Risk factors for Salmonella typhimurium DT104 and non-DT104 infection: a Canadian multi-provincial case-control study

Mānuka Oil vs. Rosemary Oil: Antimicrobial Efficacies in Wagyu and Commercial Beef against Selected Pathogenic Microbes

Essential oils possessing antimicrobial characteristics have acquired considerable interest as an alternative to chemical preservatives in food products. This research hypothesizes that mānuka (MO) and kānuka (KO) oils may possess antimicrobial characteristics and have the potential to be used as natural preservatives for food applications. Initial experimentation was conducted to characterize MOs (with 5, 25, and 40% triketone contents), rosemary oil (RO) along with kanuka oil (KO) for their antibacterial efficacy against selected Gram-negative (Salmonella spp. and Escherichia coli), and Gram-positive (Listeria monocytogenes and Staphylococcus aureus) bacteria through disc diffusion and broth dilution assays. All MOs showed a higher antimicrobial effect against L. monocytogenes and S. aureus with a minimum inhibitory concentration below 0.04%, compared with KO (0.63%) and RO (2.5%). In chemical composition, α-pinene in KO, 1, 8 cineole in RO, calamenene, and leptospermone in MO were the major compounds, confirmed through Gas-chromatography-mass spectrometry analysis. Further, the antimicrobial effect of MO and RO in vacuum-packed beef pastes prepared from New Zealand commercial breed (3% fat) and wagyu (12% fat) beef tenderloins during 16 days of refrigerated storage was compared with sodium nitrate (SN) and control (without added oil). In both meat types, compared with the SN-treated and control samples, lower growth of L. monocytogenes and S. aureus in MO- and RO- treated samples was observed. However, for Salmonella and E. coli, RO treatment inhibited microbial growth most effectively. The results suggest the potential use of MO as a partial replacement for synthetic preservatives like sodium nitrate in meats, especially against L. monocytogenes and S. aureus.

A case-case study comparing the individual risk factors and symptomatology of Salmonella Heidelberg and Salmonella Typhimurium in Ontario in 2015, following implementation of the Ontario Investigation Tools

Salmonella Heidelberg and Salmonella Typhimurium are among the most common serotypes responsible for human salmonellosis in Ontario. Introduction of the Ontario Investigation Tools (OIT) in 2014 allowed for standardized case investigation and reporting. This study compared the risk factors and symptomatology for sporadic S. Heidelberg and S. Typhimurium cases reported in Ontario in 2015, following implementation of the OIT. Multilevel logistic regression models were applied to assess associations between serotype and individual-level demographic characteristics, exposures and symptoms for sporadic confirmed cases of S. Heidelberg and S. Typhimurium in Ontario in 2015. There were 476 sporadic cases of S. Typhimurium (n = 278) and S. Heidelberg (n = 198) reported in Ontario in 2015. There were significant associations between the odds of the isolate from a case being one of these serotypes, and travel, consumption of sprouts (any type), contact with reptiles and development of malaise, fever or bloody diarrhoea. The S. Typhimurium and S. Heidelberg cases differed in both symptom presentation and risk factors for illness. Case-case comparisons of Salmonella serotypes have some advantages over case-control studies in that these are less susceptible to selection and recall bias while allowing for rapid comparison of cases to identify potential high-risk exposures that are unique to one of the serotypes when compared to the other. Comparing cases of two different Salmonella serotypes can help to highlight risk factors that may be uniquely associated with one serotype, or more strongly associated with one serotype compared to another. This information may be useful for understanding relative source attribution between common serotypes of Salmonella.

Lactobacillus johnsonii L531 ameliorates enteritis via elimination of damaged mitochondria and suppression of SQSTM1-dependent mitophagy in a Salmonella infantis model of piglet diarrhea

Newly weaned piglets challenged with Salmonella infantis were particularly susceptible, whereas oral preadministration of Lactobacillus johnsonii L531 alleviated enteritis and promoted intestinal secretory IgA production. Salmonella infantis-induced activation of NLRC4 and NLRP3 inflammasomes and (nuclear factor kappa B) NF-κB signaling in the small intestine was also inhibited by L. johnsonii L531 pretreatment, thus limiting inflammation. An IPEC-J2 cell model of S. infantis infection yielded similar results. Salmonella infantis infection also resulted in mitochondrial damage and impaired mitophagy in the ileum and IPEC-J2 cells, as demonstrated by immunofluorescence colocalization of mitochondria with microtubule-binding protein light chain 3 (LC3) and high expression of autophagy-related proteins PTEN-induced putative kinase 1 (PINK1), sequestosome 1 (SQSTM1/p62), optineurin (OPTN), and LC3 by Western blotting analysis. However, L. johnsonii L531 pretreatment reduced both the extent of mitochondrial damage and autophagy-related protein expression. Our findings suggest that the amelioration of S. infantis-associated enteritis by L. johnsonii L531 is associated with regulation of NLRC4 and NLRP3 inflammasomes and NF-κB signaling pathway activation and suppression of mitochondrial damage. Amelioration of impaired mitophagy by L. johnsonii L531 could involve eliminating damaged mitochondria and regulating S. infantis-induced activation of the NF-κB-SQSTM1mitophagy signaling pathway in host cells to prevent the further mitochondrial damage and S. infantis dissemination.

