The St. Clair County Health Department has given the LongHorn Steakhouse in Fairview Heights the OK to reopen as an investigation into the cause of an infectious disease outbreak tied to the restaurant continues.
The establishment voluntarily closed Oct. 2 when the health department announced it was investigating an outbreak of shigellosis among people who had dined there.
Shigellosis, also called shigella poisoning, is caused by shigella bacteria and affects the digestive system, according to the health department. Symptoms include a fever and diarrhea, which may become bloody.
LongHorn Steakhouse has cooperated with the health department and the Illinois Department of Public Health on the investigation, according to a Thursday news release from the health department.
The restaurant hired professional environmental cleaning services to prevent further spread of disease and continues to provide training to staff on proper handwashing protocols and safe food-handling practices, the release said.
Additionally, employees are required to have two negative tests for shigella 24 hours apart before returning to work.
No staff have tested positive for shigella, a representative of Darden Restaurants, which owns LongHorn Steakhouse, said in an email to the BND. Forty employees have been cleared to return to work after testing negative twice.
In addition to contracting a professional cleaning company to conduct a two-day disinfection of the entire restaurant and testing all staff for shigella, the representative said the restaurant has also:
- Discarded all food items, food preparation utensils and items guests commonly touch, like salt and pepper shakers, condiment bottles, breadboards and more.
- Conducted training sessions, led by food safety specialists, to reinforce food safety and sanitation practices with every staff member.
“We take this situation very seriously and appreciate the opportunity to work closely with the Health Department throughout their investigation. We are pleased to receive their approval to reopen,” the representative wrote.
As of Thursday, 26 people had positive shigella lab reports — up from 24 according to last Friday’s update from the health department . Sixty-six people also reported illness consistent with shigellosis after dining at the establishment, an increase from 44 last Friday.
Those 92 people had dined at the LongHorn Steakhouse at 6115 N. Illinois St. between Sept. 19 and Oct. 2 and range in age from 12 to 84-years-old.
A total of 12 people have been hospitalized, according to the most recent release.
The health department is continuing to investigate the cause of the shigellosis outbreak and said it will provide a final update at the conclusion of its investigation.
Meanwhile, the number of people who have retained Jory Lange, a Texas-based food poisoning lawyer, has grown to over 200, he said.
Those who have retained him are a mix of patrons who were hospitalized, went to the emergency room, an urgent care or their doctor, or had the signs and symptoms of shigella poisoning after eating at LongHorn Steakhouse, he said.
“This is a really big shigella outbreak,” Lange said. “Certainly the biggest shigella outbreak … in recent memory in the United States.”
Lange and local personal injury lawyer Eric Carlson have filed three lawsuits in St. Clair County so far in the outbreak, according to circuit court records.
What is shigellosis?
Shigellosis, also called shigella poisoning, is an infectious disease caused by shigella bacteria that affects the digestive system, according to the health department.
Symptoms include a fever and diarrhea, which may become bloody.
Dr. James Fleckenstein, professor of medicine and molecular microbiology at the Washington University of St. Louis School of Medicine, said that shigella bacteria are distantly related to E. coli.
“It’s more common in developing countries, although it is a cause of foodborne illness and illness in travelers here. So people that travel outside the United States can acquire it, but it also clearly is a sporadic cause of foodborne illness in the United States,” Fleckenstein said.
How is it spread?
“It’s very easily transmitted, because it’s what we call a low-inoculant pathogen. So it doesn’t take many organisms for people to get infected,” Fleckenstein said.
It’s estimated to take 10 to 100 bacteria to get someone sick, he added, unlike other bacteria such as salmonella or campylobacter that typically take more organisms to get sick.
Shigella is spread through a fecal-oral route, he explained. Infected individuals shed the bacteria in their stool, even if they’re asymptomatic.
“An infected food handler, for instance, who doesn’t wash their hands properly, can then potentially infect a bunch of other people by infecting a point source of food,” Fleckenstein said.
