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April 10th, 2014 posted by Paul Rega, MD, FACEP April 10, 2014 @ 12:22 pm

Soft-Ripened Cheese & Listeriosis

Notes from the Field: Multistate Outbreak of Listeriosis Linked to Soft-Ripened Cheese — United States, 2013


April 4, 2014 / 63(13);294-295

Mary J. Choi, MD1,2, Kelly A. Jackson, MPH3, Carlota Medus, PhD1, Jennifer Beal, MPH4, Carrie E. Rigdon, PhD5, Tami C. Cloyd, DVM4, Matthew J. Forstner5, Jill Ball6, Stacy Bosch, DVM3, Lyndsay Bottichio, MPH7, Venessa Cantu, MPH8, David C. Melka9, Wilete Ishow10, Sarah Slette, MS11, Kari Irvin, MS4, Matthew Wise, PhD3, Cheryl Tarr, PhD3, Barbara Mahon, MD3, Kirk E. Smith, DVM, PhD1, Benjamin J. Silk, PhD3 (Author affiliations at end of text)

On June 27, 2013, the Minnesota Department of Health notified CDC of two patients with invasive Listeria monocytogenes infections (listeriosis) whose clinical isolates had indistinguishable pulsed-field gel electrophoresis (PFGE) patterns. A query of PulseNet, the national molecular subtyping network for foodborne disease surveillance, identified clinical and environmental isolates from other states. On June 28, CDC learned from the Food and Drug Administration’s Coordinated Outbreak Response and Evaluation Network that environmental isolates indistinguishable from those of the two patients had been collected from Crave Brothers Farmstead Cheese during 2010–2011. An outbreak-related case was defined as isolation of L. monocytogenes with the outbreak PFGE pattern from an anatomic site that is normally sterile (e.g., blood or cerebrospinal fluid), or from a product of conception, with an isolate upload date during May 20–June 28, 2013. As of June 28, five cases were identified in four states (Minnesota, two cases; Illinois, Indiana, and Ohio, one each). Median age of the five patients was 58 years (range: 31–67 years). Four patients were female, including one who was pregnant at the time of infection. All five were hospitalized. One death and one miscarriage were reported.

Case–case analysis of Listeria Initiative* data (1) was conducted, comparing food exposure frequencies among the five outbreak-related cases identified by June 28 with food exposure frequencies in 1,735 sporadic listeriosis cases reported to CDC during 2004–2013. The analysis indicated that any soft cheese consumption during the month before illness onset was associated with outbreak-related listeriosis: five of five (100%) in the outbreak-related cases versus 569 of 1,735 (33%) in the sporadic cases (odds ratio = 10.8; 95% confidence interval = 1.8–∞).

The five patients were reinterviewed to assess their cheese exposures. All five patients had definitely or probably eaten one of three varieties of Crave Brothers soft-ripened cheese (Les Frères, Petit Frère, or Petit Frère with truffles). Three patients had purchased the cheese at three different restaurants, and two had purchased the cheese at two different grocery stores. The cheeses were shipped as intact wheels to the three restaurants and two grocery stores, where they had been cut and served or repackaged and sold to customers.

Testing at the Minnesota Department of Agriculture identified the outbreak pattern of L. monocytogenes in two cheese wedges (Les Frères and Petit Frère with truffles) collected from two different grocery stores in Minnesota. Inspection of the cheese-making facility revealed that substantial sanitation deficiencies during the cheese-making process itself, after the milk was pasteurized, likely led to contamination. On July 1, Crave Brothers halted production of Les Frères, Petit Frère, and Petit Frère with truffles. On July 3, Crave Brothers issued a voluntary recall of these products with a production date of July 1, 2013, or earlier. On July 11, the company voluntarily halted production of all cheese products manufactured at the facility. After product recall, one additional case was identified in Texas through whole genome sequencing, bringing the total case count for the outbreak to six.

This outbreak was linked to soft cheeses that were likely contaminated during the cheese-making process (2,3). Pasteurization eliminates Listeria in milk. However, contamination can occur after pasteurization. Cheese-making facilities should use strict sanitation and microbiologic monitoring, regardless of whether they use pasteurized milk.†

Persons at greater risk for listeriosis, including older adults, pregnant women, and those with immunocompromising conditions, should be aware that certain soft cheeses made with unpasteurized milk, or made under unsanitary conditions, regardless of whether the milk was pasteurized, have been shown to cause severe illness. These soft cheeses include fresh (unripened) cheeses, such as queso fresco (4), and soft-ripened cheeses, such as the cheeses implicated in this outbreak.

