International increase in Salmonella enteritidis: a new pandemic?

Epidemiology of Salmonella enterica serotype Enteritidis infections in southern Italy during the years 1980-1994

Increased frequency of identification of Salmonella enterica serotype Enteritidis as a causative agent of sporadic and epidemic cases of infection in humans, along with isolation in many parts of the world of strains belonging in a large proportion to a few phage types, has made phage typing alone inadequate for epidemiological investigations. In southern Italy the epidemic increase in isolation of S. enterica serotype Enteritidis that has been observed since 1990 has been associated in approximately 80% of isolates with phage type 4 (PT-4), in agreement with the epidemiological observations from other European countries. We have applied polymerase chain reaction (PCR) ribotyping in association with phage typing to a sample of non-outbreak strains and to all the outbreak strains sent for identification and typing to the Southern Italy Centre for Enterobacterial Pathogens between 1980 and 1994 from hospital and public health laboratories. This technique identified 15 distinct profiles among the 405 strains examined. Whereas a single profile (PCR ribotype a1) appeared to be closely related to PT-8, and to characterize a high percentage of the strains circulating during the early non-epidemic years (1980-1985), 11 patterns were recognizable within PT-4, and 5 within PT-1. Some of these apparently emerged after 1990. This subdivision enabled attribution of the epidemic circulation of PT-4 to multiple clones of S. enterica serotype Enteritidis.

Progression of Salmonella enteritidis phage type 4 strains in São Paulo State, Brazil

A total of 574 S. Enteritidis strains (383 from human sources and 191 from non-human sources) isolated between 1975-95, in São Paulo State, Brazil, were phagetyped. Among the strains isolated during the period of 1975-92, 80.9% of them belonged to phage type 8 (PT-8), but in 1993 strains of PT-4 accounted for 65.2% of all the S. Enteritidis isolates. In the following years, PT-4 strains accounted for 99.7% and 98.4% of phagetyped S. Enteritidis strains. The results obtained suggested that the current epidemic of S. Enteritidis in São Paulo State is clearly associated with the progression of PT-4 strains.

Specific detection of Salmonella enterica serotype Enteritidis using the polymerase chain reaction

An assay was developed for the specific detection of Salmonella enterica serotype Enteritidis, using a novel application of the polymerase chain reaction (PCR). This PCR assay is based on the mismatch amplification mutation assay, an allele-specific reaction, and can discriminate Enteritidis from all other salmonella. PCR primers were selected to amplify a 351-base pair (bp) DNA fragment from the salmonella plasmid virulence A (spv A) gene of Enteritidis. A single base difference at position 272 is present between the nucleotide sequence of the spvA gene of Enteritidis and other salmonellae. The downstream PCR primer, that encompasses position 272 of the Enteritidis spvA gene, was designed to contain a single base mismatch at the penultimate position, resulting in a 1-base mismatch with Enteritidis and a 2-base mismatch with other salmonellae that harbour the virulence plasmid. The upstream primer was completely homologous with the region immediately 5' to the spvA gene. When these primers were used and the annealing and extension reactions were performed at the same temperature, the PCR assay was specific for Enteritidis; no PCR product was detected for 40 other serotypes and 28 different genera examined. In pure culture, 120 colony forming units (c.f.u.) could be detected; a PCR product was observed from template derived from a 5 h enrichment broth culture of chicken seeded with 1 c.f.u. per gram of Enteritidis. This PCR assay is specific, reproducible, and less time consuming than the standard bacteriological methods used to detect Enteritidis.