Increasing Frequencies of Antibiotic Resistant Non-typhoidal Salmonella Infections in Michigan and Risk Factors for Disease

Non-typhoidal Salmonella (NTS) are important enteric pathogens causing over 1 million foodborne illnesses in the U.S. annually. The widespread emergence of antibiotic resistance in NTS isolates has limited the availability of antibiotics that can be used for therapy. Since Michigan is not part of the FoodNet surveillance system, few studies have quantified antibiotic resistance frequencies and identified risk factors for NTS infections in the state. We obtained 198 clinical NTS isolates via active surveillance at four Michigan hospitals from 2011 to 2014 for classification of serovars and susceptibility to 24 antibiotics using broth microdilution. The 198 isolates belonged to 35 different serovars with Enteritidis (36.9%) predominating followed by Typhimurium (19.5%) and Newport (9.7%), though the proportion of each varied by year, residence, and season. The number of Enteritidis and Typhimurium cases was higher in the summer, while Enteritidis cases were significantly more common among urban vs. rural residents. A total of 30 (15.2%) NTS isolates were resistant to ≥1 antibiotic and 15 (7.5%) were resistant to ≥3 antimicrobial classes; a significantly greater proportion of Typhimurium isolates were resistant compared to Enteritidis isolates and an increasing trend in the frequency of tetracycline resistance and multidrug resistance was observed over the 4-year period. Resistant infections were associated with longer hospital stays as the mean stay was 5.9 days for patients with resistant isolates relative to 4.0 days for patients infected with susceptible isolates. Multinomial logistic regression indicated that infection with serovars other than Enteritidis [Odds ratio (OR): 3.8, 95% confidence interval (CI): 1.23-11.82] as well as infection during the fall (OR: 3.0; 95% CI: 1.22-7.60) were independently associated with resistance. Together, these findings demonstrate the importance of surveillance, monitoring resistance frequencies, and identifying risk factors that can aid in the development of new prevention strategies.

Divergent geography of Salmonella Wangata and Salmonella Typhimurium epidemiology in New South Wales, Australia

Salmonella enterica serovar Wangata is an important cause of salmonellosis in the state of New South Wales, Australia. Standard surveillance has not identified a common food source and cases have been attributed to an unknown environmental or wildlife reservoir. Investigation of the spatial distribution of cases may provide valuable insights into local risk factors for infection and the potential role of the environment and wildlife.

Using conditional autoregressive analysis, we explored the association between laboratory-confirmed cases of S. Wangata reported to the New South Wales Department of Health and human socio-demographic, climate, land cover and wildlife features. For comparison, a model was also fitted to investigate the association of cases of Salmonella enterica serovar Typhimurium, an established foodborne serotype, with the same features. To determine if cases of S. Wangata were associated with potential wildlife reservoir species, additional variables were included in the S. Wangata model that indicated areas of high suitability for each species.

We found that cases of S. Wangata were associated with warmer temperatures, proximity to wetlands and amphibian species richness. In contrast, cases of S. Typhimurium were associated with human demographic features (proportion of the population comprising children <5 years old), climate (mean annual precipitation and mean annual temperature) and land cover (proportion comprising urban and evergreen broadleaf forest). These findings support the hypothesis that S. Wangata is likely to be associated with an environmental source. Whilst we expected S. Typhimurium to be associated with the human socio-demographic feature, the significance of the land cover features was surprising and might suggest the epidemiology of S. Typhimurium in Australia is more complex than currently understood.

The role of domestic reservoirs in domestically acquired Salmonella infections in Norway: epidemiology of salmonellosis, 2000-2015, and results of a national prospective case-control study, 2010-2012

In Norway, incidence of sporadic domestically acquired salmonellosis is low, and most frequently due to Salmonalla Typhimurium. We investigated the risk factors for sporadic Salmonella infections in Norway to improve control and prevention measures. Surveillance data for all Salmonella infections from 2000 to 2015 were analysed for seasonality and proportion associated with domestic reservoirs, hedgehogs and wild birds. A prospective case–control study was conducted from 2010 to 2012 by recruiting cases from the Norwegian Surveillance System for Communicable Diseases and controls from the Norwegian Population Registry (389 cases and 1500 controls). Univariable analyses using logistic regression were conducted and a multivariable model was developed using regularised/penalised logistic regression. In univariable analysis, eating snow, dirt, sand or playing in a sandbox (aOR 4.14; CI 2.15–7.97) was associated with salmonellosis. This was also the only exposure significantly associated with illness in the multivariable model. Since 2004, 34.2% (n = 354) of S. Typhimuirum cases had an MLVA profile linked to a domestic reservoir. A seasonal trend with a peak in August for all Salmonella types and in February for S. Typhimurium was observed. Indirect exposure to domestic reservoirs remains a source of salmonellosis in Norway, particularly for children. Information to the public about avoiding environmental exposure should be strengthened and initiatives to combat salmonellosis in the food chain should be reinforced.

