Bulletproof Blog - C. diff Makes the List of " Looming Food Supply Crises"

Posted on April 22, 2009 by C. difficile Attorney

I had a chance to chat with Larry Smith, who publishes the Bulletproof Blog. Each week Larry interviews top plaintiffs’ attorneys for their perspective on the crises likely to affect businesses in the near future.  Here's how he described our interview:

In this issue, we talk to Bill Marler of the Seattle-based Marler Clark, LLP PS. He is the legal profession’s best-known advocate for plaintiffs in food-related cases and a major force for food safety in the U.S. During his career, Mr. Marler has secured nearly $500 million for his clients. He publishes widely and speaks on food safety around the world.

Here's where C. diff came up:

Larry Smith: Are there specific products that you now have your eye on?

Bill Marler: It’s hard for anyone to predict the next crisis because we’re talking about ever-morphing pathogens. I have nothing but empathy for responsible companies challenged to somehow predict the next bacterium and where it’s going to strike. To cite just a couple of danger zones, pork products face increased risk of Methicillin-resistant Staphyloccus aureus (MRSA) bacteria and, as we effectively control Salmonella, we create opportunites for Clostridium difficile (C-dif) bacteria to proliferate in our guts. It’s a deadly threat to the elderly.

The entire interview can be read here.

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Clostridium difficile in Food -Is This the Next Thing to Keep us Up at Night?

Posted on April 17, 2009 by C. difficile Attorney

You would think we'd have enough pathogens to lose sleep over, but it seems that there is at least one more to add to the midnight pantheon.  Over the last several years we have seen multiple instances where Clostridium difficile and foodborne illness have been related. However, the Clostridium difficile infection has generally been associated with the foodborne illness after treatment for the infection by antibiotics, not as a result of actual ingestion of the Clostridium difficile bacteria. However, in the recent Salmonella Typhimurium Peanut Butter outbreak, we have two cases where children seem to be co-infected with both Clostridium difficile and Salmonella Typhimurium. Which brings us to the the important question – Is Clostridium difficile foodborne?

For background, Wikipedia reports that Clostridium difficile is a species of Gram-positive bacteria of the genus Clostridium. Clostridia are anaerobic, spore-forming rods (bacillus). C. difficile is the most serious cause of antibiotic-associated diarrhea (AAD) and can lead to pseudomembranous colitis, a severe infection of the colon, often resulting from eradication of the normal gut flora by antibiotics. The C. difficile bacteria, which naturally reside in the body, become overgrown: The overgrowth is harmful because the bacterium releases toxins that can cause bloating, constipation, and diarrhea with abdominal pain, which may become severe.

The CDC reports that mortality rates from Clostridium difficile disease in the United States increased from 5.7 per million population in 1999 to 23.7 per million in 2004. Increased rates may be due to emergence of a highly virulent strain of C. difficile.

Here are a few articles that I have found or have been sent on the topic. Clearly more research needs to be done.

Possible Seasonality of Clostridium difficile in Retail Meat, Canada (pdf)

Rodriguez-Palacios A, Reid-Smith RJ, Staempfli HR, Diagnault D, Janecko N, Avery BP et al. Possible seasonality of Clostridium difficle in retail meat, Canada. Emerg Infect Dis. 2009 May

We previously reported Clostridium difficile in 20% of retail meat in Canada, which raised concerns about potential foodborne transmissibility. Here, we studied the genetic diversity of C. difficile in retail meats, using a broad Canadian sampling infrastructure and 3 culture methods. We found 6.1% prevalence and indications of possible seasonality (highest prevalence in winter).

Clostridium difficile in Retail Meat Products, USA, 2007 (pdf)

Songer JG, Trinh HT, Killgore GE, Thompson AD, McDonald LC, Limbago BM. Clostridium difficile in retail meat products, USA, 2007. Emerg Infect Dis. 2009 May

To determine the presence of Clostridium difficile, we sampled cooked and uncooked meat products sold in Tucson, Arizona. Forty-two percent contained toxigenic C. difficile strains (either ribotype 078/toxinotype V [73%] or 027/toxinotype III [NAP1 or NAP1-related; 27%]). These findings indicate that food products may play a role in interspecies C. difficile transmission.

Clostridium difficile in Ready-to-Eat Salads, Scotland (pdf)

Bakri MM, Brown DJ, Butcher JP, Sutherland AD. Clostridium difficile in ready-to-eat salads, Scotland. Emerg Infect Dis. 2009 May

Of 40 ready-to-eat salads, 3 (7.5%) were positive for Clostridium difficile by PCR. Two isolates were PCR ribotype 017 (toxin A–, B+), and 1 was PCR ribotype 001. Isolates were susceptible to vancomycin and metronidazole but variably resistant to other antimicrobial drugs. Ready-to-eat salads may be potential sources for virulent C. difficile.

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