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Between 11–13 December 2018, local public health authorities in the West Midlands, England were alerted to 34 reports of diarrhoea with abdominal cramps. Symptom onset was ~10 h after diners ate Christmas meals at a restaurant between 7–9 December 2018. A retrospective case-control study, environmental and microbiological investigations were undertaken to determine the source and control the outbreak. An analytical study was undertaken with odds ratios (OR) and 95% confidence intervals (CI). Forty persons were recruited to the analytical study (28/40 cases). Multivariable analysis found that leeks in cheese sauce was the only item associated with illness (aOR 51.1; 95% CI 4.13–2492.1). Environmental investigations identified significant lapses in food safety, including lapses in temperature control during cooking and hot holding, likely cross-contamination between raw and cooked foods and the reuse of leftover cheese sauce for the next day's service. No food samples were taken during the exposure period. Two faecal samples were positive forClostridium perfringenswith one confirming the enterotoxigenic gene. Cheese sauce is an unusual vehicle for the organism and the first time this has been reported in England.

Clostridium perfringens food poisoning can be fatal in patients with chronic constipation. We report the investigation and management of a probable outbreak of C. perfringens food poisoning among psychiatric patients in Cape Town, South Africa, in 2013.

Edited by Francisco A. Uzal, J. Glenn Songer, John F. Prescott and Michel R. Popoff 360 pages, hardback, £100.50 Wiley Blackwell. 2015. ISBN 978 1 118 72840 6 ![Graphic][1] IMPORTANT advances in our understanding of the clostridia and their toxins have been made in the past 20 years. These diseases have considerable economic and public health significance. While much of the research is in response to the Clostridium difficile human pandemic and enterotoxogenic Clostridium perfringens food poisoning incidents, animal disease has also been investigated. This book provides a single reference for the veterinary community on all aspects … [1]: /embed/inline-graphic-1.gif

An outbreak of Clostridium perfringens ( C. perfringens ) food poisoning affected 17 of 44 (38·6%) patients interviewed on two hospital wards. A case-control study showed a statistically significant association between the consumption of roast pork and illness ( P C. perfringens type A, untypable serotype, was isolated from samples of pre-cooked vacuum sealed pork supplied by a local meat producer. Faults were noted in the food production process at the factory. Cuts of meat were too large and equipment to ensure rapid cooling of cooked meat was not installed. Cost improvements taken by hospitals, such as the use of commercially cooked meat, may not be consistent with the highest standards of food safety. Amendments to the District Catering Policy were implemented to prevent further outbreaks.

SUMMARYFive large outbreaks of food poisoning are described in which clinical, epidemiological or laboratory data indicated Clostridium perfringens as the causative organism. The foodstuff common to all incidents was boiled salmon served cold as an hors d'oeuvre. In all cases the fish had been subject to a long period of cooling or storage between boiling and consumption. It is thought that multiplication of the organism occurred during this time.Recommendations are made for the avoidance of further similar incidents.

An outbreak of Clostridium perfringens (C.welchii) food-poisoning affected a third of the patients in a large hospital, and one frail patient died. C.perfringens type A, serotype 1, was isolated from 46 (61 per cent) of 76 patients examined and from food, and a new serotype (61) was isolated from 16. The attack-rate among patients who ate a minced-ham dish was 78 per cent. The cooking and storage of this mince was faulty: cuts of meat were much too large, they were kept at room temperature too long before refrigeration, and after cooking they were put into mincers used also for raw meat. C.perfringens type A, serotype 1, was isolated from meat scraps in a mincer. Final reheating was inadequate to destroy even vegetative bacteria, and multiplication may have occurred during slow distribution to the wards. Outbreaks of C.perfringens fool-poisoning are common in hospitals, and some underlying problems are discussed. A plea is made for the Food Hygiene Regulations to apply to National Health Service premises and for simple but effective reforms in institutional catering management.

SUMMARYSerological typing was used as an epidemiological tool in the investigation of 524 outbreakes ofClostridium perfringensfood poisoning in the United Kingdom and 37 outbreaks in other countries.Five thousand five hundred and fifty-four (77%) of 7245 strains ofC. perfringensassociation 561 outbreaks were typable with the 75 Food Hygiene Laboratory antisera; in 354 (63%) of these outbreaks were typable with the 75 Food Hygiene Laboratory antisera; in 354 (63%) of these outbreaks a specific serotype was established as being responsible for the outbreak.An assessment is made of the ability of two additional sets of antisera, prepared against 34 American and 34 Japanese strains ofC. perfringens, to increase the number of strains which can be typed. The extent of cross-reaction between the three sets of antisera was determined and the results are discussed in relation to the source and history of the type strains.

A range of 49 bacteriocins was used to type 311 strains of Clostridium perfringens isolated from food poisoning outbreaks. Strains of same serotype within an outbreak showed similar patterns of susceptibility to bacteriocins, whereas strains of different serotype isolated from different sources produced many variations in bacteriocin susceptibility patterns. The 311 strains, along with isolates from a wide range of sources were screened for their ability to produce bacteriocins. A much greater proportion of the strains from food poisoning outbreaks was bacteriocinogenic than were isolates from human and animal infections, various foods and the environment.

One hundred and thirty one faecal specimens from cases of suspected Clostridium perfringens food poisoning were examined by both a reverse passive latex agglutination test and a standard ELISA test for the presence of Cl. perfringens enterotoxin. The latex agglutination test proved as sensitive and specific as the ELISA, and required less time at the bench without the need for specialized equipment.