1Minnesota Department of Health; 2EIS officer; 3Div of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 4Coordinated Outbreak Response and Evaluation Network, Food and Drug Administration; 5Minnesota Department of Agriculture; 6Wisconsin Department of Agriculture, Trade, and Consumer Protection; 7Ohio Department of Health; 8Texas Department of State Health Services; 9Center for Food Safety and Applied Nutrition, Food and Drug Administration; 10Chicago Department of Public Health; 11Indiana State Department of Health (Corresponding author: Mary J. Choi,, 651-201-5193)


  1. McCollum JT, Cronquist AB, Silk BJ, et al. Multistate outbreak of listeriosis associated with cantaloupe. N Engl J Med 2013;369:944–53.
  2. CDC. Vital signs: Listeria illnesses, deaths, and outbreaks—United States, 2009–2011. MMWR 2013;62:448–52.
  3. CDC. Multistate outbreak of listeriosis linked to imported Frescolina Marte brand ricotta salata cheese (final update). Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at
  4. CDC. Outbreak of listeriosis associated with homemade Mexican-style cheese—North Carolina, October 2000–January 2001. MMWR 2001;50:560–2.

* The Listeria Initiative is an enhanced surveillance system that has routinely collected data regarding food consumption from all patients with listeriosis since 2004. Additional information is available at Adobe PDF file.

† Joint Food and Drug Administration/Health Canada quantitative assessment of the risk of listeriosis from soft-ripened cheese consumption in the United States and Canada: draft report. Available at Adobe PDF fileExternal Web Site Icon.


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April 10th, 2014 posted by Paul Rega, MD, FACEP @ 12:21 pm

Restaurants Pose Twice the Risk of Foodborne Outbreaks as Homes

Food-borne Illnesses, Product Safety, FDA, USDA

“…….CSPI’s Outbreak Alert! database includes 7,461 unique and solved
outbreaks of foodborne illness that occurred from 1990 through 2011. The report
issued today examined the 3,933 outbreaks that occurred in the most recent
10-year period. Those outbreaks sickened 98,399 people. The CDC estimates that
48 million people are sickened annually, of which 128 thousand are hospitalized
and 3,000 die.”

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March 28th, 2014 posted by Paul Rega, MD, FACEP March 28, 2014 @ 3:35 am

Tetramine rat poison blamed for kindergarten deaths in China

Food-borne Illnesses, Product Safety, FDA, USDA

“….Thirty-two children showed symptoms of food poisoning on Wednesday afternoon. Of the seven in critical condition, two girls, aged four and five, died. Five others are recovering.

Most of the ill have been discharged from hospital……”

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March 22nd, 2014 posted by Paul Rega, MD, FACEP March 22, 2014 @ 6:30 am

Culinary life of New York: the blue “A,” green “B” and orange “C” letter grades that trumpet the sanitary conditions of the restaurant within.

Food-borne Illnesses, Product Safety, FDA, USDA


“…..Cases of salmonella, a common metric for municipal food safety, have fallen 14 percent since the program was introduced…..”



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March 19th, 2014 posted by Paul Rega, MD, FACEP March 19, 2014 @ 3:10 am

Gnathostomes in Asian swamp eels collected between 2010 and 2012 from ethnic food markets and in Florida waters

Food-borne Illnesses, Product Safety, FDA, USDA

Parasite in Live Asian Swamp Eels May Cause Human Illness Released: 3/12/2014 4:52:35 PM

Raw or undercooked Asian swamp eels could transmit a parasitic infection called gnathostomiasis to consumers.

U.S. Geological Survey scientists found parasitic worms known as gnathostomes in Asian swamp eels collected between 2010 and 2012 from ethnic food markets and in Florida waters where the eel species is invasive. If eaten raw or undercooked, these eels could transmit their parasites to people, causing mild to serious disease. Severe cases of the infection can lead to blindness, paralysis or death. The USGS study was published today in the journal Emerging Infectious Diseases.

“Because live Asian swamp eels are commonly imported to the U.S., a person’s dietary history and not just travel history should be considered when diagnosing gnathostomiasis,” said Rebecca Cole, USGS scientist and lead author of the study.

Swamp eels transported live from Southeast Asia are sold in many urban ethnic food markets in the United States, and have been released into waters in Florida, Georgia and New Jersey. During the USGS study, scientists found gnathostome worms in eels collected from markets in Manhattan, N.Y., Atlanta, Ga., and Orlando, Fla., and in wild eels caught in peninsular Florida. All of the infected eels obtained from markets were imported from Bangladesh.

