An outbreak of Yersinia enterocolitica infections caused by contaminated tofu (soybean curd)

An Outbreak of Salmonella Typhimurium Infections Linked to Ready-To-Eat Tofu in Multiple Health Districts - Ontario, Canada, May-July 2021

From May to mid-August 2021, the Ontario, Canada provincial public health agency, Public Health Ontario, in collaboration with local public health authorities and federal food safety partners, investigated a spatiotemporal cluster of 38 patients with Salmonella Typhimurium infections across multiple public health districts in Ontario. Five (13%) patients were hospitalized; no deaths were reported. The outbreak was linked to consumption of ready-to-eat seasoned tofu from one manufacturer that was distributed to multiple Ontario restaurants. Isolates from the seasoned tofu were within one or fewer allele differences to the outbreak strain by whole genome sequencing. Evidence from food safety investigations conducted by local public health authorities and the Canadian Food Inspection Agency (CFIA) revealed that unsanitary conditions could have led to cross-contamination of the tofu, and insufficient heating of the tofu at the production level likely resulted in failure to eliminate the pathogen. The CFIA issued a food recall for the tofu at hotel, restaurant, and institution levels. Tofu was identified as a novel outbreak-associated food vehicle for S. Typhimurium in this outbreak. Interventions that target the production level and all parts of the supply chain and include additional safeguarding steps that minimize microbial growth are important.

Inactivation Kinetics and Membrane Potential of Pathogens in Soybean Curd Subjected to Pulsed Ohmic Heating Depending on Applied Voltage and Duty Ratio

The aim of this research was to investigate the efficacy of the duty ratio and applied voltage in the inactivation of pathogens in soybean curd by pulsed ohmic heating (POH). The heating rate of soybean curd increased rapidly as the applied voltage increased, although the duty ratio did not affect the temperature profile. We supported this result by verifying that electrical conductivity increased with the applied voltage. Escherichia coli O157:H7, Salmonella enterica serovar Typhimurium, and Listeria monocytogenes in soybean curd were significantly (P < 0.05) inactivated by more than 1 log unit at 80 Vrms (root mean square voltage). To elucidate the mechanism underlying these results, the membrane potential of the pathogens was examined using DiBAC4(3) [bis-(1,3-dibutylbarbituric acid)trimethine oxonol] on the basis of a previous study showing that the electric field generated by ohmic heating affected the membrane potential of cells. The values of DiBAC4(3) accumulation increased under increasing applied voltage, and they were significantly (P < 0.05) higher at 80 Vrms, while the duty ratio had no effect. In addition, morphological analysis via transmission electron microscopy showed that electroporation and expulsion of intracellular materials were predominant at 80 Vrms Moreover, electrode corrosion was overcome by the POH technique, and the textural and color properties of soybean curd were preserved. These results substantiate the idea that the applied voltage has a profound effect on the microbial inactivation of POH as a consequence of not only the thermal effect, but also the nonthermal effect, of the electric field, whereas the duty ratio does not have such an effect.IMPORTANCE High-water-activity food products, such as soybean curd, are vulnerable to microbial contamination, which causes fatal foodborne diseases and food spoilage. Inactivating microorganisms inside food is difficult because the transfer of thermal energy is slower inside than it is outside the food. POH is an adequate sterilization technique because of its rapid and uniform heating without causing electrode corrosion. To elucidate the electrical factors associated with POH performance in the inactivation of pathogens, the effects of the applied voltage and duty ratio on POH were investigated. In this study, we verified that a high applied voltage (80 Vrms) at a duty ratio of 0.1 caused thermal and nonthermal effects on pathogens that led to an approximately 4-log-unit reduction in a significantly short time. Therefore, the results of this research corroborate database predictions of the inactivation efficiency of POH based on pathogen control strategy modeling.

Evaluation of Cold Atmospheric Pressure Plasma (CAPP) and plasma-activated water (PAW) as alternative non-thermal decontamination technologies for tofu: Impact on microbiological, sensorial and functional quality attributes

The efficacy of Cold Atmospheric Pressure Plasma (CAPP) for the inactivation of Salmonella enterica serovar Enteritidis, Salmonella enterica serovar Typhimurium, Listeria monocytogenes and Escherichia coli O157:H7 on tofu was evaluated. The potential of using Plasma Activated Water (PAW) as an immersion solution for controlling microbial growth in tofu throughout its shelf-life was also investigated. The effects of these strategies on the physical and functional properties of treated tofu were also studied. CAPP treatment of tofu caused a limited inactivation of microbial populations, with log₁₀ reductions attained ranging from 0.2 to 0.6 log₁₀ for S. Enteritidis and E. coli O157:H7, respectively, after a 15 min treatment. CAPP did not affect tofu's water holding capacity, but it dried it and gave rise to changes in color and texture, which were reverted by immersing the treated product in distilled water. Refrigerated storage of tofu using PAW as an immersion solution was effective in controlling microbial growth. Thus, total counts obtained after 28 days of storage were around 3 log₁₀ units lower than those observed for tofu stored immersed in non-treated deionized water. In addition, this strategy led to a product with a higher functional value than thermally-treated commercial tofu, retaining up to 80% of the initial content of total polyphenols, with better texture properties, less hardness and springiness (approximately 20-30% lower) and with minor changes in its characteristic color. Overall, these results evidence that PAW is a promising non-thermal technology which can facilitate the control of pathogenic microorganisms on tofu while retaining its physical and functional properties.

