On April 9, the Cook County Health Department, and Illinois Department of Health
ID: 168391 • Letter: O
Question
On April 9, the Cook County Health Department, and Illinois Department of Health launched an investigation after three patients had consumed several food items during their two meals together on April 7, including juice from a single 2-liter bottle of Lovely Farms Mango juice. The bottle had a "best if used by" date of April 18, 2006. Clinical specimens and leftover food and juice were collected and sent to CDC for testing. On April 13, toxin was identified in the serum and stool of all three patients. On April 15, leftover juice recovered from the home of one of the patients also tested positive for toxin. During this time, FDA launched an investigation of the Lovely Farms, Inc., manufacturing plant in Marin County, Arizona. FDA and CDC tested other bottles of that brand of mango juice, including bottles from different lots. Based on the CDC test results, on April 17, FDA issued a consumer advisory on the importance of keeping mango juice refrigerated. However, information obtained from patient interviews regarding storage and transport of the mango juice did not confirm mishandling by the patients.
On June 25, officials at the Alabama Department of Health, the Teesburg County Health Department, and CDC were notified that a patient had been hospitalized in Tees, Alabama, on June 16, with respiratory failure and descending paralysis. On June 28, toxin was identified in the patient's serum. Circulating toxin persisted more than 10 days after illness onset in this completely paralyzed patient, indicating ingestion of a massive toxin dose. Accordingly, the patient was treated with antitoxin, which prevents binding of circulating toxin to nerve endings. The patient remains hospitalized, paralyzed, and on a ventilator. The County Health Department collected an open, 450-milliliter bottle of Lovely Farms mango juice, which had been found by a family member in the hotel room where the patient had been staying during the month before being hospitalized. The hotel room had no refrigerator. The bottle, which had a "best if used by" date of June 19, 2006, had a different lot number than the bottle associated with the Illinois cases
What disease is this and what microorganism caused it?
Explanation / Answer
These observation indicates that this type of toxicity is caused by Botulinum toxins, released by Clostridium botulinum. This is a rod shaped bacteria which produce neurotoxins at normal temperature at pH higher than 4.6 (mango juice has pH of 6). This toxin binds to nerve endings and causes Acetylcholine to release continuously causing paralytic symptoms.
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