Identification of Biological Hazards in Produce Consumed in Industrialized Countries: A Review

Microbial contamination of fresh produce (fresh fruits and vegetables) poses serious public health concerns worldwide. This study was conducted as a comprehensive analysis of biological hazards in the global fresh produce chain. Data about produce-related outbreaks and illness were collected from the annual reports and databases of foodborne outbreak surveillance systems in different regions and countries from 2010 to 2015. The global patterns of and regional differences in documented outbreaks and cases were analyzed, and produce commodities and pathogens of greatest concern were identified. Data on sporadic illnesses were also collected through a comprehensive literature review of case-control studies. We found 988 produce-related outbreaks (with known agents) and 45,723 cases in all regions and countries. The numbers of produce-related outbreaks per million person-years were approximately 0.76, 0.26, 0.25, 0.13, 0.12, and 0.05 in New Zealand, Australia, the United States, the European Union, Canada, and Japan, respectively. The top three food categories and pathogens contributing to produce-related outbreaks were vegetables and nonfruits (i.e., food other than fruits; 27.0%), unspecified vegetables (12.2%), and vegetable row crops (11.7%) and norovirus (42.4%), Salmonella enterica (19.9%), and Staphylococcus aureus (7.9%), respectively. Produce consumption was identified as a protective factor, a risk factor, and either a protective or risk factor for sporadic illnesses in 11, 5, and 5 studies, respectively, among 21 case-control studies. Risks associated with produce consumption in the United States and the European Union have been linked to various factors such as irrigation water, cross-contamination, storage time and temperature abuse, infected food handlers, and unprocessed contaminated ingredients. The results of the current study indicate the complexity of produce products consumed across the globe and the difficulty in tracing illnesses back to specific food ingredients.

Goblet cell associated antigen passages are inhibited during Salmonella typhimurium infection to prevent pathogen dissemination and limit responses to dietary antigens

Dietary antigen acquisition by lamina propria (LP) dendritic cells (DCs) is crucial to induce oral tolerance and maintain homeostasis. However, encountering innocuous antigens during infection can lead to inflammatory responses, suggesting processes may limit steady-state luminal antigen capture during infection. We observed that goblet cell (GC) associated antigen passages (GAPs), a steady-state pathway delivering luminal antigens to LP-DCs, are inhibited during Salmonella infection. GAP inhibition was mediated by IL-1β. Infection abrogated luminal antigen delivery and antigen-specific T cell proliferation in the mesenteric lymph node (MLN). Antigen-specific T cell proliferation to dietary antigen was restored by overriding GAP suppression; however, this did not restore regulatory T cell induction, but induced inflammatory T cell responses. Salmonella translocation to the MLN required GCs and correlated with GAPs. Genetic manipulations overriding GAP suppression, or antibiotics inducing colonic GAPs, but not antibiotics that do not, increased dissemination and worsened outcomes independent of luminal pathogen burden. Thus, steady-state sampling pathways are suppressed during infection to prevent responses to dietary antigens, limit pathogen entry, and lessen the disease. Moreover, antibiotics may worsen Salmonella infection by means beyond blunting gut microbiota colonization resistance, providing new insight into how precedent antibiotic use aggravates enteric infection.

Enhancement of IFNγ Production by Distinct Commensals Ameliorates Salmonella-Induced Disease

The microbiota contributes to colonization resistance against invading pathogens by competing for metabolites, producing inhibitory substances, and priming protective immune responses. However, the specific commensal bacteria that promote host resistance and immune-mediated protection remain largely elusive. Using isogenic mouse lines with distinct microbiota profiles, we demonstrate that severity of disease induced by enteric Salmonella Typhimurium infection is strongly modulated by microbiota composition in individual lines. Transferring a restricted community of cultivable intestinal commensals from protected into susceptible mice decreases S. Typhimurium tissue colonization and consequently disease severity. This reduced tissue colonization, along with ameliorated weight loss and prolonged survival, depends on microbiota-enhanced IFNγ production, as IFNγ-deficient mice do not exhibit protective effects. Innate cells and CD4⁺ T cells increase in number and show high levels of IFNγ after transfer of the commensal community. Thus, distinct microbiota members prevent intestinal Salmonella infection by enhancing antibacterial IFNγ responses.

Sporadic salmonellosis in Lower Saxony, Germany, 2011-2013: raw ground pork consumption is associated with Salmonella Typhimurium infections and foreign travel with Salmonella Enteritidis infections

To investigate risk factors for sporadic salmonellosis, for each notified case four randomly selected population controls matched for age, sex and geographical region were interviewed via self-administered questionnaire. Conditional logistic regression analysis of 285 matched pairs revealed significant associations for raw ground pork consumption [odds ratio (OR) 6·0, 95% confidence interval (CI) 1·8-20·1], taking antacids (OR 5·8, 95% CI 1·4-24·5), eating meat outside the home (OR 5·7, 95% CI 2·2-14·6) and daily changing or cleaning of dishcloth (OR 2·1, 95% CI 1·2-3·9). Animal contact and ice cream consumption were negatively associated with salmonellosis (OR 0·5, 95% CI 0·2-1 and OR 0·3, 95% CI 0·1-0·6, respectively). S. Typhimurium infections were significantly associated with raw ground pork consumption (OR 16·7, 95% CI 1·4-194·4) and S. Enteritidis infections with having travelled abroad (OR 9·7, 95% CI 2·0-47·3). Raw egg consumption was not a risk factor, substantiating the success of recently implemented national control programmes in the poultry industry. Unexpectedly, hygienic behaviour was more frequently reported by cases, probably because they overestimated their hygiene precautions retrospectively. Although animal contact might enhance human immunocompetence, underreporting of salmonellosis by pet owners could have occurred. Eating raw pork products is the major risk factor for sporadic human S. Typhimurium infections in Lower Saxony.