The antimicrobial effect of thiamine dilauryl sulfate in tofu inoculated with Escherichia coli O157:H7, Salmonella Typhimurium, Listeria monocytogenes and Bacillus cereus

Thiamine dilauryl sulfate (TDS) is a food additive that is used as a bactericidal agent. This study examines the antimicrobial effect of TDS on tofu inoculated with Escherichia coli O157:H7, Salmonella Typhimurium, Listeria monocytogenes, and Bacillus cereus. Tofu was inoculated with 100 μL of each microorganism and TDS solution (0.1, 0.5, 1, and 2%) was added to all bags, which were stored at 5 and 25 °C for 5 days. Sensory evaluations were conducted with tofu stored at 5 °C. At 5 °C, with a 2% TDS, E. coli O157:H7, S. Typhimurium, L. monocytogenes, and B. cereus were reduced by 0.29, 0.36, 0.70, and 1.47 log CFU/g, respectively. None of the sensory characteristics of tofu treated with TDS were significantly different from those of the control. Consequently, this study shows the potential of TDS as an antimicrobial agent with a practical application in tofu to ensure food safety.

Detection of Yersinia enterocolitica in food: an overview

Yersinia enterocolitica is a gastrointestinal pathogen which causes yersiniosis, an illness characterized by diarrhea, ileitis, and mesenteric lymphadenitis. Y. enterocolitica is transmitted via the feco-oral route by the consumption of contaminated food or water. Several phenotypic and genotypic methods have been developed to reliably detect Y. enterocolitica in food. However, the source of infection of many recently reported foodborne outbreaks remains obscure. The detection of this pathogen in food is a challenging task, since it shares similarities with other enteric bacteria. The presence of other microorganisms in the food samples makes it even more difficult to identify this slow-growing pathogen. Therefore, the present-day emphasis is on the development of sensitive, easily automated methods suitable for in-situ detection, allowing quick and cost-effective characterization of food samples. This review summarizes and compares the currently available cultural, immunological, and molecular methods, particularly in relation to their specific merits or demerits when implemented for the detection of Y. enterocolitica in food.

Yersinia enterocoliticainfections associated with improperly pasteurized milk products: southwest Pennsylvania, March–August, 2011

In July 2011, a cluster ofYersinia enterocoliticainfections was detected in southwestern Pennsylvania, USA. We investigated the outbreak's source and scope in order to prevent further transmission. Twenty-two persons were diagnosed with yersiniosis; 16 of whom reported consuming pasteurized dairy products from dairy A. Pasteurized milk and food samples were collected from this dairy.Y. enterocoliticawas isolated from two products. Isolates from both food samples and available clinical isolates from nine dairy A consumers were indistinguishable by pulsed-field gel electrophoresis. Environmental and microbiological investigations were performed at dairy A and pasteurization deficiencies were noted. Because consumption of pasteurized milk is common and outbreaks have the potential to become large, public health interventions such as consumer advisories or closure of the dairy must be implemented quickly to prevent additional cases if epidemiological or laboratory evidence implicates pasteurized milk as the outbreak source.

Symptoms and sources of Yersinia enterocolitica-infection: a case-control study

Background

Yersinia enterocolitica (YE) is the causative agent of yersiniosis. YE encompass strains of diverse pathogenicity: YE biotypes 1B and 2-5 are considered pathogenic, whereas biotype 1A is in general considered nonvirulent. Also YE-like species, which can sometimes be misidentified as YE, are considered nonvirulent.

Methods

In order to study differences in clinical picture caused by different YE types and their possible sources a case-control study was conducted in 2006. In this case-control study, 295 case-patients with YE or YE-like finding and their 758 controls responded to the questionnaire about symptoms and possible sources of infection.

Results

Strains of pathogenic YE bio/serotypes 3-4/O:3 or 2/O:9 were found in 18%, YE biotype 1A in 65% and YE -like strains of 17% of the patients. Patients infected with the strains of pathogenic YE bio/serotypes were younger and had fever more often than those with BT 1A who suffered more from vomiting. Symptoms of reactive arthritis were reported by 10% of pathogenic YE infections, 3% of YE BT 1A, and 0.3% of the controls. Eating or tasting raw or medium done pork was a significant risk factor for pathogenic YE bio/serotype infection (OR 6.6; 95% CI 1.7-24.9) as well as eating in a canteen (OR 3.5; 95% CI 1.6-7.9). Imported fruits and berries were associated with increased risk of YE BT 1A finding.

