Isolation of Enterobacter sakazakii from midgut of Stomoxys calcitrans

Analysis of the Molecular Diversity Among Cronobacter Species Isolated From Filth Flies Using Targeted PCR, Pan Genomic DNA Microarray, and Whole Genome Sequencing Analyses

Cronobacter species are opportunistic pathogens capable of causing life-threatening infections in humans, with serious complications arising in neonates, infants, immuno-compromised individuals, and elderly adults. The genus is comprised of seven species: Cronobacter sakazakii, Cronobacter malonaticus, Cronobacter turicensis, Cronobacter muytjensii, Cronobacter dublinensis, Cronobacter universalis, and Cronobacter condimenti. Despite a multiplicity of genomic data for the genus, little is known about likely transmission vectors. Using DNA microarray analysis, in parallel with whole genome sequencing, and targeted PCR analyses, the total gene content of two C. malonaticus, three C. turicensis, and 14 C. sakazaki isolated from various filth flies was assessed. Phylogenetic relatedness among these and other strains obtained during surveillance and outbreak investigations were comparatively assessed. Specifically, microarray analysis (MA) demonstrated its utility to cluster strains according to species-specific and sequence type (ST) phylogenetic relatedness, and that the fly strains clustered among strains obtained from clinical, food and environmental sources from United States, Europe, and Southeast Asia. This combinatorial approach was useful in data mining for virulence factor genes, and phage genes and gene clusters. In addition, results of plasmidotyping were in agreement with the species identity for each strain as determined by species-specific PCR assays, MA, and whole genome sequencing. Microarray and BLAST analyses of Cronobacter fly sequence datasets were corroborative and showed that the presence and absence of virulence factors followed species and ST evolutionary lines even though such genes were orthologous. Additionally, zebrafish infectivity studies showed that these pathotypes were as virulent to zebrafish embryos as other clinical strains. In summary, these findings support a striking phylogeny amongst fly, clinical, and surveillance strains isolated during 2010–2015, suggesting that flies are capable vectors for transmission of virulent Cronobacter spp.; they continue to circulate among United States and European populations, environments, and that this “pattern of circulation” has continued over decades.

Examining the Presence of Cronobacter spp. in Ready-to-eat Edible Insects

Edible insects present a potential solution to increasing global food insecurity. However, there is limited research on the microbial hazards they may pose. These include opportunistic pathogens like Cronobacter spp. (formerly Enterobacter sakazakii). In this study, nine types of ready-to-eat edible insect products purchased in the UK were examined for their microbial load (total aerobic count, total Enterobacteriaceae count), and screened for the presence of Cronobacter sakazakii(C. sakazakii) by selective enrichment and plating on chromogenic agar. While microbial load was generally low, presumptive Cronobacter spp. were detected in five of the edible insect products. Four of the isolates were identified as C. sakazakii, using the Remel RapID ONE biochemical test kit. Genotypic characterisation of the isolates by ITS-PCR, however, demonstrated that the isolates may be other species of Cronobacter instead. Further studies into understanding microbial hazards linked to edible insects for human consumption are required.

Updates on the Cronobacter Genus

There has been considerable concern related to Cronobacter spp. in foods, especially due to their highlighted association with neonatal infections through the ingestion of reconstituted powdered infant formula (PIF). This concern resulted in improved microbiological criteria recommendations by the Codex Alimentarius Commission and revised WHO advice on the preparation of infant feeds. In recent years, the diversity of the genus has been well described, and various detection and typing methods have been developed. This review considers our current knowledge of the genus and how DNA-sequence-based methods have contributed considerably to research into improved detection methods and more reliable identification procedures, genotyping schemes, and genomic analysis. The broader occurrence of Cronobacter in food ingredients, finished products, and food manufacturing environments is covered. This review also highlights the significance of clonal lineages in microbial source tracking and the use of CRISPR-cas array profiling.

Cronobacter spp

The Cronobacter group of pathogens, associated with severe and potentially life-threatening diseases, until recently were classified as a single species, Enterobacter sakazakii. The group was reclassified in 2007 into the genus Cronobacter as a member of the Enterobacteriaceae. This chapter outlines the history behind the epidemiology, analyzes how our understanding of these bacteria has evolved, and highlights the clinical significance the Cronobacter spp. have for neonatal and elderly patient populations and treatment of the associated infections.