Application of random amplified polymorphic DNA analysis to differentiate strains of Salmonella enteritidis

A random amplified polymorphic DNA (RAPD) fingerprinting method has been developed to differentiate Salmonella enteritidis isolates. A total of 65 arbitrary primers were screened with S. enteritidis isolates of different phage types. This allowed selection of a panel of primers capable of detecting DNA polymorphisms among S. enteritidis isolates. This panel was used to examine a panel of 29 isolates of S. enteritidis which had been previously characterized by other subtyping methods, including phage typing (PT) (n = 7), ribotyping (RT) (n = 13), and pulsed-field gel electrophoresis (PFGE). Applied collectively, these three methods resolved the collection into 20 different subtypes. However, by the RAPD fingerprinting method alone, 14 RAPD subtypes were revealed. Eight isolates of S. enteritidis phage type 8 that failed to be discriminated by other typing methods (PT, RT, and PFGE) were resolved into three different subtypes by RAPD analysis. In contrast, isolates that were derived from the same sources were not differentiated by any of the subtyping methods employed, including PT, RT, PFGE, and RAPD analysis. This RAPD approach to S. enteritidis subtyping provided more discriminatory power than did any of several other subtyping methods applied individually. Once the challenging step of primer identification was accomplished, determinations of the appropriate concentrations of arbitrary primer, DNA template, and MG2+ ion were also necessary for optimal discriminatory power. The bacterial DNA used in this RAPD protocol was obtained by boiling the bacterial sample. This simple procedure yielded DNA that produced fingerprint patterns as consistent as those obtained from phenol-chloroform-extracted DNA. Clearly, when appropriately constituted primer sets are identified and employed, RAPD analysis provides a simple, rapid, and powerful subtyping method for S. enteritidis.

Development and application of enzyme-linked immunosorbent assay for specific detection of Salmonella enteritidis infections in chickens based on antibodies to SEF14 fimbrial antigen

A double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) was developed to detect antibodies to the SEF14 fimbrial antigen (SEF14-DAS ELISA) and was evaluated for its use in the specific detection of chicken flocks infected with Salmonella enteritidis. The SEF14-DAS ELISA successfully discriminated between chickens experimentally infected with S. enteritidis and those infected with S. panama or S. typhimurium, although the SEF14 responses in adult birds infected with S. enteritidis were detectable but low. In contrast, ELISAs used to detect antibodies to lipopolysaccharide (LPS) and flagella were unable to discriminate between the infected groups of chicks and adult birds infected with different Salmonella serotypes. LPS and flagellar responses were low and variable in chicks, whereas in adult hens they were found to be consistently strong. When flocks naturally infected with S. enteritidis were tested by the SEF14-DAS ELISA and ELISAs to detect LPS and flagellar antibodies, it was found that they could all identify the infected flocks, although there was little correlation between individual serum samples. The study shows that the SEF14-DAS ELISA may offer advantages over existing assays with comparable sensitivities coupled with higher specificities for the serological detection of S. enteritidis-infected chicken flocks.

Phage types and ribotypes of Salmonella enteritidis in southern Italy

Differently from other European countries, Southern Italy was affected by a considerable increase in human infections due to Salmonella enterica subsp. enterica serovar Enteritidis (S. Enteritidis) only after 1990. On the present investigation, two groups of S. Enteritidis strains isolated during the low-incidence period 1980-1984 and the epidemic period 1990-1993, respectively, have been submitted to phage-typing and ribotyping in order to ascertain whether the epidemic increase was determined by the spread of a foreign bacterial clone or not. Among the 150 isolates relative to the aforesaid two periods, 12 different phage types (PTs) were observed. PT4 was the most common phage type among the strains isolated in 1980-1984 (61%) as well as in those of the epidemic period 1990-1993 (72%). PT8 was the second most frequent (33%) phage type in 1980-1984. It was substituted by PT1 (19%) in the 1990-1993 period. Analysis of rDNA patterns obtained after Hinc II digestions and Escherichia coli rRNA hybridizations showed 8 different patterns, A to H. The great majority of the strains studied (140 isolates, 93%) belonged to the ribotype A, showing a similar frequency both in 1980-1984 (36 of 39, 92%) and in 19901993 (104 of 111, 94%). The predominance of PT4 and ribotype A among both preepidemic and epidemic strains is in agreement with the hypothesis that host genetic diversity decline and modern farming practices in the poultry industry have facilitated a widespread dissemination of preexisting endemic strains. This hypothesis urges to plan new strategies in preventing S. Enteritidis infections.