Conclusions

The symptoms of the patients with YE BT 1A differed from yersiniosis caused by the classic pathogenic YE bio/serotypes. In addition, the patients with YE BT 1A had more protracted gastrointestinal disorders and unspecific complaints. Small children were overrepresented in classic pathogenic bio/serotypes while in BT 1A or YE-like species were not found among children younger than two years. This suggests the lacking virulence of the BT 1A strains. We can not, however, rule out the possibility that some strains of genetically heterogeneous group of BT 1A may cause an illness.

Gene and genome trees conflict at many levels

Horizontal gene transfer (HGT) plays a significant role in microbial evolution. It can accelerate the adaptation of an organism, it can generate new metabolic pathways and it can completely remodel an organism's genome. We examine 27 closely related genomes from the YESS group of gamma proteobacteria and a variety of four-taxon datasets from a diverse range of prokaryotes in order to explore the kinds of effects HGT has had on these organisms.

Sources of sporadic Yersinia enterocolitica infection in children in Sweden, 2004: a case-control study

Young children account for a large proportion of reported Yersinia enterocolitica infections in Sweden with a high incidence compared with other gastrointestinal infections, such as salmonellosis and campylobacteriosis. A case-control study was conducted to investigate selected risk factors for domestic sporadic yersiniosis in children aged 0–6 years in Sweden. In total, 117 cases and 339 controls were included in the study. To minimize exclusion of observations due to missing data a multiple non-parametric imputation technique was used. The following risk factors were identified in the multivariate analysis: eating food prepared from raw pork products (OR 3·0, 95% CI 1·8–5·1) or treated sausage (OR 1·9, 95% CI 1·1–3·3), use of a baby's dummy (OR 1·9, 95% CI 1·1–3·2) and contact with domestic animals (OR 2·0, 95% CI 1·2–3·4). We believe that the importance of Y. enterocolitica infection in children has been neglected and that results from this study can be used to develop preventive recommendations.

Relevance of N-acyl-L-homoserine lactone production by Yersinia enterocolitica in fresh foods

AIMS

Determination of the food matrix impact on the potential for N-acyl-L-homoserine lactones (AHLs) production by Yersinia enterocolitica.

METHODS AND RESULTS

Induction and inhibition of a sensor strain and a fluorescent assay were used to investigate Y. enterocolitica AHL production in artificial media, as well as in different food extracts. All Y. enterocolitica strains tested produced AHLs in artificial media. Thin Layer Chromatography analysis of Y. enterocolitica strains indicated the production of 3-oxo-hexanoyl homoserine lactone and hexanoyl homoserine lactone. Yersinia enterocolitica produced AHL principally in fish and meat extracts.

CONCLUSIONS

AHL production by Y. enterocolitica was observed in products of animal origin, but were inhibited by some vegetables extracts.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study suggests that quorum sensing systems in Y. enterocolitica is significant in foods but depends upon the type of food. Determination of physiological functions in Y. enterocolitica which are regulated by quorum sensing and their relation to the production of AHLs in foods need to be further assessed.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 2. Description of outbreaks by size, severity, and settings

This article is the second in a series of several by members of the Committee on the Control of Foodborne Illness of the International Association of Food Protection, and it continues the analysis of 816 outbreaks where food workers were implicated in the spread of foodborne disease. In this article, we discuss case morbidity and mortality and the settings where the 816 outbreaks occurred. Some of the outbreaks were very large; 11 involved more than 1,000 persons, 4 with more than 3,000 ill. The larger outbreaks tended to be extended over several days with a continuing source of infections, such as at festivals, resorts, and community events, or the contaminated product had been shipped to a large number of customers, e.g., icing on cakes or exported raspberries. There were five outbreaks with more than 100 persons hospitalized, with rates ranging from 9.9 to 100%. However, overall, the hospitalization rate was low (1.4%), and deaths were rare (0.11% of the 80,682 cases). Many of the deaths were associated with high-risk persons (i.e., those who had underlying diseases, malnutrition, or both, as in a refugee camp, or young children), but a few occurred with apparently healthy adults. An analysis of the settings for the food worker-related events showed that most of the outbreaks came from food service facilities (376 outbreaks [46.1%]), followed by catered events (126 outbreaks [15.4%]), the home (83 outbreaks [10.2%]), schools and day care centers (49 [6.0%]), and health care institutions (43 outbreaks [5.3%]). However, many cases resulted from relatively few outbreaks (< 30 each) associated with community events (9,726), processing plants (8,580), mobile/temporary service (5,367), and camps/ armed forces (5,117). The single most frequently reported setting was restaurants, with 324 outbreaks and 16,938 cases. Improper hygienic practices in homes, on picnics, or at community events accounted for 89 of the 816 outbreaks. There were 18 outbreaks associated with commercial travel in air flights, trains, and cruise ships over several decades, although only the last seems to be a major concern today. Sixteen outbreaks occurred where food, primarily produce, was harvested and shipped from one country to another. Sometimes the presence of an infected worker preparing food was only one of several factors contributing to the outbreak.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 1. Description of the problem, methods, and agents involved