Ingested Salmonella enterica, Cronobacter sakazakii, Escherichia coli O157:H7, and Listeria monocytogenes: transmission dynamics from adult house flies to their eggs and first filial (F1) generation adults

BACKGROUND

The mechanical transmission of pathogenic bacteria by synanthropic filth flies is widely recognized. While many studies report the fate and the temporospatial distribution of ingested foodborne bacteria by filth flies, there is little evidence about the transmission dynamics of ingested foodborne bacteria by adult house flies (Musca domestica) to their progeny. In this study, we fed parental house fly adults with food contaminated with low, medium, and high concentrations of Salmonella enterica, Cronobacter sakazakii, Escherichia coli O157:H7, and Listeria monocytogenes and evaluated the probability of transmission of these pathogens to house fly eggs and the surface and the alimentary canal of their first filial (F1) generation adults.

RESULTS

All foodborne pathogens were present in samples containing pooled house fly eggs. The probability of transmission was higher after parental house flies ingested food containing medium bacterial loads. Cronobacter sakazakii was 16, 6, and 3 times more likely to be transmitted to house fly eggs than S. enterica, E. coli O157:H7, and L. monocytogenes, respectively. Only S. enterica and C. sakazakii were transmitted to F1 generation adults and their presence was 2.4 times more likely on their body surfaces than in their alimentary canals. The highest probabilities of finding S. enterica (60 %) and C. sakazakii (28 %) on newly emerged F1 adults were observed after parental house flies ingested food containing medium and high levels of these pathogens, respectively.

CONCLUSION

Our study demonstrates that adult house flies that fed from food contaminated with various levels of foodborne bacteria were able to transmit those pathogens to their eggs and some were further transmitted to newly emerged F1 generation adults, enhancing the vector potential of these insects. Understanding the type of associations that synanthropic filth flies establish with foodborne pathogens will help to elucidate transmission mechanisms and possible ways to mitigate the spread of foodborne pathogens.

Insights into virulence factors determining the pathogenicity of Cronobacter sakazakii

Cronobacter sakazakii is an opportunistic pathogen associated with outbreaks of life-threatening necrotizing enterocolitis, meningitis and sepsis in neonates and infants. The pathogen possesses an array of virulence factors which aid in tissue adhesion, invasion and host cell injury. Although the identification and validation of C. sakazakii virulence factors has been hindered by availability of suitable neonatal animal model, various studies has reported outer membrane protein A (ompA) as a potential virulence marker. Various other plasmid associated genes such as filamentous hemagglutinin (fhaBC), Cronobacter plasminogen activator (cpa) and genes responsible for iron acquisition (eitCBAD and iucABD/iutA) have been reported in different strains of C. sakazakii. Besides these proposed virulence factors, several biophysical growth factors such as formation of biofilms and resistance to various environmental stresses also contributes to the pathogenic potential of this pathogen. This review provides an update on virulence determinants associated with the pathogenesis of C. sakazakii. The potential reservoirs of the pathogen, mode of transmission and epidemiology are also discussed.

Prevalence and Characterization of Cronobacter spp. from Various Foods, Medicinal Plants, and Environmental Samples

Dairy or non-dairy based products were explored to determine the prevalence, molecular characterization, and antibiotic susceptibility of Cronobacter spp. The isolation was done as per ISO 22964:2006 on chromogenic media followed by further confirmation by biochemical- and 16S rRNA-based identification. From 219 samples, the chromogenic agar assay and biochemical tests yielded presumptive 45 isolates. Among them, only 36 isolates showed 282 bp band amplified from ITS-G gene confirming as Cronobacter sakazakii. The Cronobacter spp. prevalence was highest in herbs and spices (34 %) while environmental samples had contamination rates of 23 % indicating plants as a possible reservoir of this pathogen. All the isolates were resistant to β-lactam derivatives (68 %), macrolides (88.6 %), and aminoglycosides (79.9 %) but susceptible to phenicoles (31.6 %) and tetracyclines (15 %) derivatives. The results emphasize the screening of plant materials before their incorporation in food matrices.

