Introduction: This paper reports a clinico-epidemiological and microbiological investigation conducted into an outbreak of gastrointestinal infection due to Salmonella enteritidis, where the most likely food vehicle was spaghetti a la carbonara.
Methods: An historic cohort study was conducted out among persons exposed to menus at a school canteen. Data were gathered on age, sex, foods consumed and clinical symptoms. School premises and menus were inspected, food samples obtained (spaghetti and meat balls), and stool samples taken from 30 affected subjects and 8 food handlers. Isolated strains were studied using pulsed-field electrophoresis. Attack rates were computed, and the odds ratio adjusted for the remaining foodstuffs (ORa) used to calculate the independent contribution made by the respective foods to risk of infection.
Results: Study coverage was 75.7% (140/185). The overall attack rate was 72.1% (101/140), with 12.9% of those affected requiring hospitalisation. The multivariate analysis showed that, while the spaghetti maintained its association (ORa = 8.4; 95% CI 1.4-51.8), the meat balls registered a reduction in risk (ORa = 1.8; 95% CI 0.4-7.5). S. enteritidis was isolated in stool cultures from 28 affected subjects, and in 2 blood and 6 stool cultures from food handlers (5 of whom were classed as cases). Moreover, S. enteritidis was also isolated in the food samples. On pulsed-field electrophoresis, the strains registered the same electrophoresis pattern.
Conclusions: This outbreak serves to underscore the gravity of Salmonella spp. food poisoning, the danger of using inadequately cooked eggs, and the importance of interviewing food handlers to ensure proper classification (i.e., as patients or carriers). Existing recommendations as to the use of pasteurised egg products ought to be extended in scope.