First Case Report of Possible Sarcocystis truncata-induced Food Poisoning in Venison

Along with the increase in consumption of raw animal meat, the prevalence of food poisoning is increasing. A 67-year-old Japanese man had eaten raw venison 4 hours prior to the beginning of vomiting. Many white cysts were discovered in the venison, with numerous bradyzoites being detected after the cysts were punctured. The presence of the Sarcocystis spp. 18S rRNA gene was detected by polymerase chain reaction, and Sarcocystis truncata was isolated from the venison. Sarcocystis truncata has not previously been identified in sika deer (Cervus nippon) in Japan. This is the first report of possible Sarcocystis truncata-induced food poisoning following consumption of venison.

Death of captive-bred vultures caused by flunixin poisoning in Italy

Among non steroidal anti-inflammatory drugs (NSAIDs) diclofenac is considered the main cause for the decline of vulture populations in the Indian subcontinent since the '90 s. Chemical analysis showed high levels of flunixin (31,350 μg/kg) in beef which three captive Gyps vultures fed on, later dying with severe visceral gout. Levels in dead vultures' organs and tissues ranged from 4 to 38.5 μg/kg. The typical lesions and the concentrations found in beef indicate flunixin as the cause of death. This is the first observational study which correlates the concentration of flunixin in the meat ingested with that found in tissues of vultures.

Multilocus Sequence Typing (MLST) of Campylobacter jejuni Isolated From Broiler Meat in Egypt

BACKGROUND AND OBJECTIVES

Infection with Campylobacter jejuni is one of the most common causes of bacterial gastroenteritis. Infections are mostly acquired due to consumption of raw or undercooked poultry. The aim of this pilot study is to determine the prevalence and the sequence types (STs) distribution of C. jejuni isolated from broiler meat in Egypt.

MATERIALS AND METHODS

A total of 190 broiler meat samples were collected from retail chicken shops located at Mansoura, Egypt and examined bacteriologically for the presence of Campylobacter spp. The biochemically identified Campylobacter isolates were confirmed by Multiplex PCR (m-PCR). In addition, multilocus sequencing typing (MLST) was used for genotyping of C. jejuni isolates.

RESULTS

Thirty two Campylobacter isolates divided into C. coli (25 isolates) and C. jejuni (7 isolates) were recovered. Multiplex PCR results found to be 100% in line with biochemical identification. Out of 7 C. jejuni isolates genotyped by MLST, 4 isolates were assigned to ST21, 2 isolates were assigned to ST48 and one isolate was assigned to ST464.

CONCLUSION

This study provides valuable information concerning the prevalence of thermophilic Campylobacter spp. and sequence types distribution of C. jejuni recovered from broiler meat for the first time in Egypt. The identified sequence types from this study were frequently reported in human illnesses. Thus, the present results highlight the importance of the retail broiler meat as a significant source for human Campylobacter infection.

Molecular Tracing to Find Source of Protracted Invasive Listeriosis Outbreak, Southern Germany, 2012-2016

We investigated 543 Listeria monocytogenes isolates from food having a temporal and spatial distribution compatible with that of the invasive listeriosis outbreak occurring 2012–2016 in southern Germany. Using forensic microbiology, we identified several products from 1 manufacturer contaminated with the outbreak genotype. Continuous molecular surveillance of food isolates could prevent such outbreaks.

Non-O157 Shiga toxin-producing Escherichia coli associated with venison

We investigated an outbreak of non-O157 Shiga toxin-producing Escherichia coli at a high school in Minnesota, USA, in November 2010. Consuming undercooked venison and not washing hands after handling raw venison were associated with illness. E. coli O103:H2 and non-Shiga toxin-producing E. coli O145:NM were isolated from ill students and venison.