Prevalence and relative risk of Cronobacter spp., Salmonella spp., and Listeria monocytogenes associated with the body surfaces and guts of individual filth flies

Although flies are important vectors of food-borne pathogens, there is little information to accurately assess the food-related health risk of the presence of individual flies, especially in urban areas. This study quantifies the prevalence and the relative risk of food-borne pathogens associated with the body surfaces and guts of individual wild flies. One hundred flies were collected from the dumpsters of 10 randomly selected urban restaurants. Flies were identified using taxonomic keys before being individually dissected. Cronobacter spp., Salmonella spp., and Listeria monocytogenes were detected using the PCR-based BAX system Q7. Positive samples were confirmed by culture on specific media and through PCR amplification and sequencing or ribotyping. Among collected flies were the housefly, Musca domestica (47%), the blowflies, Lucilia cuprina (33%) and Lucilia sericata (14%), and others (6%). Cronobacter species were detected in 14% of flies, including C. sakazakii, C. turicensis, and C. universalis, leading to the proposal of flies as a natural reservoir of this food-borne pathogen. Six percent of flies carried Salmonella enterica, including the serovars Poona, Hadar, Schwarzengrund, Senftenberg, and Brackenridge. L. monocytogenes was detected in 3% of flies. Overall, the prevalence of food-borne pathogens was three times greater in the guts than on the body surfaces of the flies. The relative risk of flies carrying any of the three pathogens was associated with the type of pathogen, the body part of the fly, and the ambient temperature. These data enhance the ability to predict the microbiological risk associated with the presence of individual flies in food and food facilities.

Susceptibility to Cronobacter sakazakii decreases with increasing age in neonatal CD-1 mice

Neonatal, premature, or very low birth weight infants fed reconstituted powdered infant formula contaminated with Cronobacter (Enterobacter sakazakii) may develop infections resulting in severe outcomes such as septicemia, necrotizing enterocolitis, meningitis, or death. Infants who recover from infection may have morbidities such as hydrocephalus, mental retardation, or developmental delays. Although increasing age appears to reduce susceptibility to Cronobacter infection, it is not known at what age or why these infants become less susceptible. Our study objectives were to compare the susceptibilities of neonatal mice of different ages to Cronobacter sakazakii infection. Timed-pregnant CD-1 mice were allowed to give birth naturally. Neonatal mice were orally gavaged at postnatal days (PNDs) 1.5, 5.5, and 9.5 with a single dose of vehicle or 10(3), 10(7), or 10(10) CFU/ml C. sakazakii strain MNW2 in reconstituted powdered infant formula. Pups were euthanized 7 days after challenge. Brains, livers, and ceca were excised and analyzed for C. sakazakii invasion, and blood was collected for serum amyloid A analysis as a biomarker of infection. C. sakazakii invasion was age dependent; the pathogen was isolated from brains, livers, and ceca of neonatal mice treated at PNDs 1.5 and 5.5 but not from those of pups treated at PND 9.5. C. sakazakii was more invasive at PND 1.5 in brains than in livers and ceca and was isolated from 22, 14, and 18% of these tissue samples, respectively. Serum amyloid A was detected in only one treated neonate. Mortality was observed only in neonates treated at PND 1.5. In conclusion, neonatal mice had a time-dependent susceptibility to C. sakazakii infection, with resistance increasing with increasing age.

Naturally occurring culturable aerobic gut flora of adult Phlebotomus papatasi, vector of Leishmania major in the Old World

BACKGROUND

Cutaneous leishmaniasis is a neglected, vector-borne parasitic disease and is responsible for persistent, often disfiguring lesions and other associated complications. Leishmania, causing zoonotic cutaneous leishmaniasis (ZCL) in the Old World are mainly transmitted by the predominant sand fly vector, Phlebotomus papatasi. To date, there is no efficient control measure or vaccine available for this widespread insect-borne infectious disease.

METHODOLOGY/PRINCIPAL FINDINGS

A survey was carried out to study the abundance of different natural gut flora in P. papatasi, with the long-term goal of generating a paratransgenic sand fly that can potentially block the development of Leishmania in the sand fly gut, thereby preventing transmission of leishmania in endemic disease foci. Sand flies, in particular, P. papatasi were captured from different habitats of various parts of the world. Gut microbes were cultured and identified using 16S ribosomal DNA analysis and a phylogenetic tree was constructed. We found variation in the species and abundance of gut flora in flies collected from different habitats. However, a few Gram-positive, nonpathogenic bacteria including Bacillus flexus and B. pumilus were common in most of the sites examined.

CONCLUSION/SIGNIFICANCE

Our results indicate that there is a wide range of variation of aerobic gut flora inhabiting sand fly guts, which possibly reflect the ecological condition of the habitat where the fly breeds. Also, some species of bacteria (B. pumilus, and B. flexus) were found from most of the habitats. Important from an applied perspective of dissemination, our results support a link between oviposition induction and adult gut flora.