Risk factors for sporadic Vibrio parahaemolyticus gastroenteritis in east China: a matched case-control study

SUMMARY To determine risk factors for sporadic Vibrio parahaemolyticus gastroenteritis, we conducted a population-based case-control study in sentinel hospital surveillance areas of Shanghai and Jiangsu province, China. Seventy-one patients with diarrhoea and confirmed V. parahaemolyticus infections were enrolled, and they were matched with 142 controls for gender, age and residential area. From the multivariable analysis, V. parahaemolyticus infections were associated with antibiotics taken during the 4 weeks prior to illness [odds ratio (OR) 7·6, 95% confidence interval (CI) 1·1–54·4)], frequent eating out (OR 3·3, 95% CI 1·0–10·4), and shellfish consumption (OR 3·4, 95% CI 1·0–11·1), with population-attributable fractions of 0·09, 0·24, and 0·14, respectively. Protective factors included keeping the aquatic products refrigerated (OR 0·4, 95% CI 0·2–1·0) and pork consumption (OR 0·2, 95% CI 0·1–0·9) [corrected] .

Risk factors for human salmonellosis originating from pigs, cattle, broiler chickens and egg laying hens: a combined case-control and source attribution analysis

Several case-control studies have investigated risk factors for human salmonellosis while others have used Salmonella subtyping to attribute human infections to different food and animal reservoirs. This study combined case-control and source attribution data into a single analysis to explore risk factors at the point of exposure for human salmonellosis originating from four putative food-producing animal reservoirs (pigs, cattle, broilers and layers/eggs) in the Netherlands. We confirmed that most human cases (∼90%) were attributable to layers/eggs and pigs. Layers/eggs and broilers were the most likely reservoirs of salmonellosis in adults, in urban areas, and in spring/summer, whereas pigs and cattle were the most likely reservoirs of salmonellosis in children, in rural areas, and in autumn/winter. Several reservoir-specific risk factors were identified. Not using a chopping board for raw meat only and consuming raw/undercooked meat were risk factors for infection with salmonellas originating from pigs, cattle and broilers. Consuming raw/undercooked eggs and by-products were risk factors for layer/egg-associated salmonellosis. Using antibiotics was a risk factor for pig- and cattle-associated salmonellosis and using proton-pump inhibitors for salmonellosis attributable to any reservoir. Pig- and cattle-associated infections were also linked to direct contact with animals and environmental exposure (e.g. playing in sandboxes). Eating fish, meat in pastry, and several non-meat foods (fruit, vegetables and pasteurized dairy products) were protective factors. Consuming pork and occupational exposure to animals and/or raw meats were protective against layer/egg-associated salmonellosis. We concluded that individuals acquiring salmonellosis from different reservoirs have different associated risk factors, suggesting that salmonellas may infect humans through various transmission pathways depending on their original reservoirs. The outcome of classical case-control studies can be enhanced by incorporating source attribution data and vice versa.

Case-control studies of sporadic enteric infections: a review and discussion of studies conducted internationally from 1990 to 2009

Epidemiologists have used case-control studies to investigate enteric disease outbreaks for many decades. Increasingly, case-control studies are also used to investigate risk factors for sporadic (not outbreak-associated) disease. While the same basic approach is used, there are important differences between outbreak and sporadic disease settings that need to be considered in the design and implementation of the case-control study for sporadic disease. Through the International Collaboration on Enteric Disease "Burden of Illness" Studies (the International Collaboration), we reviewed 79 case-control studies of sporadic enteric infections caused by nine pathogens that were conducted in 22 countries and published from 1990 through to 2009. We highlight important methodological and study design issues (including case definition, control selection, and exposure assessment) and discuss how approaches to the study of sporadic enteric disease have changed over the last 20 years (e.g., making use of more sensitive case definitions, databases of controls, and computer-assisted interviewing). As our understanding of sporadic enteric infections grows, methods and topics for case-control studies are expected to continue to evolve; for example, advances in understanding of the role of immunity can be used to improve control selection, the apparent protective effects of certain foods can be further explored, and case-control studies can be used to provide population-based measures of the burden of disease.

Review of Canadian literature to estimate risks associated with Salmonella in broilers from retail to consumption in Canadian homes

The objective was to review the literature related to the risk of salmonellosis from chicken consumed in private homes in Canada. The pathway of concern was retail-to-consumption at private homes due to the direct link between this pathway and public health. A qualitative review was conducted by searching Canadian governmental agencies' webpages, published peer-reviewed journals, and by contacting experts in the field. Overall, with the data available, estimating risk from Salmonella in chicken breasts using only Canadian information was limited. Enumeration data for Salmonella in retail raw chicken at different regions across Canada are needed to be able to generalize the risk of salmonellosis in the Canadian population. Few Canadian surveys were found to describe consumers' food safety behaviors at Canadians' private homes. Observational designs to study food safety practices and Canadian consumers' behavior in private kitchens are needed to ensure that consumer behavior is consistent with consumer perceptions of their behavior. The results of such studies will give valuable input for designing educational programs needed to increase awareness of safe food handling practices by Canadian consumers when preparing food at their homes.