Two multistate outbreaks of Shiga toxin--producing Escherichia coli infections linked to beef from a single slaughter facility - United States, 2008

During May-August 2008, state and local health and agriculture departments, the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS), and CDC investigated two multistate outbreaks of Shiga toxin--producing Escherichia coli O157 (STEC O157) with distinct pulsed-field gel electrophoresis (PFGE) patterns. Investigations into each outbreak included epidemiologic analysis of food exposures, microbiologic testing, and food distribution tracebacks. This report summarizes the results of those investigations. During May 27-August 25, 2008, a total of 99 persons (64 from the first outbreak and 35 from the second outbreak) from 18 states had confirmed illness with an STEC O157 isolate indistinguishable from the outbreak PFGE patterns. A case-control study conducted as part of the first investigation found a statistically significant association with purchase of ground beef from one large grocery chain (matched odds ratio [mOR] = 9.3). Traceback investigations for both outbreaks led to the same slaughter facility, resulting in multiple nationwide recalls of ground beef, intact beef, and beef products used to produce ground beef. This is the first report of two distinct STEC O157 outbreaks traced to a single slaughter facility and the first documented report of outbreaks linked to STEC O157 contamination of intact beef cuts ground by a retail chain. To help reduce the risk for outbreaks of STEC O157, the public health community should continue to educate consumers regarding the proper measures to take when handling and consuming ground beef.

Inflammation, atrophy, and prostate carcinogenesis

The etiological agents that cause prostate cancer remain unknown. There is emerging evidence that "risk factor" lesions that are proposed to represent regenerative epithelium in response to environmental insults may precede the development of prostatic intraepithelial neoplasia and early carcinoma. Recent evidence suggests that these lesions, referred to collectively as proliferative inflammatory atrophy, may arise in the setting of inflammation and dietary toxins, such as "charred meat" carcinogens. Additional epidemiological, molecular pathological, and animal model work needs to be done to determine whether inflammation and atrophy are "driving" prostate carcinogenesis.

Quantitative analysis of monofluoroacetate in biological samples by high-performance liquid chromatography using fluorescence labeling with 9-chloromethylanthracene

A rapid and sensitive RP-HPLC method with fluorescence detection has been developed for the quantitative analysis of trace amounts of monofluoroacetate (MFA) in biological samples as serum, food and meat. 9-Chloromethylanthracene (9-CMA) is used as the fluorescence labeling reagent. Samples were extracted and reacted with 9-chloromethylanthracene together with tetrabutylammonium bromide as catalyst at 80 degrees C for 50 min to give a new fluorescent derivative as 9-methyleneanthracene monofluoroacetate (MA-MFA). The resulting MA-MFA was characterized with IR, (1)H NMR, (13)C NMR and MS. Chromatography separation is performed on an Agilent Hypersil ODS column with a fluorescent detector employed with the excitation and emission wavelengths as 256 nm and 412 nm, respectively. Optimal conditions for derivatization, fluorescence detection and chromatographic separation have been established. The novel method yields a good linear relationship when the MFA concentration in serum within 1 and 250 ng/mL (r=0.9988). The detection limit (signal-to-noise ratio=3 with 2 microL injected) was 0.25 ng/mL. The practical applicability of this method was demonstrated by quantitative determination of MFA-Na in a blood sample from a person who had ingested the poison.

Food poisoning by clenbuterol in Portugal

This paper describes the occurrence of four cases of acute food poisoning, involving a total of 50 people, due to the ingestion of lamb and bovine meat containing residues of clenbuterol. Symptoms shown by the intoxicated people may be generally described as gross tremors of the extremities, tachycardia, nausea, headaches and dizziness. Analytical methodology developed for the determination of clenbuterol in meat, liver and blood samples is described. Procedures are described which should be followed when the described symptoms are evident in a group of people who have ingested contaminated meat, and particularly liver of ruminants.

Methemoglobinemia misdiagnosed as ruptured ectopic pregnancy

A 22-year-old woman with an initial diagnosis of 'ruptured ectopic pregnancy' and 'hemorrhagic shock' was sent to the operation room for surgical treatment. The mucocutaneous color was deeply cyanosed and the pulse oximeter oxygen saturation (SpO2) was only 86% after tracheal intubation (100% O2). 'Chocolate-brown' blood was observed and methemoglobinemia was considered. Then the arterial blood gas (ABG) sample was obtained, an intravenous infusion of methylene blue and vitamin C followed. The patient recovered quickly, and later two other patients with similar symptoms were treated in the same way. The success was due to a correct diagnosis accompanied with prompt treatment and quick recognition of the etiology.

