{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T06:22:19Z","timestamp":1790058139128,"version":"4.0.1"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,11,13]],"date-time":"2021-11-13T00:00:00Z","timestamp":1636761600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"European Union\u2019s Horizon 2020 Research and Innovation Programme","award":["773830"],"award-info":[{"award-number":["773830"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,8,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Microsporidia are rarely reported to cause outbreaks of diarrhea. We describe a foodborne outbreak of microsporidiosis from a workplace canteen in November 2020 in Denmark.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A probable case was defined as any person using the canteen between 4 November and 13 December 2020, reporting at least one gastrointestinal symptom, whereas a confirmed case also had an Enterocytozoon bieneusi positive stool sample. A web-based questionnaire was used to collect clinical, epidemiological, and food exposure data. We performed a retrospective cohort study and tested stool samples from affected individuals for bacterial, viral, and parasitic pathogens, including E. bieneusi.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Altogether, 195 individuals completed the questionnaire. We identified 52 cases (65% male; median age 45 years [range 25\u201365]). Diarrhea (90%), fatigue (83%), and abdominal pain (79%) were the most commonly reported symptoms. Eight cases were laboratory-confirmed and had E. bieneusi genotype C. The incubation period was between 5 and 12 days, and polymerase chain reaction (PCR)-detectable spore shedding occurred up to 43 days after symptom onset. Disease was associated with consuming food from the workplace canteen on 4 November 2020 (relative risk [RR[, 2.8 [95% confidence interval [CI]: 1.4 \u2013 5.4]) and lunchboxes containing open sandwiches (RR, 3.2 [95% CI: 1.4 \u2013 7.2]) served that day.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This is the second documented foodborne outbreak of E. bieneusi genotype C-associated diarrhea worldwide. Epidemiological findings advocated an open sandwiches lunchbox from 4 November 2020, as a likely source. E. bieneusi may be an under-reported cause of outbreaks of diarrhea, and testing for it might be useful in foodborne outbreak investigations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciab949","type":"journal-article","created":{"date-parts":[[2021,11,11]],"date-time":"2021-11-11T12:10:55Z","timestamp":1636632655000},"page":"468-475","source":"Crossref","is-referenced-by-count":39,"title":["Incubation Period, Spore Shedding Duration, and Symptoms of <i>Enterocytozoon bieneusi<\/i> Genotype C Infection in a Foodborne Outbreak in Denmark, 2020"],"prefix":"10.1093","volume":"75","author":[{"given":"Daniela","family":"Michlmayr","sequence":"first","affiliation":[{"name":"Department of Bacteria, Parasites and Fungi, Infectious Disease Preparedness, Statens Serum Institut , Copenhagen , Denmark"},{"name":"European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC) , Solna , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u00eds","family":"Alves de Sousa","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology and Prevention, Infectious Disease Preparedness, Statens Serum Institut , Copenhagen , Denmark"},{"name":"European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC) , Solna , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luise","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology and Prevention, Infectious Disease Preparedness, Statens Serum Institut , Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pikka","family":"Jokelainen","sequence":"additional","affiliation":[{"name":"Department of Bacteria, Parasites and Fungi, Infectious Disease Preparedness, Statens Serum Institut , Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steen","family":"Ethelberg","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology and Prevention, Infectious Disease Preparedness, Statens Serum Institut , Copenhagen , Denmark"},{"name":"Department of Public Health, Global Health Section, University of Copenhagen , Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lasse Skafte","family":"Vestergaard","sequence":"additional","affiliation":[{"name":"Department of Bacteria, Parasites and Fungi, Infectious Disease Preparedness, Statens Serum Institut , Copenhagen , Denmark"},{"name":"Department of Infectious Disease Epidemiology and Prevention, Infectious Disease Preparedness, Statens Serum Institut , Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Schj\u00f8rring","sequence":"additional","affiliation":[{"name":"Department of Bacteria, 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