Food workers in many settings have been responsible for foodborne disease outbreaks for decades, and there is no indication that this is diminishing. The Committee on Control of Foodborne Illnesses of the International Association for Food Protection was tasked with collecting and evaluating any data on worker-associated outbreaks. A total of 816 reports with 80,682 cases were collected from events that occurred from 1927 until the first quarter of 2006. Most of the outbreaks reviewed were from the United States, Canada, Europe, and Australia, with relatively few from other parts of the world, indicating the skewed set of data because of availability in the literature or personal contact. Outbreaks were caused by 14 agents: norovirus or probable norovirus (338), Salmonella enterica (151), hepatitis A virus (84), Staphylococcus aureus (53), Shigella spp. (33), Streptococcus Lancefield groups A and G (17), and parasites Cyclospora, Giardia, and Cryptosporidium (23). Streptococcal, staphylococcal, and typhoid outbreaks seem to be diminishing over time; hepatitis A virus remains static, whereas norovirus and maybe nontyphoidal Salmonella are increasing. Multiple foods and multi-ingredient foods were identified most frequently with outbreaks, perhaps because of more frequent hand contact during preparation and serving.

Growth studies of plasmid bearing and plasmid cured Yersinia enterocolitica GER O:3 in the presence of cefsulodin, irgasan and novobiocin at 25 and 37oC

AIM

In this study, the growth characteristics of Yersinia enterocolitica biotype 4, GER O:3 plasmid bearing (P+) and plasmid cured (P-) strain types were evaluated in brain heart infusion broth supplemented with cefsulodin, irgasan, and novobiocin alone or in combination.

METHODS AND RESULTS

Growth curves were obtained for the two strain types in broth supplemented with selective agents at 25 or 37 degrees C for 32 h to obtain data on the lag phase durations and growth rates of the strains. Generally, the lag times and growth rates of the P+ and P- strains were similar for cultures incubated at 25 degrees C regardless of the selective agent added and where plasmid replication and expression were not under any significant burden. However, where the lag times and growth rates of the strains were examined at 37 degrees C, significant differences were observed in the lag phase durations of the plasmid bearing strain type compared the plasmid cured strain, an effect that was due to the burden of the plasmid and the influence of selective agents. Generally, when two or more agents were present, lag phase durations were longer for the plasmid bearing strain. Some exceptions noted where in the presence of irgasan or full selective agent (CIN) the opposite case was observed. When growth rates were compared, the plasmidless strain type was typically faster than the plasmid bearing strain in the presence of most selective agents at 37 degrees C and the growth rates of both strain types at 25 degrees C were similar where the temperature appeared to negate the effects of plasmid.

CONCLUSIONS

The data obtained in these studies suggest that selective agents (in particular irgasan) and incubation temperature play a significant role in influencing the growth characteristics of plasmid bearing and plasmid cured strains of Y. enterocolitica.

SIGNIFICANCE AND IMPACT OF THE STUDY

This data presented in this study has significant implications for enrichment methods used in the detection or recovery of plasmid bearing Y. enterocolitica strains from food, environmental or clinical samples.

Heat resistance of coliform species isolated from cooked ham, snail flesh, and 'bouchees a la reine'

AIMS

In this study, the heat resistance of coliform species isolated from cooked ham and ready-made meals was determined.

METHODS AND RESULTS

Thirteen coliform strains belonging to 12 different species were studied using laboratory medium in order to determine delta (first decimal reduction time) and z(T) values (temperature increase leading to a 10-fold reduction of delta) using the Weibull model. For seven strains, delta-values were determined at temperatures ranging from 55 to 60 degrees C, with, delta values between 0.52 and 2.98 min, at 59 degrees C. For the other six strains, lower temperature values were determined with delta-values ranging from 0.47 to 1.64 min at 54 degrees C. z(T) values calculated for the 13 strains were 3.1 to 7.5 degrees C. For eight strains, plotting of the log of survivors was not linear but rather showed shoulders or shoulders and tails.

CONCLUSIONS

Coliform species were sensitive to heat treatment with a decimal reduction time under 2 min at 60 degrees C.

SIGNIFICANCE AND IMPACT OF THE STUDY

The better knowledge of coliform heat resistance by determining thermal resistance parameters with confidence intervals will be useful for evaluating the efficiency of industrial thermal processes.

