Fatal food poisoning outbreak caused by Clostridium perfringens with expression of a non-chromosomal enterotoxin

This study reports a fatal food poisoning outbreak in Israel that affected almost 35 percent of residents in a housing facility for people with developmental and intellectual disabilities. During the outbreak, three residents died, and nine more were hospitalized. An infectious dose of a foodborne-associated strain of C. perfringens was detected in a ground cooked meat dish (ground goulash) served before illness onset and in all stools of the hospitalized patients. A comprehensive epidemiologic and molecular investigation demonstrated a clonal identity between C. perfringens isolates from the stools of six hospitalized patients and the consumed ground goulash. The sequence of these isolates also revealed their unusual plasmid-derived expression of the Clostridium enterotoxin (CPE). WGS provided insights into the pathogen properties and enabled establishing an absolute linkages between clinical cases and suspected foodborne outbreak sources.