Nicotine poisoning after ingestion of contaminated ground beef--Michigan, 2003

On January 3, 2003, the Michigan Department of Agriculture's (MDA) Food and Dairy Division and the U.S. Department of Agriculture (USDA) were notified by a supermarket of a planned recall of approximately 1,700 pounds of ground beef because of customer complaints of illness after eating the product. On January 10, the supermarket notified MDA that their laboratory had determined that the contaminant in the ground beef returned by customers with reported illness was nicotine. This report summarizes the investigation of these cases, which identified approximately 100 affected persons, and discusses actions taken to prevent additional illness, including the arrest of a person charged with deliberately poisoning the ground beef at the supermarket.

Clenbuterol ingestion causing prolonged tachycardia, hypokalemia, and hypophosphatemia with confirmation by quantitative levels

BACKGROUND

Clenbuterol is a long acting beta2-adrenergic agonist used in the treatment of pulmonary disorders. Acute clenbuterol toxicity resembles that of other beta2-adrenergic agonists. Most previously reported cases of clenbuterol toxicity describe patients who ate livestock illicitly treated with clenbuterol.

CASE REPORT

We report a case of human clenbuterol toxicity confirmed and correlated with qualitative and quantitative serum clenbuterol assays. This poisoned patient, a 28-year-old woman, developed sustained sinus tachycardia at 140/min, hypokalemia (2.4 mEq/L, 2.4 mmol/L), hypophosphatemia (0.9 mg/dL, 0.29 mmol/L), and hypomagnesemia (1.52 mg/dL, 0.76 mmol/L) after ingesting a reportedly small quantity of clenbuterol. The patient received repeated doses of metoprolol to treat her cardiovascular stimulation and potassium chloride to treat her hypokalemia. She remained symptomatic for more than 20 hours after the ingestion. Analysis by enzyme-linked immunosorbent assay and liquid chromatography/mass spectrometry revealed a serum clenbuterol concentration of 2.93 mcg/L 3 hours after the ingestion and an undetectable serum concentration 20 hours after ingestion. It is noteworthy that at a serum concentration below the limit of detection by liquid chromatography/mass spectrometry, the patient remained symptomatic. Acute clenbuterol toxicity is rarely reported following illicit use in humans, and this is the first such case to provide confirmatory toxicological analysis.

Clinical and pharmacological profile in a clenbuterol epidemic poisoning of contaminated beef meat in Italy

Long-acting beta adrenergic agonists, such as clenbuterol accumulate in the liver, but not meat of treated farm animals, and result in epidemic poisonings in consumers. We describe an outbreak of poisoning in 15 people, following the consumption of meat. Clinical symptoms (distal tremors, palpitations, headache, tachipnoea-dyspnoea, and also moderate hyperglycaemia, hypokalemia and leucocytosis) were seen in nine hospitalised patients, starting about 0.5-3 h after poisoning, and disappearing within 3-5 days later. Clenbuterol was found in the urine of all the symptomatic patients, at higher levels than pharmacokinetic computing (mean level 28 ng/ml, 36 h after ingestion), based on the levels found in the meat (1140-1480 ng/g edible tissue). Thus, epidemic poisoning can be produced following the consumption of contaminated meat. The need for a better definition of pharmaco- and toxico-kinetics, not only for drugs ingested as parent drug, but also when ingested as residues with animal tissues, is recommended.

[Epidemic rhabdomyolysis due to the eating of quail. A clinical, epidemiological and experimental study]

BACKGROUND

Few toxic outbreaks by quails ingestion have been described, none in Spain, and the toxic hasn't been identified. A toxic outbreak, by quails ingestion that ate Galeopsis ladanum seeds, is described and an animal model is developed.

PATIENTS AND METHODS

A rhabdomyolysis outbreak by quails ingestion is studied clinical and epidemiologically. Quails crops were analyzed and 20 patients were studied. A murine model was developed. Alcaloid content in Galeopsis ladanum seeds and quail meat was measured.

RESULTS

Twenty patients suffered from rhabdomyolysis (myalgia, increase of muscular enzymes and myoglobinuria) by ingestion of quails that ate Galeopsis ladanum seeds as it could be seen at their crops. Six patients needed hospital care but evolution was benign. Rats fed with quails that ate Galeopsis ladanum seeds had higher creatinkinase (CK) levels than controls rats (near significance, p = 0.0588). Several alcaloids, stachydrine included, was detected in seeds. Another alcaloid no identified was detected in quails meat.

CONCLUSIONS

Quails that eat Galeopsis ladanum seeds are toxic for human beings, causing rhabdomyolysis. A plant alcaloid could be the toxic involved in the outbreak.