Evaluation of SEF14 fimbrial dot blot and flagellar western blot tests as indicators of Salmonella enteritidis infection in chickens

The serological responses to Salmonella enteritidis flagella (H: g,m) and its fimbrial antigen SEF14 were evaluated as indicators of infection in chickens and to confirm serological results obtained by an ELISA using S enteritidis lipopolysaccharide (LPS) (O: 9,12) as the detecting antigen. The SEF14 antigen and flagella were extracted from S enteritidis and transferred to nitrocellulose paper for use in Western and dot blot tests. Antisera to 19 salmonella serotypes including S enteritidis were raised in rabbits and their cross reactivity to the flagellar and SEF14 antigens was evaluated. Cross reactivity with the SEF14 antigen was found in one antiserum, raised against S blegdam, and to flagella in eight of 19 antisera raised against various salmonella serotypes, most of which shared the flagellar factors g or m with S enteritidis. The intensity of cross reaction to flagella was strongest in S derby and S blegdam antisera. Antisera raised in chickens against S typhimurium and S panama did not cross react in either test, and neither did pooled sera from eight-week-old salmonella-free, broiler breeder parent chickens. Field sera from two commercial flocks with no history of salmonella infection were negative when tested by the LPS ELISA. These sera were also negative when tested by the flagellar and SEF14 blots. S enteritidis infection in a commercial laying flock was detected initially when the sera were tested by the LPS ELISA and confirmed in individual and pooled sera by the SEF14 and flagellar tests. S enteritidis PT4 was isolated from this flock post mortem.

The changing epidemiology of foodborne diseases

The epidemiology of foodborne diseases in the United States have changed in recent decades as new pathogens have emerged, the food supply has changed, and the number of people with heightened susceptibility to foodborne diseases has increased. Emerging pathogens are those that have recently increased or are likely to increase within 2 decades. Emergency is often the consequence of changes in some aspect of the social environment. The global economy, for example, has facilitated the rapid transport of perishable foods, increasing the potential for exposure to foodborne pathogens from other parts of the world. Other factors altering foodborne disease patterns are the types of food that people eat, the sources of those foods, and the possible decline in public awareness of safe food preparation practices. Aging, extension of life expectancy for the chronically ill through medical technology, and the AIDS epidemic have increased the public health impact of foodborne diseases because they increase the proportion of the population susceptible to severe illness after infection with a foodborne pathogen. The evolving epidemiology of foodborne diseases must be monitored and understood to implement appropriate prevention technologies.

The first Salmonella enteritidis phage type 1 infection of a commercial layer flock in Finland

The first Salmonella Enteritidis phage type (PT) 1 infection in a commercial layer flock of 2700 birds in Finland occurred in 1995. All the birds were ordered to be killed, the eggs to be destroyed and access to the layer house was denied in order to prevent spread of the infection. Ninety one commercial layers, 61 replacement pullets and 1062 eggs were collected for the analyses. The total infection level of the flock was 8%, concentrated on the 2 older age groups. S. Enteritidis PT1 was isolated from livers (5%), ovaries (2%) and from caeca (3%), of which 2 positive samples were detected with pre-enrichment and 3 without pre-enrichment by cultivation Rambach agar. Eight % of 105 pooled egg samples were positive, of which 2 were detected only from contents and 3 only from shells indicating both oviductal and faecal contamination routes of eggs. The results support the use of the extended sampling procedure in poultry flocks suspected of human food-borne Salmonella outbreaks of invasive serotypes, including not only faecal but also environmental, organ, blood and/or egg samples.