Detection and identification of species-specific bacteria associated with synanthropic mites

Internal bacterial communities of synanthropic mites Acarus siro, Dermatophagoides farinae, Lepidoglyphus destructor, and Tyrophagus putrescentiae (Acari: Astigmata) were analyzed by culturing and culture-independent approaches from specimens obtained from laboratory colonies. Homogenates of surface-sterilized mites were used for cultivation on non-selective agar and DNA extraction. Isolated bacteria were identified by sequencing of the 16S rRNA gene. PCR amplified 16S rRNA genes were analyzed by terminal restriction fragment length polymorphism analysis (T-RFLP) and cloning sequencing. Fluorescence in situ hybridization using universal bacterial probes was used for direct bacterial localization. T-RFLP analysis of 16S rRNA gene revealed distinct species-specific bacterial communities. The results were further confirmed by cloning and sequencing (284 clones). L. destructor and D. farinae showed more diverse communities then A. siro and T. putrescentiae. In the cultivated part of the community, the mean CFUs from four mite species ranged from 5.2 × 10(2) to 1.4 × 10(3) per mite. D. farinae had significantly higher CFUs than the other species. Bacteria were located in the digestive and reproductive tract, parenchymatical tissue, and in bacteriocytes. Among the clones, Bartonella-like bacteria occurring in A. siro and T. putresecentiae represented a distinct group related to Bartonellaceae and to Bartonella-like symbionts of ants. The clones of high similarity to Xenorhabdus cabanillasii were found in L. destructor and D. farinae, and one clone related to Photorhabdus temperata in A. siro. Members of Sphingobacteriales cloned from D. farinae and A. siro clustered with the sequences of "Candidatus Cardinium hertigii" and as a separate novel cluster.

Human isolates of Cronobacter sakazakii bind efficiently to intestinal epithelial cells in vitro to induce monolayer permeability and apoptosis

BACKGROUND

Cronobacter sakazakii (CS) is an emerging opportunistic pathogen that causes life-threatening infections in infants. This pathogen has been implicated in the outbreaks of necrotizing enterocolitis (NEC) with associated rates of high mortality and morbidity. In this study, we compared the abilities of CS strains isolated from human and environmental sources to bind to intestinal epithelial cells and trigger apoptosis.

MATERIALS AND METHODS

CS strains were isolated from human and environmental sources and their abilities to bind to intestinal epithelial cells were determined. Monolayer permeability was determined by transepithelial electrical resistance (TEER) and horseradish peroxidase (HRP) leakage. Apoptosis was examined by ApoTag and AnnexinV-7AAD staining. PKC activation was evaluated by non-radioactive PepTag assay.

RESULTS

Human isolates of CS bind to rat and human enterocytes more efficiently than environmental strains. Additionally, these strains induced increased enterocyte monolayer permeability as indicated by a decrease in TEER and an increase in transcellular leakage of exogenously added HRP. Human isolates also caused tight junction disruption and significant apoptosis of enterocytes compared with environmental strains due to increased production of inducible nitric oxide. We also observed that human CS isolates caused 2-fold increase in the activation of phosphokinase C (PKC) than environmental strains. Blocking the PKC activity in enterocytes by an inhibitor, Gö 6983, suppressed CS-mediated tight junction disruption, monolayer permeability, and apoptosis of the cells.

CONCLUSION

These results suggest that human isolates of CS more efficiently bind to and cause damage to intestinal epithelial cells compared with environmental strains.

Decreasing Enterobacter sakazakii (Cronobacter spp.) food contamination level with bacteriophages: prospects and problems

Enterobacter sakazakii (Cronobacter spp.) is an opportunistic pathogen, which can cause rare, but life-threatening infections in neonates and infants through feeding of a contaminated milk formula. We isolated 67 phages from environmental samples and tested their lytic host range on a representative collection of 40 E. sakazakii strains. A cocktail of five phages prevented the outgrowth of 35 out of 40 test strains in artificially contaminated infant formula. Two E. sakazakii phages represented prolate head Myoviridae. Molecular tests identified them as close relatives of Escherichia coli phage T4. The remaining three phages represented isometric head Myoviridae with large genome size of 140 and 200 kb, respectively, which belonged to two different DNA hybridization groups. A high dose of 10(8) pfu ml(-1) of phage could effectively sterilize a broth contaminated with both high and low pathogen counts (10(6) and 10(2) cfu ml(-1)). In contrast, broth inoculated with 10(4) phage and 10(2) bacteria per ml first showed normal bacterial growth until reaching a cell titre of 10(5) cfu ml(-1). Only when crossing this threshold, phage replication started, but it could not reduce the contamination level below 100 cfu ml(-1). Phages could be produced with titres of 10(10) pfu ml(-1) in broth culture, but they were not stable upon freeze-drying. Addition of trehalose or milk formula stabilized the phage preparation, which then showed excellent storage stability even at elevated temperature.