Clenbuterol residues in non-liver containing meat as a cause of collective food poisoning

beta 2-adrenergic agonists, particularly clenbuterol, are illegally used as growth promoters to obtain lean in meat. Their administration in feedlots can constitute a severe risk for animal welfare and exposes consumers to involuntary drug consumption at pharmacological active concentrations. Reported poisoning episodes have been associated with the consumption of beef liver where clenbuterol residues concentrate. In August 1996, 62 persons asked for medical help at the emergency rooms of 2 hospitals near the city of Caserta (Italy). Their clinical profile was characteristic of previously occurring clenbuterol intoxication, which reported superventricular extrasystoles and atrial fibrillation. All patients had non-liver beef meat consumption 10-30 min to 2-3 h before symptoms developed. An ELISA screening test specific for clenbuterol confirmed the drug's presence. Definitive confirmation of clenbuterol and determination of the drug content in meat samples were obtained by GC-MS, using 2 different derivatization. Concentrations in the meats ranged from 0.8 to 7.4 mg/kg. These analytical data provided evidence of the seriousness of the poisoning and helped the National Health System identify other possible misinterpreted cases. This case demonstrates that clenbuterol poisoning can also occur after consumption of beef meat other than liver.

A new variant of food poisoning: enteroinvasive Klebsiella pneumoniae and Escherichia coli sepsis from a contaminated hamburger

For the first time, we report Klebsiella pneumoniae as an enteroinvasive food-borne pathogen transmitted from a hamburger. A 28-year-old previously healthy African-American male ingested a portion of a hamburger from a fast food chain. Symptoms of gastroenteritis rapidly deteriorated to multiorgan failure. Blood and hamburger cultures grew Escherichia coli and Klebsiella pneumoniae. Since Klebsiella had not previously been reported as enteroinvasive, the isolates were compared. Full biochemical profiles, antimicrobial sensitivity, plasmid profile, and toxin assay by DNA hybridization probe were completely concordant. The patient survived the episode of food-borne sepsis. Deliberate or inadvertent employee contamination of food products with feces may be a potential source of life-threatening food-borne illness.

Hamburger-associated Escherichia coli O157:H7 infection in Las Vegas: a hidden epidemic

OBJECTIVES

This study sought to determine whether a multistate fast food hamburger-associated outbreak of Escherichia coli O157:H7 infection involved Las Vegas residents as well and, if so, why public health officials had not detected it.

METHODS

A matched case-control study was conducted among persons with bloody diarrhea and their healthy meal companions. Hamburger production, distribution, and cooking methods were reviewed. Unused hamburger patties were cultured, and E. coli O157:H7 isolates were characterized. Local laboratory stool culture practices were reviewed.

RESULTS

Fifty-eight cases of bloody diarrhea were identified. Illness was associated with eating regular hamburgers (matched odds ratio [OR] = 9.0, 95% confidence interval [CI] = 1.02,433.4), but 25% of ill persons reported eating only jumbo hamburgers. Regular and jumbo hamburger patties yielded E. coli O157:H7 indistinguishable from the lone clinical isolate. No local laboratory cultured routinely for E. coli O157:H7 until after the outbreak.

CONCLUSIONS

A large outbreak of E. coli O157:H7 infections escaped timely notice in Las Vegas because local laboratories did not culture for this pathogen. Health officials should encourage laboratories to screen at least all bloody stools on sorbitol-MacConkey medium.

Scombroid poisoning

Scombroid poisoning is described in the literature as a toxic poisoning caused by ingestion of certain dark meat fish undergoing bacterial decomposition. Poisoning results from the ingestion of a heat-stable toxin. We describe the case of a man who presented to the emergency department several hours after eating tuna steak with evidence of scombroid poisoning that was associated with loss of vision and atrial tachycardia with block. All signs and symptoms resolved after treatment for scombroid poisoning.