Identification of substrates and chaperone from the Yersinia enterocolitica 1B Ysa type III secretion system

All pathogenic Yersinia enterocolitica strains carry the pYV plasmid encoding the Ysc-Yop type III secretion (TTS) system, which operates at 37 degrees C. In addition, biovar 1B Y. enterocolitica strains possess a second, chromosomally encoded, TTS system called Ysa, which operates, at least in vitro, under low-temperature and high-salt (LTHS) conditions. Six open reading frames, sycB, yspB, yspC, yspD, yspA, and acpY, neighbor the ysa genes encoding the Ysa TTS apparatus. Here we show that YspA, YspB, YspC, and YspD are secreted by the Ysa TTS system under LTHS conditions. SycB is a chaperone for YspB and YspC and stabilizes YspB. YspB, YspC, and SycB share some similarity with TTS substrates and the chaperone encoded by the Mxi-Spa locus of Shigella flexneri and SPI-1 of Salmonella enterica. In addition, Ysa also secretes the pYV-encoded YopE under LTHS conditions, indicating that YopE is a potential effector of both Y. enterocolitica TTS systems. YspC could also be secreted by S. flexneri, but no functional complementation of ipaC was observed, which indicates that despite their similarity the Ysa and the Mxi-Spa systems are not interchangeable. When expressed from the yopE promoter, YspB and YspC could also be secreted via the Ysc injectisome. However, they could not form detectable pores in eukaryotic target cells and could not substitute for YopB and YopD for translocation of Yop effectors.

A case-control study of Yersinia enterocolitica infections in Auckland

OBJECTIVE

To identify major risk factors for Yersinia enterocolitica (YE) and identify measures to reduce YE infections.

METHODS

A prospective case control study, group age matched, using 186 cases of YE identified by community pathology laboratories and 379 randomly selected controls. Conducted between April 1995 and June 1996 in Auckland, New Zealand. Face-to-face interviews used a standardised questionnaire examining exposures to factors potentially associated with YE infections including untreated water, unreticulated sewerage, consumption of selected foods, selected food handling practices and socio-demographic factors. Multivariate logistic regression was used to calculate adjusted odds ratios for the potential risk factors. Population attributable risk (PAR) was calculated for significant exposures.

RESULTS

Having more than two people living in the home was more common among cases than controls (OR = 2.2). Town supply water (OR = 0.2), reticulated sewerage (OR = 0.34) and looking after a young child (OR = 0.51) were significantly less common. Of the meats, only pork (OR = 1.34) had a higher consumption rate, while bacon (OR = 0.75) and smallgoods (OR = 0.73) were consumed less frequently by cases than controls. Eating food from a sandwich bar was more frequent among cases (OR = 1.18). Fruit and vegetable consumption was marginally less (OR = 0.98). The population attributable risk of these factors was 0.89, implying that 89% of YE would be eliminated if adverse exposures were removed.

CONCLUSIONS

The risk of YE illness is increased by contact with untreated water, unreticulated sewerage and consumption of pork. Investigation of non-town water supply, informal sewerage systems and methods of preparation and consumption of pork are recommended to determine how YE enters the human food chain.

Yersinia enterocolitis mimicking Crohn's disease in a toddler

A 31/2-year-old girl presented with persistent abdominal pain, fever, vomiting, and diarrhea accompanied by rash, oral ulceration, anemia, and an elevated sedimentation rate. Initial evaluation revealed no pathogens and was extended to include abdominal ultrasound and computed tomography showing marked ileocecal edema and mesenteric adenopathy. Colonoscopy revealed focal ulceration from rectum to cecum with histology of severe active colitis with mild chronic changes. Enteroclysis demonstrated a nodular, edematous terminal ileum. Because of the patient's clinical deterioration despite antibiotics, these features were construed consistent with Crohn's disease, and glucocorticoid therapy was begun. By the ninth hospital day, admission cultures grew Yersinia enterocolitica, and trimethoprim/sulfamethoxazole was begun followed by prompt clinical improvement. The delay in diagnosis afforded an unusually comprehensive clinical description of the presentation and diagnosis of Yersinia enterocolitis in childhood.