“Consumers should be aware of the risk of contracting gnathostomiasis from Asian swamp eels if they are eating raw or undercooked eels,” Cole said.

Co-author and USGS scientist Leo Nico said it is notable that North American species of gnathostome parasites have infected wild, invasive Asian swamp eels in Florida. Although the North American species found in the wild Florida eels has not been reported as infecting humans, some scientists suggest that all Gnathostoma species can most likely infect people. According to the authors, it is also concerning that this parasite could be transmitted into native fish and wildlife populations and domestic cats or dogs.

Swamp eels are native to Southeast Asia, and wild-caught and domestically-reared eels are widely consumed as food by humans. The eels are a common source of human gnathostomiasis in many parts of Asia. Wild populations of these invasive eels were first found in Florida in 1997, likely the result of the live food trade or aquarium releases. There are five established populations in the continental U.S. — three in Florida, and one each in Georgia and New Jersey. Introduced swamp eels have also been present in Hawaii for many decades.

The eels, which can reach lengths of about three feet, have the potential to become widespread in the U.S., impacting native aquatic and wetland species. The species has few known predators in the U.S., breathes air and can move across land, and can survive in both hot and cold climates.

For more information on USGS zoonotic, or animal-caused, illnesses, please visit the USGS National Wildlife Health Center website. FAQs on Asian swamp eels are available online.


Abstract:   In Southeast Asia, swamp eels (Synbranchidae: Monopterus spp.) are a common source of human gnathostomiasis, a foodborne zoonosis caused by advanced third-stage larvae (AL3) of Gnathostoma spp. nematodes. Live Asian swamp eels are imported to US ethnic food markets, and wild populations exist in several states. To determine whether these eels are infected, we examined 47 eels from markets and 67 wild-caught specimens. Nematodes were identified by morphologic features and ribosomal intergenic transcribed spacer–2 gene sequencing. Thirteen (27.7%) M. cuchia eels from markets were infected with 36 live G. spinigerum AL3: 21 (58.3%) in liver; 7 (19.4%) in muscle; 5 (13.8%) in gastrointestinal tract, and 3 (8.3%) in kidneys. Three (4.5%) wild-caught M. albus eels were infected with 5 G. turgidum AL3 in muscle, and 1 G. lamothei AL3 was found in a kidney (both North American spp.). Imported live eels are a potential source of human gnathostomiasis in the United States.

EID, Volume 20, Number 4—April 2014


Gnathostoma spinigerum in Live Asian Swamp Eels (Monopterus spp.) from Food Markets and Wild Populations, United States

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March 14th, 2014 posted by Paul Rega, MD, FACEP March 14, 2014 @ 3:15 am

A 25 kilo Spanish Mackerel caught off the mid north coast of Australia over the weekend sent 9 to hospital with Ciguatera poisoning.

Food-borne Illnesses, Product Safety, FDA, USDA———-

Pearn J: Neurology of ciguatera. J Neurol Neurosurg Psychiatry
2001; 70(1): 4-8 [available at
Lewis RJ: The changing face of ciguatera. Toxicon 2001; 39(1):
97-106 [abstract available at
Chateau-Defat ML, Chinain M, Cerf N, et al: Seawater temperature,
_Gambierdiscus_ spp. Variability and incidence of ciguatera poisoning
in French Polynesia. Harmful Algae 2005; 4: 1053-62 [abstract
available at <>].

CDC. Surveillance for foodborne-disease outbreaks – United States,
1998-2002. MMWR 2006; 55(SS-10): 1-34 [available at
Lewis R, Ruff T: Ciguatera: ecological, clinical, and
socioeconomic perspectives. Crit Rev Environ Sci Technol 1993; 23(2):
137-56 [abstract available at


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March 6th, 2014 posted by Paul Rega, MD, FACEP March 6, 2014 @ 5:53 am

NYC Fish Industry: Mycobacterium marinum (M. marinum) & a rare skin infection

Food-borne Illnesses, Product Safety, FDA, USDA

NY Times

Infections Linked to Chinese Seafood Markets in New York


“…..At least 30 people have contracted a rare skin infection after buying seafood at markets in Chinese neighborhoods across New York City…..”

