the foods analyzed at a chemical lab (see results below)
without any conclusive results.  We're wondering if there might
be some chemical reaction with the utensils or something else we
haven't considered.  We are hoping you will be able to shed some
light on the possible cause.

The details of each incident are as follows:

On May 30, the food consumed was "macaroni bake" (consisting of
fresh button mushrooms, small elbow macaroni, broccoli, bell
pepper, green onion, sesame oil, ascefatida, soy sauce, sweet
basil, lemon juice, natural sea salt, bouillon cube flavoring,
organic butter, organic whole milk, cheese and paprika), tofu and
mata paneer (curd dish).

The symptoms John experienced were flatulence and burping
("sulphur" burps) after one hour; abdominal cramps 6 hours later;
vomitting and nausea afterwards lasting about 11 hours or more. 
Another person experienced flatulence, bloating, nausea but no
vomitting and took a few days to fully recover.  

On June 20, the food consumed was oat water (consisting of
strained cooked oats and purified water.)

The symptoms John experienced was bloated stomach, flatulence and
nausea.  

Another person experienced flatulence, bloating, headache and
nausea for a few hours.  A third person experienced bloating,
flatulence and a little nausea which went away fairly quickly.

On August 1, the food consumed was rice porridge (consisting of
rice and purified water.)  John ate the most of the three people
who tried this dish.  John added about 1/3 of an avocado (which
was definitely not rotten) to the rice porridge while it was
still relatively hot.  The avocado had some sodium vitamin C
(sodium ascorbate crystals) sprinkled on it.

The symptoms John experienced was the same sulphur burps,
followed later by gastroentiritis symptoms (nausea, vomitting)
followed by diahorrhea.  Two other people experienced mild
symptoms of flatulence and a little bloating lasting around 45
minutes.  They did not eat any of the avocado.

All utensils used (spoons, knives, spatulas, etc.) are stainless
steel.  The pots are Revere Ware.  A Corning Ware dish was used
for the macaroni bake.  The cutting boards are made of organic
wood.  Some of the cooking pots are old and pitted, however,
heavy metal testing was done and doesn't seem to be the problem.

The food is prepared in a home under strict aseptic conditions
and transported to another home for consumption.  The food is
cooked, put into stainless steel fite pans after cooking, wrapped
in towels and driven to the other home (about 30 minutes away).
They are then put into the oven set at 158 degrees or refrigerate
(depending on the preparation.)

The kitchen the meals are prepared in is very clean, however, it
tends to be steamy with no air flow--moisture collects on the
window sills when cooking is going on.  One of the food preparers
has chronic psoriasis on his head and while he wears a hairnet,
gloves and a germ mask while cooking, we wonder if flakes from
his clothing may be causing a problem?

Lab Results

Date: June 1, 1995

Cheese                                                 Units     Methods

Aerobic Plate Count 35 deg. C                2.4E6      CFU/g     pour
Presumptive Coliforms                        <3      MPN/g     mpn fd
Faecal Coliforms                                  Nil        MPN/g     mpn fd
Coag positive Staphylococci                  <10      CFU/g     spread
Bacillus Cereus                                   <10     CFU/g     spread
Clostridium perfringens                      <10      CFU/g     spread

Mushrooms

Aerobic Plate Count 35 deg. C                1.7E6     CFU/g     pour
Presumptive Coliforms                        1100      MPN/g     mpn fd
Faecal Coliforms                                  <3        MPN/g     mpn fd
Coag positive Staphylococci                  <10       CFU/g     spread
Bacillus Cereus                                   <10       CFU/g     spread
Clostridium perfringens                      <10       CFU/g     spread

Milk

Aerobic Plate Count 35 deg. C                7.2E4     CFU/g     pour
Presumptive Coliforms                        <3        MPN/g     mpn fd
Faecal Coliforms                                  Nil       MPN/g     mpn fd
Coag positive Staphylococci                  <10       CFU/g     spread
Bacillus Cereus                                   <10       CFU/g     spread
Clostridium perfringens                      <10       CFU/g     spread


Mata Paneer

Aerobic Plate Count 35 deg. C                -         CFU/g     pour
Presumptive Coliforms                        -         MPN/g     mpn fd
Faecal Coliforms                                  -         MPN/g     mpn fd
Coag positive Staphylococci                  -         CFU/g     spread
Bacillus Cereus                                   -         CFU/g     spread
Clostridium perfringens                      Absent    /g        spd/en
Clostridium perfringens                      -         CFU/g     spread
Staphylococcal Enterotoxin                   -         -         immuno

Tofu

Aerobic Plate Count 35 deg. C                8.4E6     CFU/g     pour
Presumptive Coliforms                        >1100     MPN/g     mpn fd
Faecal Coliforms                                  <3        MPN/g     mpn fd
Coag positive Staphylococci                  <10       CFU/g     spread
Bacillus Cereus                                   <10       CFU/g     spread
Clostridium perfringens                      Absent    /g        spd/en
Clostridium perfringens                      <10       CFU/g     spread
Staphylococcal Enterotoxin                   Absent    -         immuno
     
Methods of Analysis:

immuno    By immunoassay
mpn fd    MPN Method for Foods
pour      Pour Plate Enumeration
spd/en    Spread Plate/Selective Enrich 
spread    Spread Plate Enumeration

Comments:

Results apply to samples as received.  Methods used are Public
Health Laboratory Methodologies of the Institute of Environmental
Science and Research (ESR).

Coagulase positive Staphylococcus aureus was isolated from the
mushrooms in low numbers.

The only significant result from the foods tested was the
Bacillus cereus count obtained from the organic milk.  However,
due to this product having exceeded the best before date, this
result cannot be tied to the quality of the milk before it
reached the best before date.  It is recommended that products
which have reached the best before date should not be consumed. 
It this product was consumed after the best before date, it is
quite possible that it may have been the cause of the symptoms
exhibited by the patients.  It is not known whether the
pasteurization process that the organic milk was put through was
adequate.  This could mean that Bacillus cereus organisms may
have been present in the milk and were able to multiply to the
levels found in the sample tested.

Date: June 26, 1995

Item           Yeast & Mould            Staphylococcus   Bacillus
               (c.f.u. per g)           aureus (c.f.u.     cereus
                                        per g)              (c.f.u. per g)

oat water batch <10                     <10                 <100

rolled oats batch <10                   <10                 <100

Uncle Tobys       <10                   <10              <100
traditional oats


Methods used are those laid down by the Association of Official
Analytical Chemists in the 7th Edition of the Bacteriological
Analytical Manual 1992.
The Compendium of Methods for the Microbiological Examination of
Foods.  3rd Edition, 1992.



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