Genetic and biochemical characterization of an exopolygalacturonase and a pectate lyase from Yersinia enterocolitica

Yersinia enterocolitica, an invasive foodborne human pathogen, degrades polypectate by producing two depolymerizing enzymes, pectate lyase (PL) and polygalacturonase (PG). The gene encoding the PG activity, designated pehY, was located in a 3-kb genomic fragment of Y. enterocolitica ATCC 49397. The complete nucleotide sequence of this 3-kb fragment was determined and an open reading frame consisting of 1803 bp was predicted to encode a PG protein with an estimated M(r) of 66 kDa and pI of 6.3. The amino acid sequence of prePG showed 59 and 43% identity to that of the exopolygalacturonase (exoPG) of Erwinia chrysanthemi and Ralstonia solanacearum, respectively. The Y. enterocolitica PG overproduced in Escherichia coli was purified to near homogeneity using perfusion cation exchange chromatography. Analysis of the PG depolymerization products by high performance anion-exchange chromatography and pulsed amperometric detection (HPAEC-PAD) revealed the exolytic nature of this enzyme. The Y. enterocolitica PL overproduced in E. coli was also partially purified and the M(r) and pI were estimated to be 55 kDa and 5.2, respectively. HPAEC-PAD analysis of the PL depolymerization products indicated the endolytic nature of this enzyme. Southern hybridization analyses revealed that pehY and pel genes of Y. enterocolitica are possibly encoded in the chromosome rather than in the plasmid. Purified exopolygalacturonase (over 10 activity units) was unable to macerate plant tissues.

Yersinia enterocolitica: the charisma continues

Yersinia enterocolitica, a gram-negative coccobacillus, comprises a heterogeneous group of bacterial strains recovered from animal and environmental reservoirs. The majority of human pathogenic strains are found among distinct serogroups (e.g. O:3, O:5,27, O:8, O:9) and contain both chromosome- and plasmid (60 to 75 kb)-mediated virulence factors that are absent in "avirulent" strains. While Y. enterocolitica is primarily a gastrointestinal tract pathogen, it may produce extraintestinal infections in hosts with underlying predisposing factors. Postinfection sequelae include arthritis and erythema nodosum, which are seen mainly in Europe among patients with serogroups O:3 and O:9 infection and HLA-B27 antigen. Y. enterocolitica is acquired through the oral route and is epidemiologically linked to porcine sources. Bacteremia is prominent in the setting of immunosuppression or in patients with iron overload or those being treated with desferrioxamine. metastatic foci following bacteremia are common and often involve the liver and spleen. Of particular concern is blood transfusion-related bacteremia. Evidence has accumulated substantiating the role of Y. enterocolitica as a food-borne pathogen that has caused six major outbreaks in the United States. The diagnosis of Y. enterocolitica gastroenteritis is best achieved through isolation of the bacterium on routine or selective bacteriologic media. When necessary, serogrouping, biogrouping, and assessment for plasmid-encoded virulence traits may aid in distinguishing virulent from "avirulent" strains. Epidemiologically, outside of identified food-borne outbreaks, the source (reservoir) of Y. enterocolitica in sporadic cases is speculative. Therefore, prevention and control measures are difficult to institute.

Clamped homogenous electric fields (CHEF) gel-electrophoresis of DNA restriction fragments for comparing genomic variations among strains of yersinia enterocolitica and Yersinia spp

Yersinia enterocolitica gastroenteritis was first recognized in the early 1960s and has since been reported with increasing frequency. To determine if strains of Y. enterocolitica, within a restricted region isolated over 8 years (1985-1993), originated from a single or multiple clones, pulsed-field gel electrophoresis (PFGE) of large chromosomal DNA restriction fragments generated by XbaI or NotI was used. A total of 27 isolates of Y. enterocolitica were analyzed, 24 from Austria (Vienna and Graz) consisting of serogroups 0:3 (17 isolates), 0:9 (6 isolates), 0:5 (1 isolate); 2 from Germany of serogroups 0:3 and 0:9 (1 isolate each); 1 from the U.S.A. of serogroup 0:8. Genomic fingerprints of these strains were compared to those of 8 other Yersinia species to ascertain if their restriction endonuclease digestion profiles (REDP) were serogroup and/or species specific. The 27 Y. enterocolitica strains could be divided into 16 genomic varieties according to their restriction patterns with NotI and XbaI. PFGE was highly discriminatory as strains belonging to the same serogroup could be subdivided into different genomic groups. Furthermore, Y. enterocolitica strains isolated from the same region, over an 8 year period, belonged to a few closely related clones. The genomic fingerprints of Yersinia were found to be species and serogroup specific.

Sources of sporadic Yersinia enterocolitica infections in Norway: a prospective case-control study

Yersinia enterocolitica is a recognized cause of gastroenteritis in northern Europe. During October 1988-January 1990, a prospective case-control study was performed to address risk factors associated with sporadic Y. enterocolitica infections in southeastern Norway. Sixty-seven case-patients (mean age 23.4 years, range 8 months-88 years) and 132 age-, sex- and geographically-matched controls were enrolled in the study. Multivariate analysis of the data showed that persons with Y. enterocolitica infection reported having eaten significantly more pork items (3.79 v. 2.30 meals, P = 0.02) and sausage (2.84 v. 2.20 meals, P = 0.03) in the 2 weeks before illness onset than their matched controls; only one patient had eaten raw pork. Patients were also more likely than controls to report a preference for eating meat prepared raw or rare (47 v. 27%, P = 0.01), and to report drinking untreated water (39 v. 25%, P = 0.01) in the 2 weeks before illness onset. Each of these factors was independently associated with disease, suggesting a link between yersiniosis and consumption of undercooked pork and sausage products and untreated water. Efforts should be directed towards developing techniques to reduce Y. enterocolitica contamination of pork and educating consumers about (1) proper handling and preparation of pork items and (2) the hazards of drinking untreated water.