Risk factors for salmonella gastroenteritis in children less than five years of age in Taiwan

BACKGROUND

Nontyphoid Salmonella spp. have been among the most common pathogens of acute gastroenteritis in children in Taiwan. However, the principal sources of transmission remain poorly defined.

METHODS

A matched case-control study was conducted from January 2009 to October 2010. Cases were children aged 2-60 months who were hospitalized at 3 medical centers in Taiwan because of diarrhea and found to have culture-proven nontyphoidal Salmonella infection. Controls were healthy children or children with acute diseases other than gastroenteritis and matched to cases by age, gender, study site and enrollment date.

RESULTS

A total of 396 cases and 930 matched controls were included for analysis. Multivariate analysis using conditional logistic regression identified contact with household members having diarrhea (matched odds ratio [mOR], 17.9; 95% confidence interval [CI]: 8.82-36.34; P < 0.0001), consumption of instant powdered milk (mOR, 2.04; 95% CI: 1.05-3.94; P = 0.0344), visits to health-care facilities (mOR, 1.66; 95% CI: 1.12-2.48; P = 0.0126) and consumption of purchased groundwater (mOR, 1.50; 95% CI: 1.06-2.11; P = 0.0214) within 1 week preceding enrollment as independent factors associated with increased risk of salmonellosis. Hand washing before meals (P = 0.0311), breastfeeding (P = 0.0370), consumption of chicken (P = 0.0019) and consumption of food prepared by caregivers (P = 0.0011) were protective against Salmonella infection.

CONCLUSIONS

The principal transmission routes of Salmonella infection in Taiwanese children are person-to-person, waterborne and environmental contacts. The possibility of powdered milk and groundwater contamination of Salmonella cannot be excluded and requires further investigation.

Risk factors associated with sporadic salmonellosis in adults: a case-control study

In order to identify and assess recent risk factors for sporadic human infections with Salmonella enterica, we conducted a case-control study in Lower Saxony, Germany. The data collection was based on standardized telephone interviews with 1017 cases and 346 controls aged >14 years. Odds ratios were calculated in single-factor and multi-factor analyses for Salmonella cases and two different control groups, i.e. population controls and controls with rotavirus infection. Multi-factor analysis revealed associations between sporadic Salmonella infections for two exposures by both sets of controls: consumption of raw ground pork [adjusted odds ratio (aOR) 2·38, 95% confidence interval (CI) 1·27-4·44] and foreign travel (aOR 2·12, 95% CI 1·00-4·52). Other exposures included consumption of food items containing eggs (aOR 1·43, 95% CI 0·80-2·54), consumption of chicken meat (aOR 1·77, 95% CI 1·26-2·50), outdoor meals/barbecues (aOR 3·96, 95% CI 1·41-11·12) and taking gastric acidity inhibitors (aOR 2·42, 95% CI 1·19-4·92), all were significantly associated with respect to one of the two control groups. The impact of consuming food items containing eggs or chicken meat was lower than expected from the literature. This might be a consequence of Salmonella control programmes as well as increased public awareness of eggs and chicken products being a risk factor for salmonellosis. Efforts to reduce Salmonella infections due to raw pork products should be intensified.

Source attribution of human salmonellosis using a meta-analysis of case-control studies of sporadic infections

Salmonella is an important cause of human illness. Disease is frequently associated with foodborne transmission, but other routes of exposure are recognized. Identifying sources of disease is essential for prioritizing public health interventions. Numerous case-control studies of sporadic salmonellosis have been published, often using different methodologies and settings. Systematic reviews consist of a formal process for literature review focused on a research question. With the objective of identifying the most important risk factors for salmonellosis, we performed a systematic review of case-control studies and a meta-analysis of obtained results. Thirty-five Salmonella case-control studies were identified. In the meta-analysis, heterogeneity between studies and possible sources of bias were investigated, and pooled odds ratios estimated. Results suggested that travel, predisposing factors, eating raw eggs, and eating in restaurants were the most important risk factors for salmonellosis. Sub-analyses by serotype were performed when enough studies were available.

The microbiota mediates pathogen clearance from the gut lumen after non-typhoidal Salmonella diarrhea

Many enteropathogenic bacteria target the mammalian gut. The mechanisms protecting the host from infection are poorly understood. We have studied the protective functions of secretory antibodies (sIgA) and the microbiota, using a mouse model for S. typhimurium diarrhea. This pathogen is a common cause of diarrhea in humans world-wide. S. typhimurium (S. tm^att, sseD) causes a self-limiting gut infection in streptomycin-treated mice. After 40 days, all animals had overcome the disease, developed a sIgA response, and most had cleared the pathogen from the gut lumen. sIgA limited pathogen access to the mucosal surface and protected from gut inflammation in challenge infections. This protection was O-antigen specific, as demonstrated with pathogens lacking the S. typhimurium O-antigen (wbaP, S. enteritidis) and sIgA-deficient mice (TCRβ^−/−δ^−/−, J_H^−/−, IgA^−/−, pIgR^−/−). Surprisingly, sIgA-deficiency did not affect the kinetics of pathogen clearance from the gut lumen. Instead, this was mediated by the microbiota. This was confirmed using ‘L-mice’ which harbor a low complexity gut flora, lack colonization resistance and develop a normal sIgA response, but fail to clear S. tm^att from the gut lumen. In these mice, pathogen clearance was achieved by transferring a normal complex microbiota. Thus, besides colonization resistance ( = pathogen blockage by an intact microbiota), the microbiota mediates a second, novel protective function, i.e. pathogen clearance. Here, the normal microbiota re-grows from a state of depletion and disturbed composition and gradually clears even very high pathogen loads from the gut lumen, a site inaccessible to most “classical” immune effector mechanisms. In conclusion, sIgA and microbiota serve complementary protective functions. The microbiota confers colonization resistance and mediates pathogen clearance in primary infections, while sIgA protects from disease if the host re-encounters the same pathogen. This has implications for curing S. typhimurium diarrhea and for preventing transmission.

