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November 20, 2012
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Your Health

Investigating Source of
Unexplained C. diff Infections

OSU, OARDC microbiologists encourage public health officials to look at contaminated food as a possible source of C. diff infections.

The increasing incidence of a difficult-to-control bacterial illness is leading researchers to suspect that contaminated foods might be contributing to the problem.

Clostridium difficile (C. diff) can cause a serious infection that is responsible for 14,000 American deaths annually, according to the Centers for Disease Control and Prevention (CDC). It is estimated that there are about 500,000 U.S. cases of C. diff infection annually and that about 3%-5% of healthy adults are carriers of toxic C. diff bacteria but experience no symptoms.

Normally associated with the use of broad-spectrum antibiotics during a stay in the hospital or in other healthcare settings, C. diff infection is marked by frequent, watery diarrhea; abdominal pain or tenderness; and inflammation of the colon, or colitis. Toxins released by the bacterium can attack the lining of the intestines, and severe infections can lead to sepsis or intestinal perforation. The elderly and immuno-compromised individuals are most at risk.

Although no cases as yet have been specifically linked with food, it is estimated that 20%-27% of cases of C. diff infection are not associated with healthcare settings.

“It’s not clear where they come from,” said Jeffrey LeJeune, microbiologist with Ohio State University (OSU) Extension and the Ohio Agricultural Research and Development Center (OARDC), the outreach and research arms of OSU’s College of Food, Agricultural, and Environmental Sciences. “We want to encourage public health officials to look at food as a possibility.”

LeJeune, along with former doctoral student Alex Rodriguez-Palacios and University of Delaware food scientist Dallas Hoover, wrote on “Clostridium difficile: An Emerging Food Safety Risk” in a recent issue of Food Technology, the official publication of the Institute of Food Technologists (IFT). They were asked to submit the article after participating in a panel discussion on the topic at the 2011 IFT annual meeting. A PDF of the article is available by clicking here.

Rodriguez-Palacios, who is now a postdoctoral scholar at the Case Western Reserve University School of Medicine, has conducted numerous studies on C. diff and its presence in food products, particularly ground meat. His doctoral research under LeJeune was on the “Ecology and Epidemiology of Human Pathogen Clostridium difficile in Foods, Food Animals and Wildlife.”

“C. diff is found throughout the environment — in water, rivers, soil, food, everywhere,” said Rodriguez-Palacios. “People can pick it up from anywhere, but we are more exposed to food than to these other things.”

In their paper, the scientists reviewed 37 studies of C. diff presence in foods in both North America and Europe. From their analysis, they said it is clear that C. diff can be found in retail beef, veal, pork and poultry; seafood and fish; and in vegetables.

“Foods that are ready to eat or that we typically eat raw are more likely to be a problem,” Rodriguez-Palacios said. “But we also know that a small number of food animals have C. diff at the time of slaughter. There are now recent indications of food contamination during processing.”

C. diff grows at temperatures between 77° F and 113° F. However, the bacterium produces resistant spores that permit it to survive in harsh environments. The spores aren’t inactivated until they reach a temperature of 163°-185° for 15 minutes. “Even higher cooking temperatures are needed to be on the safe side,” Rodriguez-Palacios said.

“The problem is, we don’t typically cook our foods to that high of a temperature,” LeJeune said. The USDA’s cooking guidelines say to cook cuts or roasts of beef, pork, lamb and veal to a minimum internal temperature of 145°; ground beef, pork, lamb and veal to 160°; and all poultry to 165°.

“Not all pathogens are created equal,” LeJeune said. “C. diff is tougher than other pathogens in terms of its environmental survival. That’s probably why we find it all over.”

The researchers hope their paper prompts health authorities to further consider the possibility that food could be a vector for cases of C. diff infection.

“This is especially important now because genome sequencing has shown that patients during C. diff outbreaks are getting sick with C. diff strains that cannot be explained by person-to-person transmission. Strains affecting people appear to be coming from outside healthcare centers,” Rodriguez-Palacios said, citing a recent study published in BMJ Open, an online medical journal.

Determining whether C. diff is transmitted from food consumption will take some extra effort, LeJeune said. “You have to look for it specifically,” he said. “It doesn’t show up on a culture plate with other foodborne pathogens, like Salmonella or E. coli."

In the meantime, the scientists encourage good food safety practices as a way to reduce the risk of C. diff infections and other potential cases of foodborne illness, including:

More details on food safety precautions are available on Ohio State’s Food Safety website at http://foodsafety.osu.edu; click “Ask Mom” for consumer-related information. The website is sponsored by OARDC and OSU Extension.

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