Predictive modelling of growth of Yersinia enterocolitica: the effects of temperature, pH and sodium chloride

The growth responses of Yersinia enterocolitica as affected by NaCl concentration, pH value and storage temperature were studied in laboratory medium. Growth curves at concentrations of NaCl in the range 0.5-6.5% (w/v), pH values in the range 4.0-7.0 and storage temperatures in the range 5-30 degrees C were fitted using the Gompertz routine and the derived parameters modelled. Growth curves could then be regenerated for any set of conditions within the matrix studied and values for growth rate, generation time, lag time and time to 1000-fold increase predicted. The model was validated against data from the literature and was found to give realistic estimates for generation time in media and a range of foods including meat and meat products, milk, eggs, fish and tofu. All predictions were consistently 'fail-safe'.

Pyrazinamidase, CR-MOX agar, salicin fermentation-esculin hydrolysis, and D-xylose fermentation for identifying pathogenic serotypes of Yersinia enterocolitica

We evaluated several simple laboratory tests that have been used to identify pathogenic serotypes of Yersinia enterocolitica or to indicate the pathogenic potential of individual strains. A total of 100 strains of Y. enterocolitica were studied, including 25 isolated during five outbreak investigations, 63 from sporadic cases, and 12 from stock cultures. The pyrazinamidase test, which does not depend on the Yersinia virulence plasmid, correctly identified 60 of 63 (95% sensitivity) strains of pathogenic serotypes and 34 of 37 (92% specificity) strains of nonpathogenic serotypes. Salicin fermentation-esculin hydrolysis (25 degrees C, 48 h) correctly identified all 63 (100% sensitivity) strains of the pathogenic serotypes and 34 of 37 (92% specificity) strains of the nonpathogenic serotypes. The results of the pyrazinamidase and salicin-esculin tests disagreed for only 7 of the 100 strains of Y. enterocolitica, and these would require additional testing. Congo red-magnesium oxalate (CR-MOX) agar determines Congo red dye uptake and calcium-dependent growth at 36 degrees C, and small red colonies are present only if the strain contains the Yersinia virulence plasmid. This test has proven to be extremely useful for freshly isolated cultures, but only 15 of 62 strains of pathogenic serotypes that had been stored for 1 to 10 years were CR-MOX positive. None of the 16 strains of Y. enterocolitica serotype O3 fermented D-xylose, so this test easily differentiated strains of this serotype, which now appears to be the most common in the United States. Although antisera that can actually be used to serotype strains of Y. enterocolitica are not readily available, the four simple tests described above can be used to screen for pathogenic serotypes.

The microbiological quality of drinking water supplies of Izmir City: the incidence of Yersinia enterocolitica

A total of 100 water samples collected from piped public supplies, wells with and without motor pumps, springs and commercially bottled spring waters were microbiologically examined. In order to determine microbiological quality, aerobic bacterial and coliform counts were estimated and the presence of Escherichia coli and Yersinia enterocolitica was investigated. Of the samples tested, 85 of them met the specifications set by TFR (Turkish Food Regulation) for coliforms, whereas 72 of them met the specifications for aerobic bacteria. The number of samples containing Y. enterocolitica and E. coli were found to be 6 and 5, respectively.

The influence of pH, temperature and organic acids on the initiation of growth of Yersinia enterocolitica

The influence of incubation temperature, and of acetic, lactic and citric acids on the minimum pH for the initiation of growth of six strains of Yersinia enterocolitica was determined. The strains included two of serotype O : 9, two of serotype O : 3, and one each of serotypes O : 8 and O : 5, 27. In a culture medium acidified with HCl to pH values between 4.0 and 6.0 at intervals of approximately 0.1 unit the minimum pH at which growth was detected after incubation at 20 degrees, 10 degrees, 7 degrees and 4 degrees C for 21 d was in the ranges 4.18-4.36, 4.26-4.50, 4.36-4.83 and 4.42-4.80, respectively. The minimum pH for growth was also determined in media that contained 17, 33 and 50 mmol/l acetic acid adjusted to pH values between 5.1 and 5.9 at intervals of approximately 0.2 unit, 24, 48 and 95 mmol/l citric acid adjusted to pH values between 4.1 and 4.9 at intervals of approximately 0.2 unit, and 22, 44, and 111 mmol/l lactic acid adjusted to pH values between 4.3 and 5.7 at intervals of approximately 0.4 or 0.5 unit. The effect of these concentrations of organic acids was, in most cases, to increase the minimum pH that allowed growth. The order of effectiveness of the organic acids in raising the minimum pH for growth was acetic greater than lactic greater than citric and the minimum inhibitory concentrations were greater at higher temperatures.