The first Salmonella enteritidis phage type 1 infection of a commercial layer flock in Finland

The first Salmonella Enteritidis phage type (PT) 1 infection in a commercial layer flock of 2700 birds in Finland occurred in 1995. All the birds were ordered to be killed, the eggs to be destroyed and access to the layer house was denied in order to prevent spread of the infection. Ninety one commercial layers, 61 replacement pullets and 1062 eggs were collected for the analyses. The total infection level of the flock was 8%, concentrated on the 2 older age groups. S. Enteritidis PT1 was isolated from livers (5%), ovaries (2%) and from caeca (3%), of which 2 positive samples were detected with pre-enrichment and 3 without pre-enrichment by cultivation Rambach agar. Eight % of 105 pooled egg samples were positive, of which 2 were detected only from contents and 3 only from shells indicating both oviductal and faecal contamination routes of eggs. The results support the use of the extended sampling procedure in poultry flocks suspected of human food-borne Salmonella outbreaks of invasive serotypes, including not only faecal but also environmental, organ, blood and/or egg samples.

Molecular epidemiology of Salmonella enteritidis. An outbreak and sporadic cases studied by means of pulsed-field gel electrophoresis

Large outbreaks of diarrhoea due to Salmonella enteritidis in Aichi-ken, Japan, provided the opportunity to investigate aspects of the molecular epidemiology of this and related organisms. This was performed by comparing the plasmid profile types, phage types, antimicrobial resistance, and the restriction fragment length polymorphisms (RFLPs) by pulsed-field gel electrophoresis (PFGE) of S. enteritidis from outbreaks and sporadic cases. Among the isolates studied, 10 distinctive RFLP types were found with XbaI and four with NotI, while 12 combination types were identified among the 68 isolates from 16 Health Centres in Aichi-ken, Japan. A total of 22 isolates from four outbreaks, however, had the same RFLP and phage types. The RFLP type was subdivided by means of the plasmid profile and phage type. Conversely, plasmid profile and phage type were separated by means of RFLP. This PFGE method may prove useful for subclassifying S. enteritidis and differentiating isolates of the same plasmid profile and phage type.

Interference between Salmonella serotypes in intestinal colonisation of chickens: correlation with in vitro behaviour

The effect of colonisation of the alimentary tract of newly hatched chicks by different Salmonella serotypes on the establishment in the gut by other Salmonella strains inoculated afterwards was assessed. Although profound inhibition of colonisation had been found previously to be genus-specific, considerable variation was found within the Salmonella genus. Some strains were found to be much more inhibitory than others and some were more easily inhibited than were others. There was not an absolute relationship between inhibitory activity and colonisation ability. No relationship was seen between inhibition and serotype or phage types within serotypes. There was no correlation between in vivo inhibition and the extent of inhibition that occurred in early stationary phase cultures in rich, undefined broth cultures.

Current perspectives in salmonellosis

Salmonellosis remains an important human and animal problem worldwide and, despite extensive research effort, many of the details of its pathogenesis are not known. While there have been recent advances in some aspects of pathogenesis, other areas are not understood. The host adaptation shown by several serotypes and the recent dramatic changes in the predominance of particular serotypes are examples. Molecular techniques using in vitro model systems have identified several genes involved in adhesion and invasion, though their function and even their relevance to disease remain poorly defined. Similarly, several potential toxins have been identified and the genes cloned, although their significance is far from clear. Some of the essential genes on the large virulence plasmids have been defined, and these are known to be necessary for the establishment of systemic infection. Two of these genes are regulatory, but the function of the other genes is unknown. A general theme has been the identification of gene systems involved in regulation of virulence. New vaccines, based on 'rational attenuation' are being designed, and these have also been used to carry heterologous antigens; such vaccines are currently undergoing trials. The improved understanding of the pathogenesis of salmonellosis may also provide a model of wide applicability to a more general understanding of bacterial pathogenesis. New techniques, including the polymerase chain reaction, are being applied to diagnose salmonellosis.

