Salmonellosis Associated with Marijuana A Multistate Outbreak Traced by Plasmid Fingerprinting

• Published in: The New England journal of medicine Vol. 306; no. 21; pp. 1249 - 1253
• Main Authors: Taylor, David N, Wachsmuth, I. Kaye, Shangkuan, Yung-hui, Schmidt, Emmett V, Barrett, Timothy J, Schrader, Janice S, Scherach, Charlene S, McGee, Harry B, Feldman, Roger A, Brenner, Don J
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 27.05.1982
• Subjects: Adult; Age; Alabama; Antibiotics; Cannabis; Cannabis - microbiology; Child; Deoxyribonucleic acid; Disease control; Disease Outbreaks - epidemiology; DNA; Drug Contamination; E coli; Enteritis; Epidemiology; Escherichia coli; Female; Fingerprinting; Food contamination & poisoning; Food sources; Gastroenteritis - etiology; Georgia; Households; Humans; Infant; Laboratories; Male; Marijuana; Michigan; Middle Aged; Narcotics; Nosocomial infections; Ohio; Outbreaks; Plasmids; Salmonella; Salmonella - genetics; Salmonella - isolation & purification; Salmonella Infections - epidemiology; Salmonella Infections - etiology; Salmonella Infections - microbiology; Salmonellosis; United States; Ohio; Georgia; Alabama; United States; Michigan
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198205273062101

In January and February of 1981, 85 cases of enteritis caused by Salmonella muenchen were reported from Ohio, Michigan, Georgia, and Alabama. Initial investigation failed to implicate a food source as a common vehicle, but in Michigan 76 per cent of the patients, in contrast to 21 per cent of the control subjects, admitted personal or household exposure to marijuana (P<0.001, relative risk = 20). Marijuana samples obtained from patients' households contained as many as 10 7 S. muenchen per gram. The outbreak-related isolates of S. muenchen were sensitive to all antibiotics and were phenotypically indistinguishable from other S. muenchen. Plasmid fingerprinting, however, revealed that all isolates related to marijuana exposure contained two low-molecular-weight plasmids (3.1 and 7.4 megadaltons), which were absent in control strains. Plasmid analysis of the isolates showed that the outbreaks in Ohio, Michigan, Georgia, and Alabama were related, and analysis of isolates submitted from various other states demonstrated that cases associated with marijuana may have been dispersed as far as California and Massachusetts. (N Engl J Med. 1982; 306:1249–53.) SALMONELLA is considered one of the most common foodborne pathogens. Over 50 outbreaks caused by this organism are reported annually to the Centers for Disease Control. Although there are more than 1800 different salmonella serotypes, 10 serotypes account for more than two thirds of the total isolates in the United States. 1 Most outbreaks result from group exposure to a contaminated food item or meal, but exposure to products that are contaminated at the time of production and have a wide distribution may lead to multistate outbreaks. Such multistate outbreaks have been most successfully traced when they have been caused by . . .