Health Department Warns Patrons of Seafood Markets in Chinatowns about Skin Infections From Handling Live or Raw Fish or Seafood
People who handle live or raw fish or seafood from markets in Chinatowns are urged to wear waterproof gloves when preparing these items and seek medical care if they have red, tender bumps on their hands or arms.
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March 5th, 2014 posted by Paul Rega, MD, FACEP March 5, 2014 @ 4:54 am

Multistate Outbreak of Multidrug-Resistant Salmonella Heidelberg Infections Linked to Foster Farms Brand Chicken

At a Glance:

  • Case Count: 481
  • States: 25
  • Deaths: 0
  • Hospitalizations: 38%
  • Recall: Yes

Persons infected with the outbreak strain of Salmonella Heidelberg, by State as of February 28, 2014

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March 3rd, 2014 posted by Paul Rega, MD, FACEP March 3, 2014 @ 1:01 pm

Roos Foods of Kenton, DE is recalling various cheeses because of potential to be contaminated with Listeria monocytogenes

Recall — Firm Press Release


FDA posts press releases and other notices of recalls and market withdrawals from the firms involved as a service to consumers, the media, and other interested parties. FDA does not endorse either the product or the company.


EXPANDED – Roos Foods Voluntarily Recalls Variety of Cheeses (listed below) Due to Possible Health Risk


Virginia Mejia
(302) 653-8458

FOR IMMEDIATE RELEASE – February 25, 2014 – Update: Roos Foods has voluntarily expanded their February 23, 2014 recall to include all lots of Amigo and Mexicana brands of Requesón (part-skim ricotta in 15 oz. and 16 oz. plastic containers and all lots of Amigo, Mexicana and Santa Rosa De Lima brands of Queso de Huerta (fresh curd cheese).

Roos Foods, Kenton De Recalls ALL LOTS of the Following Cheeses:

Mexicana: Cuajada En Terron, Cuajada/Cuajadita Cacera, Cuajada Fresca, Queso Fresca Round, Queso Dura Viejo Hard Cheeses; Amigo: Cuajada En Terron, Cuajada/Cuajadita Cacera, Cuajada Fresca, Queso Fresca Round, Queso Dura Viejo Hard Cheeses; Santa Rosa De Lima: Cuajada En Terron, Cuajada/Cuajadita Cacera, Cuajada Fresca, Queso Fresca Round, Queso Dura Viejo Hard Cheeses and Anita Queso Fresco Because Of Possible Health Risk.

Roos Foods of Kenton, DE is recalling the above cheeses because they have the potential to be contaminated with Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women. Products were distributed in Maryland, Virginia and Washing ton D.C through retail stores.

The products are packaged in flexible plastic bags and rigid plastic clam shell packages in 12 oz. and 16 oz. sizes under the brand names: Mexicana, Amigo, Santa Rosa De Lima, and Anita.

As a follow-up to reported illness, samples of various intact/unopened cheeses produced or repacked by Roos Foods, Inc., collected by the Commonwealth of Virginia Dept of Agriculture & Consumer Services and Maryland Dept. of Health and Mental Hygiene found to contain Listeria monocytogenes which appear to be linked to the illnesses.

The company has ceased the production and distribution of the products as FDA and the company continue their investigation as to what caused the problem.

Customers should destroy all lots of the above listed products of the brand names Mexicana, Amigo, Santa Rosa De Lima and Anita. For any refund, please return recalled products to store.

If you have any further questions please contact Virginia Mejia phone number (302) 653-8458. Monday thru Friday from 9 am to 3 pm EST.



(UPDATE) Expanded Press Release

Expanded Press Release (In Spanish)

Original Press Release

FDA Investigation


RSS Feed for FDA Recalls Information [what's this?]

Photo: Product Labels

Recalled Product Photos Are Also Available on FDA’s Flickr Photostream.

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February 25th, 2014 posted by Paul Rega, MD, FACEP February 25, 2014 @ 12:03 am

An outbreak strain of Listeria monocytogenes : California (1) and Maryland (7)

  • A total of eight persons infected with the outbreak  strain of Listeria monocytogenes were reported from two states.
    • The number of ill persons identified in each state  was as follows: California (1) and Maryland (7)
    • Seven of eight ill persons were hospitalized. One  death was reported in California. Five of the illnesses (2 mother-newborn pairs  and a newborn) were related to pregnancy.
    • All  patients are of Hispanic ethnicity.
  • The outbreak strain of Listeria monocytogenes that caused the  illnesses has been found in cheese products produced by Roos FoodsExternal Web Site Icon of Kenton, Delaware,  These  cheeses have been recalled.External Web Site Icon
  • Further investigation into the source of these illnesses is  ongoing.

Persons infected with the outbreak-associated strain of Listeria monocytogenes, by state as of February 21, 2014

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