Molecular analysis of Salmonella enteritidis by pulsed-field gel electrophoresis and ribotyping

A total of 61 isolates of Salmonella enteritidis were analyzed by the techniques of pulsed-field gel electrophoresis (PFGE) and ribotyping. Twenty-three of the isolates were from Zurich, Switzerland, and 38 isolates were from the University Hospital, Kuala Lumpur, Malaysia. Five of the Malaysian isolates were hospital-related outbreak strains and were shown to be indistinguishable by PFGE analysis following digestion with three different restriction endonucleases, XbaI (5'-TCTAGA-3'), SpeI (5'-ACTAGT-3'), and AvrII (5'-CCTAGG-3'). The PFGE pattern of an isolate from a suspected carrier staff nurse was found to be identical to those of the hospital outbreak isolates. These isolates were also indistinguishable by ribotyping with SmaI and SphI. The same single PFGE pattern was also detected in 29 of 32 sporadic isolates of S. enteritidis. Four closely related ribotypes were detected among these 29 isolates. Similarly, outbreak-related strains from Switzerland showed close genetic identity by PFGE and ribotyping. Strains obtained from poultry showed more variations in their PFGE patterns and ribotypes, although the patterns were still closely related. In addition, SphI ribotypes A and D among the Swiss strains correlated with phage types 4 and 8, respectively. No correlation of phage types with PFGE pattern was noted. Both PFGE and ribotyping indicate that the S. enteritidis strains circulating in Malaysia and Switzerland are very similar and may be clonally related. Comparison of the PFGE patterns with the ribotypes for 23 Swiss and 16 Malaysian isolates showed that there was a 69% concordance in the grouping of isolates. We conclude that the close genetic similarity observed between epidemiologically unrelated and outbreak-related isolates of S. enteritidis suggests that both PFGE and ribotyping are of limited value in the epidemiological analysis of these particular isolates, possibly because of the highly clonal nature of pathogenic strains of S. enteritidis.

Evaluation of new culture media for rapid detection and isolation of salmonellae in foods

Conventional methods for Salmonella detection in foods can require up to 6 and at least 4 days. We have observed that the total analysis time can be reduced to 48 h by using Salmosyst broth as a liquid medium for both preenrichment and selective enrichment and Rambach agar (RA), a new selective plate medium. In samples of artificially contaminated ground beef Salmonella enteritidis was detected at a concentration of 0.4 CFU/g (10 CFU/25 g) by both a conventional method and the new method. Of 519 samples of foods for sale, 38 were Salmonella positive by both methods while 471 were negative. Nine samples which were negative by the conventional method were positive by the Salmosyst-RA method, while one sample positive by the first method was negative by the last. Therefore, the Salmosyst-RA method showed 97.9% sensitivity compared with the 81.2% sensitivity of the conventional method. The new method was also highly specific (98% specificity) in presumptive identification of Salmonella colonies. Furthermore, a 6-h preenrichment in Salmosyst broth has been proved sufficient for the repair of heat-injured Salmonella cells and for subsequent recovery by selective enrichment. In conclusion, the Salmosyst-RA method shows several advantages over both conventional and rapid noncultural methods: (i) only two media are required instead of the five media for conventional methods; (ii) in real time it is comparable to other rapid noncultural methods, which require 30 to 31 h; (iii) it is highly sensitive and specific; and (iv) it allows the isolation of Salmonella strains which can be characterized by appropriate phenotypic and genotypic typing methods for epidemiological investigations.

[Food poisoning outbreak caused by Salmonella Enteritidis in the northwest of São Paulo State, Brazil]

