Thực phẩm Listeriosis 335Two patients, including one neonate, died. All patients reported consumption of gravad or smoked rainbow trout or salmon, five of whom recalled definitely or possibly consuming the same brand. Four subtypes were identified among patient isolates using restriction enzyme analysis (REA) with three enzymes and phage typing (designated clonal types A–D); six isolates were clonal type B, seen only once previously in Sweden. Investigators launched an environmental investigation, in which samples from the producer processing area along with gravad and smoked fish collected from patient refrigerators, retailers, and the producer were screened. Samples from the processing area and from fish yielded L. monocytogenes. Molecular subtyping results linked environmental and food isolates to eight of nine cases. Type B was recovered from samples of gravad fish from the home of one patient and from the producer, along with residue found in the packing machine, providing laboratory confirmation of the vehicle and identifying the likely environmental source of product contamination. Similar to several other investigations, the same subtype had been isolated from a product from this producer 6 months earlier, indicating that this subtype was likely among the resident environmental microflora. In addition, L.monocytogenes types C and D were isolated from product sampled at the processing plant, explaining two additional cases. One sample yielded two subtypes, highlighting the utility of characterizing more than one L. monocytogenes colony from a given sample during investigations.
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