Neonatal mice as models for Cronobacter sakazakii infection in infants

Cronobacter sakazakii is an opportunistic pathogen that has been isolated from powdered infant formulas. C. sakazakii infection can result in serious illnesses such as bacteremia, septicemia, meningitis, and death in at-risk infants who are orally fed contaminated reconstituted powdered infant formulas. The objective of this study was to compare the susceptibilities of BALB/c, C57BL/6, and CD-1 mice to C. sakazakii strain MNW2. We acquired timed-pregnant CD-1 mice and allowed them to give birth naturally. On postnatal day 3.5, each pup was administered a total dose of approximately 10(2) to 10(11) CFU C. sakazakii strain MNW2 in reconstituted powdered infant formula. Mice were observed twice daily for morbidity and mortality. At postnatal day 10.5, the remaining pups were euthanized, and brain, liver, and cecum were excised and analyzed for the presence of C. sakazakii. C. sakazakii was isolated from brains, livers, and ceca in all three mouse strains. The CD-1 mouse strain was the most susceptible of the three, with the lowest infectious dose (10(2) CFU) and the lowest lethal dose (also 10(2) CFU).

[Enterobacter sakazakii in powdered infant food formulas]

Species of the Cronobacter genus ("Enterobacter sakazakii" s. l.) are emergent food-borne pathogens that can cause rare but severe neonatal meningitis, bacteriaemia, and necrotizing enterocolitis. Preterm, low-birth-weight, and immuno-compromised infants exposed to these bacterial species are at particular risk. Over the last 50 years, the literature has reported, mainly in newborn children, more than one hundred cases of infection due to these pathogens. The objective of this review was to synthesize the recent advances in knowledge of species of the Cronobacter genus, in particular with regards to taxonomy, physiology, pathogenicity, clinical cases, the methods for detection, isolation, and characterization, and their presence in powdered formulae for infants and young children, which were identified as the main infection vector. Researchers and international public health authorities have explored the ways contamination occur to better control the risks of pathogen development. Appropriate analysis and control measures were implemented in areas processing powdered formulae for infants and young children, and caregivers and families were informed to undertake good hygienic practices.

Cronobacter ('Enterobacter sakazakii'): current status and future prospects

The genus Cronobacter accommodates the 16 biogroups of the emerging opportunistic pathogen known formerly as Enterobacter sakazakii. Cronobacter spp. are occasional contaminants of milk powder and, consequently, powdered infant formula and represent a significant health risk to neonates. This review presents current knowledge of the food safety aspects of Cronobacter, particularly in infant formula milk powder. Sources of contamination, ecology, disease characteristics and risk management strategies are discussed. Future directions for research are indicated, with a particular focus on the management of this increasingly important bacterium in the production environment.

Enterobacteriaceae and related organisms isolated from shell eggs collected during commercial processing

In the United States, commercial shell eggs are washed and graded before retail. Since passage of the Egg Products Inspection Act in 1971, processing guidelines have been set to ensure that external and internal characteristics are maintained. However, less is known about how commercial processing affects the safety of shell eggs. To identify enteric bacteria entering plants and persisting throughout processing, eggs were collected from 3 US commercial shell egg-processing plants on 3 separate visits. On each plant visit, 12 eggs were collected from each of 12 sites along the processing line: accumulator, prewash rinse, first washer, second washer, sanitizer rinse, dryer, oiler, check detection/scales, 2 egg grader/packer head lanes, rewash belt entrance, and rewash belt exit. Each egg was sampled by a rinse technique, and the rinsate was plated onto violet red bile glucose agar with overlay for the detection and enumeration of Enterobacteriaceae. From each plate, up to 5 colonies were randomly selected and isolated for identification to genus or species by using biochemical tests. Several genera and species were detected at each of the 3 plants. Sites from which the greatest numbers of isolates were identified were those collected from eggs during preprocessing (accumulator, prewash rinse) or from eggs judged as dirty (rewash belt entrance or exit). Sites yielding the smallest number of isolates were those during or at the end of processing. Escherichia coli and Enterobacter spp. were isolated from each of the 9 plant visits. Other genera isolated from at least 1 of the 3 plants included Cedecea, Citrobacter, Erwinia, Hafnia, Klebsiella, Kluyvera, Leclercia, Morganella, Proteus, Providencia, Rahnella, Salmonella, and Serratia. Non-Enterobacteriaceae isolated and identified included Aeromonas, Chryseomonas, Listonella, Pseudomonas, Sphingobacterium, Vibrio, and Xanthomonas. All of the genera and species were recovered less frequently from fully processed eggs than from unwashed eggs, indicating that shell eggs are less contaminated with bacteria as a result of commercial washing procedures.