A foodborne outbreak which affected 211 persons occurred, in a School, in 1993. The epidemiological data obtained by interviewing the affected and non affected persons sampled showed as predominant symptoms: diarrhoea, fever (77.7%), abdominal cramps (67.7%), vomiting (65.8%), hot-and-cold sensations (54.5%) and headache (44.5%). The median incubation period was of 17 hours, the limits being 3 and 29 hours. The disease period was of from 3 to 4 days. The food concerned was a kind of paté, a mayonnaise mixture prepared with fresh eggs with boiled potatoes that was consumed with bread. The biological material analysis-3 coprocultures, and leftovers of the food revealed the presence of one and the same organism: Salmonella Enteritidis. In the food, the numbers of this bacterium per gram were sufficient to account for the manifestation of the disease (10(4) and 10(5)g). The antibiogram of all th isolates showed the same sensibility pattern. The preparation related to this outbreak suggests the endogenous contamination of the eggs; the cross contamination-the outbreak affected three school periods, as the food was prepared separately for each school period; and the conditions under which the food was kept during the time from preparation to consumption. The observation of the 3 food handlers, by successive coprocultures, for one week, indicates that they were not asymptomatic carriers nor were they affected as a result of this outbreak by the causal bacteria.

Analysis of Salmonella enteritidis isolates by arbitrarily primed PCR

An arbitrarily primed PCR (AP-PCR) was developed to analyze the genomic DNAs of Salmonella enteritidis isolates from human outbreaks and from avian sources. The AP-PCR generated seven distinct randomly amplified DNA patterns among the S. enteritidis isolates studied. Differences in the DNA patterns among isolates of S. enteritidis phage types 13a and 8 as well as among S. enteritidis phage type 14b were observed. The AP-PCR analysis can be used to determine the differences among isolates within the same phage types and may be useful for tracing back the source of S. enteritidis outbreaks in humans more precisely.

Phage conversion in Salmonella enterica serotype Enteritidis: implications for epidemiology

A model system for the study of phage conversion of Salmonella enterica serotype Enteritidis is reported. Temperate phages 1,2,3 and 6 from the phage typing scheme were used to convert several individually recognized phage types into others. Phage type 4 was converted to PT8, PT6a to PT4, PT6a to PT7, PT13 to PT13a and PT15 to PT11; some new phage lysis patterns were also detected. This model was used to examine the relationships between phage types within a previously defined clonal lineage, SECLIII, to establish whether or not Enteritidis like Salmonella enterica serotype Typhi and Salmonella enterica serotype Paratyphi B possessed type determining phages. We were able to convert PT1 to PT20, and PT15 to PT11.

Salmonella enteritidis: the egg and I

The world-wide clinical incidence of Salmonella Enteritidis has increased markedly. The increase is associated with the enhanced ability of the bacterium to systemically colonise layer chickens. Subsequent contamination and consumption of intact shell eggs from colonised layer hens, either directly or in foods containing raw or lightly cooked eggs, causes human disease. Despite investigation, no change in the biology of the bacterium has been correlated with increased colonisation in chickens. To date, no method of control at the production level has proven effective; consumer education is the best means of minimising the public health risk.

Identification of the domain which determines the g,m serotype of the flagellin of Salmonella enteritidis

Clones expressing fragments of the flagellin protein of Salmonella enteritidis were constructed and screened with a g,m-specific monoclonal antibody. Results showed that the g,m epitope is localized between amino acids 258 and 348 of the flagellin. The fliC gene, encoding the flagellin of S. enteritidis, was proven to be the only flagellin gene present in S. enteritidis.

DNA probe for detecting Salmonella enteritidis in food

Salmonellosis is the most frequently reported foodborne illness in the United States, with Salmonella enteritidis being the leading cause of these outbreaks. Nucleotide sequence comparisons of the Salmonella plasmid virulence (spv) genes of S. enteritidis with those of S. typhimurium and S. dublin have revealed that a single base-pair change unique to S. enteritidis is present in the spvA gene. An 18-base synthetic oligonucleotide probe (SE-probe) that is completely homologous to the spvA gene of S. enteritidis but which has one base pair mismatch with other salmonellae was shown to be specific for S. enteritidis. In colony hybridization blots, 129 isolates of S. enteritidis, 29 other species of Salmonella, and 17 non-Salmonella spp. were tested with the SE-probe. The SE-probe hybridized with 96% of the S. enteritidis strains tested but did not react with the other Salmonella or non-Salmonella strains. These data suggest that the SE-probe can be used in a specific and rapid detection assay for S. enteritidis.