A foodborne outbreak causing a cholinergic syndrome

We report a foodborne outbreak causing a cholinergic syndrome in three members of a family. The clinical presentation was characterized by nausea, vomiting, abdominal pain, and weakness. Physical examination revealed evidence of peripheral motor weakness and decreased level of consciousness in all three patients. Bradycardia, hypotension, and seizures occurred in two patients. Although initial therapy included administration of antitoxin for possible botulism, subsequent investigation revealed evidence of accidental organophosphate (fensulfothion) poisoning. The ubiquitous use of organophosphates as agricultural and household insecticides has ensured their continuing importance as causes of foodborne poisoning in both developed and developing countries. Physicians must remain alert to the possibility of non-bacterial causes of foodborne outbreaks in order to initiate prompt and appropriate investigations and specific therapy.

Clostridium perfringens food-borne outbreak: an epidemiological investigation

On 3 April 1994, the Western Sector Public Health Unit was notified of an outbreak of gastroenteritis at a Christian youth camp. Attending the camp were 820 people; 241 (42 per cent) of 574 camp participants who completed a questionnaire reported illness. Of these, 230 met the case definition. Main symptoms reported were stomach cramps (78 per cent), diarrhoea (67 per cent) and nausea (46 per cent). Bacterial analysis of leftover chicken grew 2.3 x 10(7) and 3.3 x 10(7) colonies/g of Clostridium perfringens, and we identified Type A enterotoxin of C. perfringens in four of seven stool samples collected from ill people. Camp participants who consumed chicken at lunch on the second day of the camp were nearly four times as likely to be ill than those who did not (relative risk 3.81, 95 per cent confidence interval 3.07 to 4.72). There were deficiencies in hygiene and food preparation. We highlight the importance of time and temperature controls in food preparation and storage to prevent contamination and subsequent poisoning by C. perfringens or other food pathogens. This investigation demonstrates the importance of a multidisciplinary team when investigating disease outbreaks.

Escherichia coli O 157:H7-associated hemolytic-uremic syndrome after ingestion of contaminated hamburgers

We conducted a retrospective analysis of 37 children with Escherichia coli O157:H7-associated hemolytic-uremic syndrome. The infection was traced to contaminated hamburgers at a fast-food restaurant chain. Within 5 days of the first confirmed case, the Washington State Department of Health identified the source and interrupted transmission of infection. Ninety-five percent of the children initially had severe hemorrhagic colitis. Nineteen patients (51%) had significant extrarenal abnormalities, including pancreatitis, colonic necrosis, glucose intolerance, coma, stroke, seizures, myocardial dysfunction, pericardial effusions, adult respiratory disease syndrome, and pleural effusions. Three deaths occurred, each in children with severe multisystem disease. At follow-up two children have significant impairment of renal function (glomerular filtration rate < 80 ml/min/per 1.73 Hm2); both of these children have a normal serum creatinine concentration. Hemolytic-uremic syndrome is the most common cause of acute renal failure in children, and this experience emphasizes the systemic nature of this disease. Clinicians should anticipate that multisystem involvement may occur in these patients, necessitating acute intervention or chronic follow-up. This outbreak of Hemolytic-uremic syndrome also highlights the microbiologic hazards of inadequately prepared food and emphasizes the importance of public health intervention in controlling Hemolytic-uremic syndrome.

Clostridium perfringens gastroenteritis associated with corned beef served at St. Patrick's Day meals--Ohio and Virginia, 1993

Clostridium perfringens is a common infectious cause of outbreaks of foodborne illness in the United States, especially outbreaks in which cooked beef is the implicated source. This report describes two outbreaks of C. perfringens gastroenteritis following St. Patrick's Day meals in Ohio and Virginia during 1993.

Molecular epidemiology of Escherichia coli O157:H7 strains by bacteriophage lambda restriction fragment length polymorphism analysis: application to a multistate foodborne outbreak and a day-care center cluster

Genomic DNAs prepared from 168 isolates of Escherichia coli O157:H7 were analyzed for restriction fragment length polymorphisms on Southern blots probed with bacteriophage lambda DNA. The isolates analyzed included strains from a recent large multistate outbreak of E. coli O157:H7 infection associated with consumption of poorly cooked beef in restaurants, a day-care center cluster, and temporally and geographically unrelated isolates. E. coli O157:H7 isolates recovered from the incriminated meat and from 61 (96.8%) of 63 patients from Washington and Nevada possessed identical lambda restriction fragment length patterns. The lambda restriction fragment length polymorphisms observed in 11 (91.7%) of 12 day-care center patients were identical, but they differed from that of the strain associated with the multistate outbreak. E. coli O157:H7 from 42 patients temporally or geographically unrelated to either cluster of infection possessed unique and different lambda restriction fragment length patterns, except for paired isolates from three separate clusters of infection. These data demonstrate that the hybridization of DNA digests of E. coli O157:H7 with radiolabelled bacteriophage lambda DNA can be a useful, stable, and discriminatory epidemiologic tool for analyzing the linkage between strains of E. coli O157:H7.