Numerous pathogens infect the gut. Protection against these infections is mediated by mucosal immune defenses including secreted IgA as well as by the competing intestinal microbiota. However, so far the relative importance of these two different defense mechanisms remains unclear. We addressed this question using the example of non-typhoidal Salmonella (NTS) gut infections which can be spread in stool of infected patients over long periods of time. We used a mouse model to reveal that the intestinal microbiota and the adaptive immune system hold different but complementary functions in fighting NTS infections. A primary Salmonella infection disrupts the normal microbiota and elicits Salmonella-specific sIgA. sIgA prevents disease when the animal is infected with NTS for a second time. However, sIgA was dispensable for pathogen clearance from the gut. Instead, this was mediated by the microbiota. By re-establishing its normal density and composition, the microbiota was necessary and sufficient for terminating long-term fecal Salmonella excretion. This establishes a novel paradigm: The microbiota clears the pathogen from the gut lumen, while sIgA protects from disease upon re-infection with the same pathogen. This has implications for the evolutionary role of sIgA responses as well as for developing microbiota-based therapies for curing infected patients.

Matching criteria in case-control studies in the field of antimicrobial resistance

OBJECTIVE

We evaluated the available evidence from case-control studies in the field of antimicrobial resistance to identify the degree that matching was performed and the criteria used to do so.

METHODS

We performed a systematic search of the PubMed database (articles archived by 08/2006) to identify relevant studies. Studies that used the individual matching technique were further analyzed.

RESULTS

115 case-control studies with a focus on antimicrobial resistance were identified: 28 regarding Acinetobacter baumannii, 25 regarding Pseudomonas aeruginosa, and 62 for other bacteria. Individual matching was performed in 32 (27.8%) out of the 115 studies. Age was the most frequently used matching criterion in 22 of 32 (69%) evaluated matched case-control studies, while sex was used in 11 (34%), presence of underlying illness in 8 (25%), site of infection in 5 (16%), and area of residence in 4 studies (12.5%). Other criteria were used in less than 10% of the studies. Analysis of data for matched pairs was performed in 18 of 32 (56.3%) studies that used a matched case-control design.

DISCUSSION

The available evidence from the analyzed data from case-control studies in the field of antimicrobial resistance shows that individual matching is employed only in a proportion of such studies and only for a few characteristics, when it was used. Also, analysis for matched pairs was not used by almost a half of the relevant studies.

Microbe sampling by mucosal dendritic cells is a discrete, MyD88-independent step in DeltainvG S. Typhimurium colitis

Intestinal dendritic cells (DCs) are believed to sample and present commensal bacteria to the gut-associated immune system to maintain immune homeostasis. How antigen sampling pathways handle intestinal pathogens remains elusive. We present a murine colitogenic Salmonella infection model that is highly dependent on DCs. Conditional DC depletion experiments revealed that intestinal virulence of S. Typhimurium SL1344 ΔinvG mutant lacking a functional type 3 secretion system-1 (ΔinvG)critically required DCs for invasion across the epithelium. The DC-dependency was limited to the early phase of infection when bacteria colocalized with CD11c⁺CX3CR1⁺ mucosal DCs. At later stages, the bacteria became associated with other (CD11c⁻CX3CR1⁻) lamina propria cells, DC depletion no longer attenuated the pathology, and a MyD88-dependent mucosal inflammation was initiated. Using bone marrow chimeric mice, we showed that the MyD88 signaling within hematopoietic cells, which are distinct from DCs, was required and sufficient for induction of the colitis. Moreover, MyD88-deficient DCs supported transepithelial uptake of the bacteria and the induction of MyD88-dependent colitis. These results establish that pathogen sampling by DCs is a discrete, and MyD88-independent, step during the initiation of a mucosal innate immune response to bacterial infection in vivo.

[Risk factors for the occurrence of sporadic Campylobacter, Salmonella and rotavirus diarrhea in preschool children]

BACKGROUND

Sporadic cases of diarrhea in preschool children are highly frequent, especially those caused by rotavirus, Campylobacter and Salmonella. The aim of this study was to identify some of the factors associated with these processes.

MATERIAL AND METHODS

A case-control study of hospitalized incident cases aged less than 3 years old was performed. Questionnaires were administered at admission, before the results of stool tests were known. Susceptibility, food exposure, and environmental factors were investigated. Infants aged less than 1 year were analyzed separately.

