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      Entameoba histolytica, giardia and salmonella were isolated from
      patient stools by a local national military laboratory. Coliform
      organisms were cultured from the ice.
     
                g. October l99O, King Fahd: 100 cases of
      gastroenteritis presented in less than one week. The suspected
      source was green salad or salad serving utensils from an on-base
      USAF-supervised dining tent.
     
                h. October 1990, Riyadh: 400 cases of gastroenteritis
      presented in less than one week. Shigella sonnet was cultured
      from the stools of 15 patients. Green salads prepared in a USAF-
      supervised dining tent by third country nationals and served
      during a dinner meal were implicated as the source of infection
      by time-distribution curve.
     
                 i. November 1990, Cairo West: 15 cases presented over a
      three hour period with sudden onset of vomiting, prostration,
      abdominal cramping and diarrhea. A sanitation evaluation of the
      dining hall revealed no significant discrepancies. Leftover
      foods were shipped to NAMRU-6 (U.S. Navy laboratory) for
      analysis. Staphylococcus aureus enterotoxin was found in
      spaghetti and meat sauce.
     
               j. December 1990, Taif: 86 cases of gastroenteritis
     presented over a three day period, of which 79 were hospitalized.
     Medical management of these cases involved the temporary
     assignment from other ATHs of two auxiliary nursing teams. Most
     of the more seriously ill patients were transferred to a local
     national hospital along with four nurses, six medical
     technicians, two physicians, one diet therapist, and one
     laboratory technician. Salmonella, tyne O was cultured from 41
     of 48 patients in a local national hospital laboratory. Also,
     27% of patient stools reported contained Entameaba histolyica
     cysts. The suspected source was grossly contaminated (feces and
     feathers) raw eggs from an unapproved source which were served
     undercooked (soft-scrambled) for breakfast in a USAF-supervised
     dining facility. Ninety-seven percent of the ill patients had
     eaten eggs (other foods = 60-63%). Patients described the eggs
     as runny. The bottoms of the egg crates were contaminated with
     straw, feces and dirt. Approximately 201 of the eggs arrived
     cracked. Cracked eggs were not segregated and disposed of but
     rather were cooked and served. Although soiled with feces and
     feathers, no effort was made to wash the egg shells. Receipt
     inspection by EH had not been performed. Contracting and food
     service o~ficers were reportedly unaware of need to involve EH in
     the receipt inspection and approved source verification process.
     The dining facility handwashing stations for foodhandlers and
     patrons were inadequate and minimal use was made of those
     available. All eggs in remaining stock were subsequently
     destroyed. Approximately 400 m.an days or^ productivity were lost
     because of this outbreak.
     
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