Report FinalSummary FBIOutbreak 7.19.2023-Final

Final Summary of the Foodborne Outbreak Linked to Morel Mushrooms
Published Date: July 19, 2023
Over 50 individuals reported becoming sick with gastrointestinal (GI) symptoms after eating at Dave’s
Sushi in Bozeman, MT between March 28 and April 17, 2023. As previously reported, two of these
individuals died and three were hospitalized. Patrons who reported becoming ill were aged 18 to 74
years, and most individuals became ill within three hours following their meal at the restaurant.
Diarrhea, nausea, vomiting, and abdominal pain were among the most common symptoms of the
reported cases.
The Gallatin City-County Health Department (GCCHD) and the Montana Department of Public Health
and Human Services (MT DPHHS) were able to reach and interview 63 people who dined at the
restaurant during the dates in question. Of those, 41 were patrons who reported becoming ill after
dining at the restaurant (cases), and 22 were patrons who dined at the restaurant but did not become ill
(controls). An analysis of the interview findings was used to compare the menu items eaten by the two
groups and determine which food items were associated with illness. The public health departments
worked with the Centers for Disease Control and Prevention (CDC) to analyze the study results.
Study results indicated that consuming morel mushrooms at the restaurant was strongly associated with
developing GI illness. Additionally, individuals who reported consuming a greater quantity of sushi
containing morels were more likely to develop illness compared to those who reported consuming
fewer pieces.
MT DPHHS and GCCHD also worked with the U.S. Food and Drug Administration (FDA) to perform
testing on food samples. DNA sequencing was performed on the morel mushroom samples, and
identified the species as Morchella sextelata, a type of true morel. Samples of morel mushrooms
collected from the restaurant were also screened for pesticides, heavy metals, bacterial toxins, and
pathogens. No significant findings were identified.
The toxins in morel mushrooms that may cause illness are not fully understood. However, it is known
that using proper morel mushroom preparation techniques, including cooking, can help reduce toxicity
and risk of illness. According to documents provided by the restaurant, the morel mushrooms served
during March and April 2023 were prepared raw or only lightly cooked, depending on the date of
preparation.
A subset of the CDC analysis compared illness from dining at the restaurant on two dates: April 8, when
the morels reportedly underwent some cooking process by being marinated in a sauce immediately
after the sauce had been boiled, and April 17, when the morels were uncooked and marinated in a
sauce that had not been boiled. Consumption of morels on both dates was associated with developing
illness. However, consumption of morels was more strongly associated with developing illness on April
17, when the morels were reportedly prepared without any cooking process. Most individuals with
severe outcomes dined at the restaurant on April 17.
An FDA traceback investigation showed that restaurants in other states received morel mushrooms from
the same supplier during the same timeframe as Dave’s Sushi. A more thorough investigation into a
subset of these restaurants showed that all six of the restaurants interviewed reported cooking,
sautéing, or otherwise thoroughly heating the mushrooms before serving. None of the restaurants
reported receiving any consumer complaints associated with developing illness after eating morels at
the respective restaurant.
The findings of this investigation are subject to at least two limitations. First, this investigation could not
determine what specific characteristic of the morel mushrooms caused the outbreak. There may have
been differences in how the morel mushrooms were stored and prepared on April 8 and 17 that were
not identified through the outbreak investigation. Storage of the morel mushrooms, in addition to the
differences in cooking method described above, could have played a role in making people sick. Second,
the specific toxin or pathogen in the morel mushrooms served at the restaurant is unknown and could
not be confirmed through laboratory testing. However, the signs and symptoms of illness reported were
consistent with what could result from eating morel mushrooms that were not properly handled,
prepared, or cooked. There are scientific gaps in knowledge regarding morel mushrooms in the wider
public health, medical toxicology, and mycology realms that need further research in order to better
understand how morel mushrooms affect human health. Based on the strong epidemiological data,
morel mushrooms were the most likely cause of the outbreak but there may be other contributing
factors that were not identified during the investigation and that remain unknown.
Anyone eating, selling, or serving morel mushrooms should use caution when doing so. There are
varieties of poisonous wild mushrooms that look very similar to morel mushrooms.
Public health officials recommend those preparing morels should confirm the identity of each
mushroom, and consult with a knowledgeable expert, as poisonous species have been known to grow
near edible species in the wild. Choose mushrooms that are dry and firm, and avoid those that are
bruised, discolored, slimy, or otherwise spoiled. Morel mushrooms should be refrigerated at a
temperature of 40°F or below, in breathable type packaging, such as a paper bag. Morels should be
cooked thoroughly prior to consumption, as this is likely to reduce toxin levels present in the
mushrooms.
Individuals who become ill after consuming morels should contact their healthcare provider
immediately and/or call the Poison Control Hotline at 1-800-222-1222.
Publishing Entities:
Montana Department of Health and Human Services

Gallatin City-County Health Department

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Final Summary of the Foodborne Outbreak Linked to Morel Mushrooms

Published Date: July 19, 2023

Montana Department of Health and Human Services

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