Profile of Escherichia coli O157:H7 pathogen responsible for hamburger-borne outbreak of hemorrhagic colitis and hemolytic uremic syndrome in Washington

We analyzed Escherichia coli O157:H7 isolates from stool samples of five patients who had bloody diarrhea and were infected during a large food-borne outbreak of hemorrhagic colitis in Washington state. The isolates were assessed for Shiga-like toxin profile, adherence and plasmid traits, mouse virulence, capsule, and enterohemolysin production. The profiles of the five isolates were indistinguishable from each other and similar to that of E. coli O157:H7 strain EDL933, an organism responsible for a similar hamburger-associated food poisoning episode in 1982.

Update: multistate outbreak of Escherichia coli O157:H7 infections from hamburgers--western United States, 1992-1993

From November 15, 1992, through February 28, 1993, more than 500 laboratory-confirmed infections with E. coli O157:H7 and four associated deaths occurred in four states--Washington, Idaho, California, and Nevada. This report summarizes the findings from an ongoing investigation that identified a multistate outbreak resulting from consumption of hamburgers from one restaurant chain.

Foodborne nosocomial outbreak of Salmonella reading--Connecticut

This report describes an outbreak of nosocomial salmonellosis associated with consumption of improperly thawed and cooked turkey. Although the outbreak occurred 1 year ago, this report is a timely reminder of the importance of proper cooking and handling of turkey--especially during the holiday season.

Collective human food poisonings by clenbuterol residues in veal liver

Twenty-two patients were reported to complain of tremor, headaches, tachycardia and dizziness 1-3 h after eating veal liver. As clinical symptoms were not suggestive of an infectious cause, the presence of veterinary drug residues was suspected. Clenbuterol, a beta 2-agonist, was being illegally used in cattle because of its anabolizing properties and may explain the observed effects. Assays of clenbuterol in samples of veal liver showed concentrations of 0.375 and 0.500 micrograms/g. To our knowledge, this is one of the first reports of clinical symptoms in humans associated with the consumption of veterinary drug residue-containing food.

Food poisoning outbreaks associated with manufactured foods in England and Wales: 1980-1989

In the ten-year period, 1980-89, 294 reported outbreaks of food poisoning were associated with eating pre-cooked sliced meats, meat products and other manufactured foods in England and Wales, including 65 outbreaks in which the product was imported. Salmonellas were the most commonly reported agent, causing 132 (45%) of the outbreaks; other bacteria caused a further 51 (17%) outbreaks. The remainder were due to viruses (five outbreaks), scombrotoxin (60 outbreaks), or were of unknown cause (46 outbreaks). The number of outbreaks associated with manufactured foods accounted for only a small proportion (less than 5%) of food poisoning outbreaks reported to CDSC during this period and needs to be set against the huge amounts of manufactured foods consumed. However, because of the quantities made and the widespread distribution of particular products, such outbreaks may affect many individuals who are geographically widespread.

An outbreak of Escherichia coli O157:H7 colitis associated with consumption of precooked meat patties

An outbreak of Escherichia coli O157:H7 hemorrhagic colitis at a Minnesota junior high school in October 1988 comprised 32 cases among 1562 students (attack rate, 2.0%). Four children were hospitalized; none developed hemolytic-uremic syndrome. Case children were more likely than controls to have eaten heat-processed meat patties (odds ratio, 6.2; 95% confidence interval, 2.0-20.1; P less than .001) in the school cafeteria on a specific day. The minimum estimated attack rate among students who ate these patties was 8%. The patties should have been sufficiently cooked by the manufacturer to destroy enteric pathogens before they were frozen and distributed. E. coli were cultured from frozen patties that were manufactured at the same plant on the same dates as the implicated patties, but serotype O157:H7 was not isolated. Heat-processed meat patties may serve as vehicles for E. coli O157:H7 infection, and currently there are no federal or state regulatory standards to ensure the safety of these products.