Because the number of bacteria required to make somebody sick is low, shigella poisoning can happen in daycares and households if proper handwashing isn’t taking place.
How is shigellosis treated?
“The vast majority of people will get better on their own,” Fleckenstein said.
Most people generally get better within a week or so, he said. In most cases antibiotics are not needed and rehydration with something like Pedialyte is sufficient, he said.
However, people who are immunosuppressed or who have symptoms like a protracted fever, severe abdominal pain, bloody diarrhea probably need to seek medical attention, he said.
Only rarely are their complications associated with shigella poisoning in the United States, Fleckenstein said.
For example, reactive arthritis affects about 2% of people infected with certain types of shigella bacteria, according to the Centers for Disease Control and Prevention.
How common is shigellosis in the United States?
Shigella poisoning isn’t as common as campylobacter or E. coli infections now, Fleckenstein said.
While it used to be the most common cause of bloody diarrhea in the United States, it no longer is and has been surpassed by enterohemorrhagic E. coli, which produce a specific toxin that’s related to toxins that some shigella strains produce.
“They’re called shiga-like toxins,” Fleckenstein said. “Those are actually more common in the U.S. Those are very commonly associated with foodborne outbreaks.”
According to a June 2023 report from the CDC, there were about 4.9 cases of shigella poisoning per 100,000 people in the United States in 2022, including those internationally and domestically acquired.
The report looked at data collected from labs in 10 states: Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, Tennessee, California, Colorado and New York.
“It’s not exceedingly rare, it happens, but it’s not something we see everyday fortunately,” Fleckenstein said.
To find the prevalence of foodborne shigellosis outbreaks linked to restaurants, the CDC recommended looking at the “National Outbreak Reporting System” view of its Bacteria, Enterics, Ameba, and Mycotics — or BEAM — dashboard .
This view of the dashboard does not include all disease outbreaks for a variety or reasons, including that health departments might not report all outbreaks to the CDC.
According to the dashboard, there have been a total of seven foodborne shigella outbreaks linked to restaurants in the United States between 1998 and 2022. Those seven outbreaks led to 1,054 illnesses, 14 hospitalizations and zero deaths.
Bill Marler, a foodborne illness attorney with more than 30 years of experience, said that shigella outbreaks at restaurants “certainly happen,” but they’re not as frequent as salmonella or campylobacter outbreaks. They are, however, more common than listeria outbreaks.
Marler said he typically has one or two shigella restaurant outbreak cases caused by either a contaminated product or a sick worker each year.
Most of the cases he works on are caused by the latter, he said, but sometimes it’s not possible to tell.
For example, he said he’s been representing several people affected by an outbreak tied to a conference in August 2023 at the Westin Bonaventure Hotel in Los Angeles, California.
Attendees at the conference ate boxed lunches prepared by the hotel, he said, so it was likely that there was either a contaminated product used in the sandwiches or there was an ill worker who made the sandwiches.
“They never really figured out what was the direct cause,” Marler said.
Why is there a difference between the number of confirmed & possible cases?
That difference in numbers is not unusual in these kinds of investigations, Marler said.
Confirmed cases refer to people who tested positive for shigella in their stool, while probable cases are people who ate at the restaurant and had symptoms consistent with shigella poisoning, he explained.
Probable cases are still provable medically and legally, he added.
The discrepancy between the number of confirmed and probable cases from the health department and the number of people who have retained legal representation could be caused by some people not contacting the health department and contacting a lawyer directly, according to Marler.
Some of those cases could be difficult to prove if there’s no evidence of a person dining at the restaurant or medical records showing they got sick, he said.
How can shigella outbreaks be prevented?
There’s no vaccine yet, Fleckenstein at Washington University in St. Louis said, but the best way to prevent shigella outbreaks is through thorough cooking, since shigella bacteria can’t withstand extreme temperatures, and handwashing.
He emphasized the importance of thorough handwashing, particularly among people who are already infected so they don’t pass it on to their friends and family.
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