RESULTS

A total of 117 patients (rotavirus in 31, Campylobacter in 228 and Salmonella in 21, negative results in 37) and 84 controls were studied. Several protective factors, such as breast feeding and prior antibiotic use, were identified. Risk factors for diarrhea were exposure to meat products (eating or environmental exposure in the kitchen), some kinds of pets, and attendance at day care. Differences were found by etiology and age. In the culture-negative group, no risk factors were identified.

CONCLUSION

The problems posed by epidemiological study of this issue are discussed. The main findings in each group of cases are interpreted and proposals are made for their application in the control and prevention of these diseases.

Epidemiology and risk factors for endemic typhoid fever in Uzbekistan

BACKGROUND

To investigate the risk factors for infection with endemic typhoid fever in the Samarkand region of Uzbekistan.

METHODS

Case-control study of culture-confirmed bloodstream infection with Salmonella Typhi. Patients were compared to age-matched community controls. Salmonella Typhi isolates were tested for antimicrobial susceptibility.

RESULTS

We enrolled 97 patients and 192 controls. The median age of patients was 19 years. In a conditional regression model, consumption of unboiled surface water outside the home [adjusted odds ratio (aOR)=3.0, 95% confidence interval (CI)=1.1-8.2], use of antimicrobials in the 2 weeks preceding onset of symptoms (aOR=12.2, 95% CI 4.0-37.0), and being a student (aOR=4.0, 95% CI 1.4-11.3) were independently associated with typhoid fever. Routinely washing vegetables (aOR 0.06, 95% CI 0.02-0.2) and dining at a tea-house (aOR 0.4, 95% CI 0.2-1.0) were associated with protection against illness. Salmonella Typhi resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole was identified in 6 (15%) of 41 isolates tested.

CONCLUSIONS

Endemic typhoid fever in Uzbekistan is transmitted by contaminated water. Recent use of antimicrobials also increased risk of infection. Targeted efforts at improving drinking water quality, especially for students and young adults, are likely to decrease transmission of typhoid fever. Measures to decrease the unnecessary use of antimicrobials would be expected to reduce the risk of typhoid fever and decrease the spread of multiple drug-resistant Salmonella Typhi.

Regional, seasonal, and antimicrobial resistance distributions of salmonella typhimurium in Canada: a multi-provincial study

BACKGROUND

This study was conducted to describe the geographical and seasonal distributions of reported human Salmonella Typhimurium (ST) definitive type 104 (DT104) cases, to compare these characteristics to those of non-DT1 04 cases, and to investigate specific antimicrobial resistance (AMR) patterns in four Canadian provinces.

METHODS

All laboratory-confirmed ST cases originating from passive reporting in Alberta, British Columbia, and Saskatchewan, and every second case in Ontario identified from December 1999 through November 2000 were investigated.

RESULTS

A total of 470 human Salmonella Typhimurium cases were identified during the study period. DT104 was the most common phage type, although its incidence varied by province. The proportion of DT104 cases living in urban Ontario, British Columbia and Saskatchewan did not differ from the general population, but in Alberta, the DT104 cases were more likely to live in rural areas. Overall, DT104 isolates were more often R-type ACSSuT compared to non-DT104 cases, and R-type AKSSuT was often associated with DT208. DT104 cases displayed no seasonality whereas non-DT104 cases were more frequent in the summer than in the winter.

INTERPRETATION

Our results suggest that DT104 and non-DT104 cases vary by province, urban vs. rural residential status and by resistance patterns. Lack of seasonality in the DT104 cases may indicate a lesser influence of the agro-environmental route (i.e., farm -manure - water and direct contact) compared to the agro-food route (i.e., farm - animals -food) for these infections. Strain characterization and integration of surveillance information related to ST from animal, food and humans is warranted.

Regional, seasonal, and antimicrobial resistance distributions of salmonella typhimurium in Canada: a multi-provincial study

BACKGROUND

This study was conducted to describe the geographical and seasonal distributions of reported human Salmonella Typhimurium (ST) definitive type 104 (DT104) cases, to compare these characteristics to those of non-DT1 04 cases, and to investigate specific antimicrobial resistance (AMR) patterns in four Canadian provinces.

METHODS

All laboratory-confirmed ST cases originating from passive reporting in Alberta, British Columbia, and Saskatchewan, and every second case in Ontario identified from December 1999 through November 2000 were investigated.

RESULTS

A total of 470 human Salmonella Typhimurium cases were identified during the study period. DT104 was the most common phage type, although its incidence varied by province. The proportion of DT104 cases living in urban Ontario, British Columbia and Saskatchewan did not differ from the general population, but in Alberta, the DT104 cases were more likely to live in rural areas. Overall, DT104 isolates were more often R-type ACSSuT compared to non-DT104 cases, and R-type AKSSuT was often associated with DT208. DT104 cases displayed no seasonality whereas non-DT104 cases were more frequent in the summer than in the winter.

INTERPRETATION

Our results suggest that DT104 and non-DT104 cases vary by province, urban vs. rural residential status and by resistance patterns. Lack of seasonality in the DT104 cases may indicate a lesser influence of the agro-environmental route (i.e., farm -manure - water and direct contact) compared to the agro-food route (i.e., farm - animals -food) for these infections. Strain characterization and integration of surveillance information related to ST from animal, food and humans is warranted.