Enterobacter sakazakii invasion in human intestinal Caco-2 cells requires the host cell cytoskeleton and is enhanced by disruption of tight junction

Enterobacter sakazakii is an opportunistic pathogen that causes systemic bacteremia and meningitis with high mortality, and powdered infant formula is a frequent source of this bacterium. However, the mechanisms that this organism uses to invade and translocate through the intestinal barrier are unknown. Using Caco-2 epithelial cells, we were able to demonstrate penetration of E. sakazakii and to determine invasion-associated properties. We found that E. sakazakii entry and invasion were dependent on the exposure time and multiplicity of infection and required bacterial de novo protein synthesis but was independent of cell polarity in the presence of tight junctions. Moreover, the presence of actin filaments and microtubule structures was required, and disruption of the tight junction significantly enhanced the initial association with Caco-2 cells and the efficiency of invasion, which provides a possible explanation for the preferential occurrence of this infection in babies and neonates. This is the first description of E. sakazakii invasion of host intestinal cells, and our findings suggest that this emerging pathogen employs a novel invasion mechanism for development of systemic infection.

An immunoglobulin binding protein (antigen 5) of the stable fly (Diptera: Muscidae) salivary gland stimulates bovine immune responses

The stable fly, Stomoxys calcitrans (L.) (Diptera: Muscidae), is an economically important pest of livestock. Previous studies demonstrated lymphocyte suppression by crude salivary gland extract (SGE) of the stable fly. A dominant 27-kDa protein identified in the SGE was reported to stimulate immunodominant antibody responses in exposed cattle. The purpose of this study was to determine whether this protein, now identified as ahomolog of insect proteins named antigen 5 (Ag5), was responsible for the lymphocyte suppression and whether naive calves can mount an immune response to it. Calves raised in the winter were immunized with recombinant Ag5 (rAg5) expressed in Drosophila S2 cells or with "natural" Ag5 protein isolated by preparative gel electrophoresis of SGE. Control calves were immunized with adjuvant alone. Rising antibody concentrations to rAg5 were detected in two of three calves immunized with rAg5 and one of three calves immunized with natural Ag5. Recall lymphocyte responses to rAg5 were detected at 21 and 28 d postimmunization in calves immunized with rAg5 but not in calves immunized with the natural Ag5 or those exposed to adjuvant alone. Mitogen-stimulated bovine lymphocyte responses were not suppressed by rAg5. Further investigation using immunoblotting revealed that rAg5 binds to the Fc and F (ab')2 portions of bovine IgG, but not to an Fab fragment. These findings suggest that Ag5 of the stable fly salivary gland is not immunosuppressive but that it has immunoglobulin binding properties and can invoke specific antibody and memory lymphocyte responses in immunized calves.

Prevalence and genetic diversity of Enterobacter sakazakii in ingredients of infant foods

Various food samples in Korea were examined for the presence of Enterobacter sakazakii. Dried shrimp had the highest contamination rate among the examined dried fish products. E. sakazakii isolates were confirmed using an API 20E kit and a polymerase chain reaction (PCR) targeting the rDNA operons. The isolates were subtyped by pulsed-field gel electrophoresis (PFGE) using XbaI to elucidate the genetic diversity of the organisms. Ten pulsotypes were identified using PFGE and 22 types were identified from the random amplified polymorphism DNA (RAPD) assay. An antibiotic resistance test was performed by disk diffusion assay using eight antibiotics: nalidixic acid, ciprofloxacin, chloramphenicol, ampicillin, tetracycline, gentamicin, kanamycin, and cephalothin. Most of the E. sakazakii isolates were resistant to ampicillin or cephalothin but susceptible to the other antibiotics. The analysis of E. sakazakii isolates using PFGE, RAPD, and the antibiotic resistance test identified 18 composite types from 113 isolates, suggesting diverse sources of contamination.