The ail locus is found uniquely in Yersinia enterocolitica serotypes commonly associated with disease

Yersinia enterocolitica is a heterogeneous group of organisms with more than 50 serotypes and several biotypes. Only a few of these serotypes cause gastrointestinal disease in otherwise healthy hosts; these serotypes are the pathogenic serotypes. Although Y. enterocolitica requires a high-molecular-weight plasmid to cause disease, chromosome-encoded determinants are required for the full expression of virulence. The ability of Yersinia spp. to invade eucaryotic cells is thought to be a virulence factor, because nonpathogenic serotypes are noninvasive in animals and in tissue culture cell models. Current evidence indicates that invasion ability is chromosome encoded. We recently reported cloning two loci, inv and ail, from Y. enterocolitica O8 strain 8081c that allow Escherichia coli to invade tissue culture cells. We investigated the link between invasion in an in vitro tissue culture invasion (TCI) model and hybridization to probes derived from the two invasion loci, inv and ail. We examined 177 Yersinia strains. Strains of serotypes and species associated with disease were TCI+, whereas strains of serotypes and species not associated with disease were TCI-. Only TCI+ strains had DNA homologous to probes derived from ail. All strains (TCI+ and TCI-) had DNA homologous to probes derived from inv, but there were certain restriction fragment-linked polymorphisms that were associated primarily with TCI+ strains. These observations held true for strains epidemiologically associated with disease. Both the inv and ail loci were found to be clearly located on the chromosome. No other genera, including other invasive organisms, had DNA homologous to inv or ail. These data support the hypothesis that the ail locus encodes a Y. enterocolitica invasion factor that may be involved in pathogenesis.

Thermal inactivation of Campylobacter species, Yersinia enterocolitica, and hemorrhagic Escherichia coli O157:H7 in fluid milk

Heat treatment of raw milk in an HTST pasteurizer operated at 60.0 to 72.0 degrees C for a minimum holding time of 16.2 s rapidly inactivated mixtures of hemorrhagic Escherichia coli O157:H7, Yersinia enterocolitica and Campylobacter spp. (C. fetus, C. coli, and C. jejuni). Each of the three genera in the mixture was inoculated at a level of approximately 1.0 x 10(5) cfu/ml. At 60.0 degrees C, hemorrhagic E. coli showed a maximum 2 log10 reduction in counts and no viability at greater than or equal to 64.5 degrees C. Yersinia enterocolitica and Campylobacter spp. showed greater heat sensitivity with a 4 log10 reduction in counts at 60.0 degrees C and absence of viable cells at greater than or equal to 63.0 degrees C. These findings reiterate the need for stringent control of thermal processes in the manufacture of dairy products from raw or heat-treated (non-pasteurized) milk.

Factors contributing to the reduced invasiveness of chlorine-injured Yersinia enterocolitica

The invasion of epithelial cells in vitro and in vivo by chlorine-injured Yersinia enterocolitica was assessed by direct microscopic observations. These experiments showed that injury by chlorine inhibited invasiveness of virulent Y. enterocolitica. Two requirements appeared to be necessary for invasiveness: the organism must be viable and metabolically active, and the organism must have certain surface components to initiate engulfment. Inhibition of RNA synthesis by rifampin and protein synthesis by chloramphenicol, tetracycline, and spectinomycin inhibited the invasiveness but not the attachment of Y. enterocolitica to epithelial cells. Membrane preparations from untreated and antimicrobial-agent-treated Y. enterocolitica blocked the invasiveness of virulent Y. enterocolitica, whereas membranes from chlorinated cells were unable to block invasiveness. Chlorine did not change the hydrophobicity or surface charge of injured Y. enterocolitica. The results indicate that invasion was more than simple association of the bacterium with the epithelial cell and involved a specific trigger to stimulate engulfment.

Yersinia enterocolitica infections and pork: the missing link

To determine the risk factors for Yersinia enterocolitica (YE) infection in Belgium, which is the country with the highest incidence of this infection, 40 persons with YE infections due to serotype O:3 (n = 36) or O:9 (n = 4) were compared with matched controls. Most patients had acute gastroenteritis; 1 had a liver abscess. 20% were admitted to hospital; the mean duration of hospital stay was 9 days. YE infection was strongly associated with eating raw pork in the 2 weeks before onset (odds ratio = 12, p = 0.00002), a factor that accounted for 58% of the YE infections studied. 14 (18%) of 79 families surveyed at a well-baby clinic fed their children raw pork from a median age of 18 months. Specific control measures to reduce contamination and consumption of raw pork may reduce the incidence of YE infections.