Risk factors for Salmonella Enteritidis and Typhimurium (DT104 and non-DT104) infections in The Netherlands: predominant roles for raw eggs in Enteritidis and sandboxes in Typhimurium infections

Since 1996 Salmonella Typhimurium DT104 salmonellosis has increased in The Netherlands. This prompted a case-control study of risk factors for salmonellosis to inform transmission routes for this phage type. Cases were laboratory-confirmed patients with a Salmonella infection and controls were selected from population registries by frequency matching for age, sex, degree of urbanization and season. Cases and controls received a questionnaire on risk factors. Of the 1171 cases, 573 (49%) responded: 245 S. Enteritidis and 232 S. Typhimurium cases (both DT104 and non-DT104), of which 58 were DT104. Of the 10250 controls, 3409 (33%) responded. Use of H2 antagonists [odds ratio (OR) 4.4, 95% CI 1.6-12.2] and proton pump inhibitors (OR 4.2, 95% CI 2.2-7.9), consumption of raw eggs (OR 3.1, 95% CI 1.3-7.4) and products containing raw eggs (OR 1.8, 95% CI 1.1-3.0) were associated with endemic S. Enteritidis infection. Risk factors for endemic S. Typhimurium infection were use of proton pump inhibitors (OR 8.3, 95% CI 4.3-15.9), occupational exposure to raw meat (OR 3.0, 95% CI 1.1-7.9), playing in a sandbox (for children aged 4-12 years) (OR 2.4, 95% CI 1.6-3.7), consumption of undercooked meat (OR 2.2, 95% CI 1.1-4.1) and use of antibiotics (OR 1.9, 95% CI 1.0-3.4). Use of proton pump inhibitors (OR 11.2, 95% CI 3.9-31.9) and playing in a sandbox (OR 4.4, 95% CI 1.8-10.7) were the only risk factors for S. Typhimurium DT104 salmonellosis. This study confirms known risk factors for salmonellosis. However, playing in a sandbox was a predominant new risk factor for S. Typhimurium salmonellosis in children [population attributable risk (PAR) 14%], and especially for S. Typhimurium DT104 (PAR 32%).

A recurring salmonellosis epidemic in New Zealand linked to contact with sheep

One strain of Salmonella Brandenburg began causing large numbers of human infections in New Zealand in 1998. We investigated the emergence of this strain using combined notification and laboratory data on human and animal disease and a case-control study. S. Brandenburg infection in humans was characterized by spring peaks and high rates in the southern half of the South Island. This epidemic pattern followed very closely that seen in sheep. The case-control study found that infection was significantly associated with occupational contact with sheep and having a household member who had occupational contact with sheep, during the 3 days prior to illness or interview. We conclude that S. Brandenburg has become established as a zoonotic disease in New Zealand. Preventing infection requires control of the epidemic in sheep through vaccination, changes in farm management practices, and promotion of hand washing and other precautions to protect farmers and their families.

Emerging microbiological food safety issues related to meat

Avian influenza viruses and antibiotic-resistant pathogens have become topics of current public health interest. This paper will focus on the significance of these pathogens to the meat industry as well as other emerging microbiological food safety topics likely to impact the meat industry. These include surveillance of foodborne pathogens, microbial source tracking, risk assessment, and human populations at increased risk of infection by foodborne microbes. These emerging issues will likely lead to even greater challenges to producing microbiologically safe meat products than the industry has ever experienced. However, accompanying such challenges will be innovative solutions that provide even greater public health protection to meat-containing foods.

Salmonella enterica serovar Typhimurium pathogenicity island 2 is necessary for complete virulence in a mouse model of infectious enterocolitis

Salmonella species cause a wide range of disease in multiple hosts. Salmonella enterica serovar Typhimurium causes self-limited intestinal disease in humans and systemic typhoid-like illness in susceptible mice. The prevailing dogma in murine S. enterica serovar Typhimurium pathogenesis is that distinct virulence mechanisms-Salmonella pathogenicity islands 1 and 2 (SPI1 and SPI2)-perform distinct roles in pathogenesis, the former being important for invasion and intestinal disease and the latter important for intracellular survival and systemic persistence and disease. Although evidence from bovine infections has suggested that SPI2 has a role in ileal disease, there is no evidence that SPI2 is important for inflammation in a disease that more closely recapitulates human colitis. Using S. enterica serovar Typhimurium strains that lack functional type III secretion systems, we demonstrate that SPI2 is essential for complete virulence in murine infectious enterocolitis. Using a recently characterized murine model (M. Barthel,S. Hapfelmeier, L. Quintanilla-Martinez, M. Kremer, M. Rohde, M. Hogardt, K. Pfeffer, H. Russmann, and W. D. Hardt, Infect. Immun. 71:2839-2858, 2003), we demonstrate that SPI1 mutants are unable to cause intestinal disease 48 h after infection and that SPI2-deficient bacteria also cause significantly attenuated typhlitis. We show that at the peak of inflammation in the cecum, SPI2 mutants induce diminished intercellular adhesion molecule 1 expression and neutrophil recruitment but that wild-type and mutant Salmonella are similarly distributed in the lumen of the infected organ. Finally, we demonstrate that attenuation of intestinal inflammation is accompanied by resolution of typhlitis in the mutant, but not wild-type, infections. Collectively, these results indicate that SPI2 is needed for enterocolitis, as well as for systemic disease.