Isolation and Identification ofEnterobacter sakazakiiin Infant Milk Formulas

Enterobacter sakazakii is a pathogen of increasing medical concern, due to it being implicated in cases of meningitis, sepis, and necrotizing enterocolitis associated with the consumption of contaminated infant milk formula. At present, the method adopted by the Mexican food industry for the isolation and identification of E. sakazakii is based on the methodology of the United States Food and Drug Administration (FDA). However, this procedure is laborious and requires 7 days to obtain a confirmative result. The objective of this study was to determine the presence of E. sakazakii in two types of powdered infant milk formula, using an alternative method that requires less time and a smaller sample size than the FDA protocol. We adapted Leuschner's procedure by eliminating violet red bile glucose agar (VRBG) plates and instead adopting white light incubation to stimulate yellow pigment development. This allowed for isolation of E. sakazakii from powdered infant milk formula using a smaller sample and requiring only 5 days for analysis. Results showed that 92% of formula 1 and 32% of formula 2 was positive for E. sakazakii. The high contamination level of E. sakazakii suggests the need for monitoring hygienic conditions in the manufacturing plant and to assess the prevalence of E. sakazakii in powdered infant milk formulas sold in México.

Enterobacter sakazakii in food and beverages (other than infant formula and milk powder)

The ubiqitous microorganism Enterobacter sakazakii is a rare contaminant of infant formula and may cause severe systemic infection in neonates. So far, other food is not known to cause E. sakazakii-infections. The scarce information about the ecology of E. sakazakii and the uncertainty concerning the source of infection in children and adults warrant a summary of the current knowledge about the presence of this opportunistic microorganism in food other than infant formula. This review systematizes publications on the presence of E. sakazakii in food and beverages until June 2006. Food other than infant formula has been rarely investigated for the presence of E. sakazakii. Nevertheless, this microorganism could be isolated from a wide spectrum of food and food ingredients. E. sakazakii was isolated from plant food and food ingredients like cereal, fruit and vegetables, legume products, herbs and spices as well as from animal food sources like milk, meat and fish and products made from these foods. The spectrum of E. sakazakii-contaminated food covers both raw and processed food. The kind of processing of E. sakazakii-contaminated food was not restricted to dry products. Fresh, frozen, ready-to-eat, fermented and cooked food products as well as beverages and water suitable for the preparation of food, were found to be contaminated by E. sakazakii. Although E. sakazakii-contaminated food do not have general public health significance, measures for prevention should consider the presence of E. sakazakii in food, food ingredients, their processing and preparation as possible source of contamination, colonization or infection.

Invasive Enterobacter sakazakii disease in infants

Enterobacter sakazakii kills 40%–80% of infected infants and has been associated with powdered formula. We analyzed 46 cases of invasive infant E. sakazakii infection to define risk factors and guide prevention and treatment. Twelve infants had bacteremia, 33 had meningitis, and 1 had a urinary tract infection. Compared with infants with isolated bacteremia, infants with meningitis had greater birthweight (2,454 g vs. 850 g, p = 0.002) and gestational age (37 weeks vs. 27.8 weeks, p = 0.02), and infection developed at a younger age (6 days vs. 35 days, p<0.001). Among meningitis patients, 11 (33%) had seizures, 7 (21%) had brain abscess, and 14 (42%) died. Twenty-four (92%) of 26 infants with feeding patterns specified were fed powdered formula. Formula samples associated with 15 (68%) of 22 cases yielded E. sakazakii; in 13 cases, clinical and formula strains were indistinguishable. Further clarification of clinical risk factors and improved powdered formula safety is needed.

Isolation of Enterobacter sakazakii from stable flies, Stomoxys calcitrans L. (Diptera: Muscidae)

Enterobacter sakazakii is an opportunistic foodborne pathogen that causes meningitis, enterocolitis, and sepsis, primarily in immunocompromised infants. Previously, it was suggested that stable flies, Stomoxys calcitrans, were a vector or reservoir of this pathogen. In our study, by means of a culturing approach combined with 16S rDNA PCR-restriction fragment length polymorphism genotyping and sequencing, we screened 928 individual stable flies collected in Kansas and Florida. Two stable flies (0.2%) were positive for E. sakazakii. In addition, 411 (44%) stable flies carried bacteria-forming red colonies (presumably enterics) on a violet red bile glucose agar (mean count = 6.4 x 10(4) CFU per fly), and 120 (13%) stable flies carried fecal coliforms (mean count = 8.7 X 10(3) CFU per fly). Sequencing of 16S rDNA showed that enterics from violet red bile glucose agar were represented by several genera, including Escherichia, Shigella, Providencia, Enterobacter, Pantoea, Proteus, Serratia, and Morganella. Our study shows that stable flies carry bacteria typically present in animal manure (a developmental site of stable fly larvae), which indicates that the natural reservoir of E. sakazakii is the digestive tract or manure of domestic animals. The low prevalence of E. sakazakii associated with stable flies suggests that stable flies do not play a major role as a reservoir or vector of this pathogen.

