A food poisoning outbreak by Shigella boydii in Kerman-Iran

Abstract

Background: Food poisoning is a common infectious disease and Shigella is at the top of causative pathogens. All species of Shigella cause an acute bacterial disease involving the large and distal small intestine that presents with diarrhea, vomiting, and abdominal pain. Objectives: To interpret clinical and paraclinical characteristics of patients in the food poisoning outbreak by Shigella boydii in Kerman-Iran. Methods: On October 2015, 241 residents of the Anduhjerd town of Kerman, Iran, came to clinics and hospitals with a complaint of food poising. Meanwhile, 118 people referred to Afzalipoor Hospital-a referral center. Among them, 21 patients were admitted due to fever, dysentery, old age, or bad general condition. We assessed and reported clinical and paraclinical characteristics of all these 21 hospitalized patients. Results: The mean age of patients was 38.1 years old while 71.4% of them were women. In the history of all patients, the use of cooked wheat groats, as a votive food from the neighborhood inhabited, was detected, which was a long time period between cooking and consumption while food was not kept in the refrigerator. The time period between food consumption and onset of symptoms varied from eight to 13 hours and the most common symptoms were diarrhea (90.4%), vomiting (85.7%), and abdominal pain (80.9%). Five patients (19%) had bloody diarrhea, although 71.4% of stool exams were positive for WBC and RBC, and 23.8% of stool cultures were positive with Shigella boydii. In the course of hospitalization, 5 other patients (19%) developed dysentery and eight of them (38%) developed labial herpes. All patients received rehydration and antibiotic therapy, and were discharged with no complication. Conclusions: This is the first outbreak of Shigella boydii in Iran that occured in a votive food distribution. Votive food is a very common convention in Iran; therefore, there must be more notices about cooking and keeping food until the consumption to prevent such events.