Incubation period, spore shedding duration, and symptoms of Enterocytozoon bieneusi genotype C infection in a foodborne outbreak in Denmark, 2020
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Incubation period, spore shedding duration, and symptoms of Enterocytozoon bieneusi genotype C infection in a foodborne outbreak in Denmark, 2020. / Michlmayr, Daniela; de Sousa, Luís Alves; Müller, Luise; Jokelainen, Pikka; Ethelberg, Steen; Vestergaard, Lasse Skafte; Schjørring, Susanne; Mikkelsen, Sarah; Jensen, Carl Widstrup; Rasmussen, Lasse Dam; Stensvold, Christen Rune.
In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Vol. 75, No. 2, 2022, p. 468–475.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Incubation period, spore shedding duration, and symptoms of Enterocytozoon bieneusi genotype C infection in a foodborne outbreak in Denmark, 2020
AU - Michlmayr, Daniela
AU - de Sousa, Luís Alves
AU - Müller, Luise
AU - Jokelainen, Pikka
AU - Ethelberg, Steen
AU - Vestergaard, Lasse Skafte
AU - Schjørring, Susanne
AU - Mikkelsen, Sarah
AU - Jensen, Carl Widstrup
AU - Rasmussen, Lasse Dam
AU - Stensvold, Christen Rune
N1 - © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2022
Y1 - 2022
N2 - BACKGROUND: Microsporidia are rarely reported to cause outbreaks of diarrhea. We describe a foodborne outbreak of microsporidiosis from a workplace canteen in November 2020 in Denmark.METHODS: A probable case was defined as any person using the canteen between November 4 and December 13, 2020, reporting at least one gastrointestinal symptom, whereas a confirmed case also had an Enterocytozoon bieneusi positive stool sample. A web-based questionnaire was used to collect clinical, epidemiological, and food exposure data. We performed a retrospective cohort study and tested stool samples from affected individuals for bacterial, viral, and parasitic pathogens, including E. bieneusi.RESULTS: Altogether, 195 individuals completed the questionnaire. We identified 52 cases (65% male; median age 45 years [range 25 - 65]). Diarrhea (90%), fatigue (83%), and abdominal pain (79%) were the most commonly reported symptoms. Eight cases were laboratory-confirmed, and had E. bieneusi genotype C. The incubation period was between 5 and 12 days, and PCR-detectable spore shedding occurred up to 43 days after symptom onset. Disease was associated with consuming food from the workplace canteen on November 4, 2020 (RR, 2.8 [95% confidence interval [CI] 1.4 - 5.4]) and lunchboxes containing open sandwiches (RR, 3.2 [95% CI 1.4 - 7.2]) served that day.CONCLUSIONS: This is the second documented foodborne outbreak of E. bieneusi genotype C-associated diarrhea worldwide. Epidemiological findings advocated an open sandwiches lunchbox from November 4, 2020, as a likely source. E. bieneusi may be an under-reported cause of outbreaks of diarrhea, and testing for it might be useful in foodborne outbreak investigations.
AB - BACKGROUND: Microsporidia are rarely reported to cause outbreaks of diarrhea. We describe a foodborne outbreak of microsporidiosis from a workplace canteen in November 2020 in Denmark.METHODS: A probable case was defined as any person using the canteen between November 4 and December 13, 2020, reporting at least one gastrointestinal symptom, whereas a confirmed case also had an Enterocytozoon bieneusi positive stool sample. A web-based questionnaire was used to collect clinical, epidemiological, and food exposure data. We performed a retrospective cohort study and tested stool samples from affected individuals for bacterial, viral, and parasitic pathogens, including E. bieneusi.RESULTS: Altogether, 195 individuals completed the questionnaire. We identified 52 cases (65% male; median age 45 years [range 25 - 65]). Diarrhea (90%), fatigue (83%), and abdominal pain (79%) were the most commonly reported symptoms. Eight cases were laboratory-confirmed, and had E. bieneusi genotype C. The incubation period was between 5 and 12 days, and PCR-detectable spore shedding occurred up to 43 days after symptom onset. Disease was associated with consuming food from the workplace canteen on November 4, 2020 (RR, 2.8 [95% confidence interval [CI] 1.4 - 5.4]) and lunchboxes containing open sandwiches (RR, 3.2 [95% CI 1.4 - 7.2]) served that day.CONCLUSIONS: This is the second documented foodborne outbreak of E. bieneusi genotype C-associated diarrhea worldwide. Epidemiological findings advocated an open sandwiches lunchbox from November 4, 2020, as a likely source. E. bieneusi may be an under-reported cause of outbreaks of diarrhea, and testing for it might be useful in foodborne outbreak investigations.
U2 - 10.1093/cid/ciab949
DO - 10.1093/cid/ciab949
M3 - Journal article
C2 - 34791090
VL - 75
SP - 468
EP - 475
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
SN - 1058-4838
IS - 2
ER -
ID: 300980536