BEAM 133? NW HEdtisTI-i UEPARTMENT Environmental Foods Nursing Vital Records 20 3rd St Lafayette, IN 47901 629 6th St Lafayette, IN 47901 Phone: (765) 423-9221 Phone: (765) 42.3 ~9221 FAX: (765) 4239154 FAX: (765) 423?9797 Agave Azul Investigation: Summary of Findings April 10, 201?? The Tippecanoe County Heaith Department (TCHD), with the assistance of the Tippecanoe County Coroner, the Indiana State Department of Health (ISDH), the US. Centers for Disease Control and Prevention (CDC), and the US. Food and Drug Administration (FDA), conducted an investigation of gastrointestinal illness that occurred in four individuals shortly after dining at Agave Azul in TWest Lafayette, Indiana on October 22, 2016. The affected individuals had consumed dishes containing beef, chicken, or pork, One of the affected individuals was hospitalized, became critically and, despite aggressive medical intervention, passed away on October 26, 2016. The and rapid onset of illness experienced by the affected individuals were consistent with infection due to Ciostridium per??ingens, a common cause of foodborne illness. Fecal specimens were obtained from two of the affected individuals, including the decedent, and analyzed by demonstrating the presence of Ciostridium petfiingens. Further analysis of specimens from the decedent performed by CDC also confirmed the presence of Clostridium per?'ingens. The Tippecanoe County Coroner determined the decedent?s cause of death to be ischernic colitis due to Closh?idlum perfrhigens. Inspections of Agave Azul conducted by TCHD from October 2016 through February 2017 revealed several deficiencies in food handling practices. Of particular concem were critical violations involving the holding of cooked food at inadequate temperatures prior to serving, a condition which is conducive to the growth of Closh?idium per?'ingens. According to CDC, illness due to Clostridium per??ingens is typicaliy caused by consuming foods such as beef and poultry prepared in large quantities and kept warm at temperatures below 140 for prolonged periods before serving. Samples of food prepared at Agave Azul were collected by TCHD inspectors on October 27, 2016 and submitted to FDA for analysis. While FDA was unable to con?nn the presence of Ciostridium per?'ingens in the food specimens, it should be noted that signi?cant delays occurred in the testing process at the laboratory and may have affected the accuracy of the tests. ISDH concluded that the most likely source of infection was food consumed at Agave Azul. Summary: 0 Foodborne illness occurred in four individuals who dined at Agave Azul on the same day 0 Clostridiurn was definitively identi?ed as the pathogen in two of the affected individuals; the characteristics of illness experienced by the other affected individuals were consistent with Clostridium perfringens infection 0 Timing of onset strongly indicates Agave Azul as the source of infection 0 Agave Azul?s food handling practices, particularly the consistent practice of holding hot food at inadequate temperatures prior to serving, would promote the growth of pathogens such as Clostridium perfringens Conclusion: TCHD concludes that it is highly likely that the affected individuals contracted Clostridium per??hlgens through consumption of food prepared at Agave Azul. Jeremy P. Adler, M.D. Craig A. Rich, R.E.H.S. Health Of?cer Administrator