Enterobacter sakazakii: an emerging pathogen in powdered infant formula

Enterobacter sakazakii represents a significant risk to the health of neonates. This bacterium is an emerging opportunistic pathogen that is associated with rare but life-threatening cases of meningitis, necrotizing enterocolitis, and sepsis in premature and full-term infants. Infants aged <28 days are considered to be most at risk. Feeding with powdered infant formula (PIF) has been epidemiologically implicated in several clinical cases. Infants should be exclusively breast-fed for the first 6 months of life, and those who are not should be provided with a suitable breast-milk substitute. PIF is not a sterile product; to reduce the risk of infection, the reconstitution of powdered formula should be undertaken by caregivers using good hygienic measures and in accordance with the product manufacturer's food safety guidelines.

Enterobacter sakazakii: a coliform of increased concern to infant health

The first cases of neonatal meningitis believed to have been caused by Enterobacter sakazakii were reported in 1961. Prompted by several subsequent outbreaks of E. sakazakii infections in neonates and an increasing number of neonates in intensive care units being fed rehydrated powdered infant formula, considered to be a source of the pathogen, public health authorities and researchers are exploring ways to eliminate the bacterium or control its growth in dry infant formula, processing environments and formula preparation areas in hospitals. Reviewed here are advances in taxonomy and classification of E. sakazakii, methods of detecting, isolating and typing the bacterium, antibiotic resistance, clinical etiology and pathogenicity. Outbreaks of E. sakazakii infections in neonates and adults are summarized. Reports on the presence of E. sakazakii in clinical settings, the environment and foods and food processing facilities are reviewed. Tolerance of the pathogen to environmental stresses, its behavior in powdered and rehydrated infant formulae and hazard analysis and risk management are discussed. Research needs are presented.

Microbiological, epidemiological, and food safety aspects of Enterobacter sakazakii

Enterobacter sakazakii is considered to be an opportunistic pathogen and has been implicated in foodborne diseases causing meningitis or enteritis, especially in neonates and infants. The U.S FoodNet 2002 survey rate of invasive infections with this organism in infants under 1 year of age was 1 per 100,000 infants. Severity of the disease is a matter of concern. In a recent study on the occurrence of E. sakazakii in production environments from food (milk powder, chocolate, cereal, potato, and pasta) factories and households, this organism was isolated with varying frequency from nearly all environments examined, strongly indicating that it is widespread. Stationary phase E. sakazakii cells are remarkably resistant to osmotic and drying stresses compared with other species of the Enterobacteriacae. In this article, we review the literature on this organism with special respect to the information relevant for food safety.

Identification of Enterobacteriaceae from washed and unwashed commercial shell eggs

To evaluate the effect of processing on the safety and quality of retail shell eggs, a storage study was conducted with unwashed and commercially washed eggs. This work demonstrated that commercial processing decreased microbial contamination of eggshells. To know which species persisted during storage on washed or unwashed eggs, Enterobacteriaceae isolates were selected and identified biochemically. For each of three replications, shell eggs were purchased from a commercial processing plant, transported back to the laboratory, and stored at 4 degrees C. Once a week for 6 weeks, 12 eggs for each treatment (washed and unwashed control) were rinsed in sterile phosphate-buffered saline. A 1-ml aliquot of each sample was plated onto violet red bile glucose agar with overlay and incubated at 37 degrees C for 24 h. Following incubation, plates were observed for colonies characteristic of the family Enterobacteriaceae. A maximum of 10 isolates per positive sample were streaked for isolation before being identified to the genus or species level using commercially available biochemical strips. Although most of the isolates from the unwashed control eggs belonged to the genera Escherichia or Enterobacter, many other genera and species were identified. These included Citrobacter, Klebsiella, Kluyvera, Pantoea, Providencia, Rahnella, Salmonella, Serratia, and Yersinia. Non-Enterobacteriaceae also recovered from the unwashed egg samples included Xanthomonas and Flavimonas. Very few washed egg samples were contaminated with any of these bacteria. These data provide useful information on the effectiveness of processing in removing microorganisms from commercial shell eggs.