Plasmid analysis of Australian strains of Salmonella enteritidis

Using an in-well lysis technique, 73 Australian strains of Salmonella enteritidis were shown to possess a large plasmid, similar in size to that possessed by a reference phage type 4 strain. Restriction analysis of the large plasmid from nine strains using EcoRI, HindIII and PstI suggested that these plasmids are similar to or the same as the 38 MDa plasmid described in strains of this species from other parts of the world.

A Salmonella enteritidis 11RX pilin induces strong T-lymphocyte responses

Our previous work, using proteins fractionated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis to define antigens of Salmonella enteritidis 11RX able to stimulate T cells from S. enteritidis 11RX-primed (BALB/c x C57BL/6)F1 mice, had indicated the presence of a major antigenic determinant of 14 to 18 kDa (H.-M. Vordermeier and I. Kotlarski, Immunol. Cell. Biol. 68:299-305, 1990). The 14-kDa size is similar to that of the monomeric units of one of the fimbrial structures, SEF14, produced by a human enteropathogen, S. enteritidis 27655 (J. Feutrier, W. W. Kay, and T. J. Trust, J. Bacteriol. 168:221-227, 1986). Here we present data which indicate that S. enteritidis 11RX also produces this protein and that it is able to elicit delayed-type hypersensitivity reactions in S. enteritidis 11RX-primed animals and to stimulate in vitro proliferation of, and cytokine release from, T cells obtained from these animals, implying that this fimbrial protein is likely to be an important immunogen of S. enteritidis. The protein was purified to homogeneity and is free from contamination with lipopolysaccharide. Standard immunoblot analysis with unabsorbed S. enteritidis 11RX antiserum and antiserum absorbed with Salmonella typhimurium C5 and various strains of Escherichia coli, as well as a panel of anti-14-kDa-protein monoclonal antibodies, suggests that this fimbrial protein is not the common antigen expressed by a number of organisms belonging to the family Enterobacteriaceae. Immunogold electron microscopy with one of these monoclonal antibodies confirms that the 14-kDa protein and SEF14 are identical.

Changing epidemiology of human salmonellosis in Hong Kong, 1982-93

A comprehensive analysis of the epidemiology of salmonellosis in a major hospital in Hong Kong from 1982-93 is reported. The trend of salmonella isolations over the past 12 years and changes in the occurrence of individual serotypes are delineated. A total of 5328 isolates were analyzed. Groups B (Salmonella typhimurium and S. derby) and E (S. anatum) were the commonest serogroups isolated from the intestinal tract in all age groups. A significant increase in the isolation of group D salmonellae has been observed since 1989. This is accounted for by a substantial rise in S. enteritidis isolation as seen in Western countries, despite a concomitant decrease of S. typhi. The extraintestinal isolation index (EII) is proposed as an index of the virulence potential of individual serotypes and serogroups. Group D salmonella was found to be the most invasive serogroup. While group D was the predominant serogroup isolated from extraintestinal sites in patients older than 1 year, group B serotypes (especially S. typhimurium) were more frequently seen in infants younger than 12 months.

Salmonella enteritidis phage types in Germany

In order to monitor the epidemiological situation of S. enteritidis in Germany, in 1990-91 1138 isolates from more than 180 locations in West Germany were phage typed. 1124 strains (98.8%) from all sources were typeable, belonging to 21 different phage types (PT). PT4 strains were isolated most frequently (70.8%). In addition, PT7, 25, 34 and 8 were of epidemiological relevance with incidences of 7.2 to 4.5%. The comparison of data shows that in Germany, like in other parts of Europe, PT4 predominates. This phage type is, however, infrequent in North America, where PT8 has the highest incidence.

Genomic lineage of Salmonella enterica serovar Dublin

Thirty five strains of the host adapted Salmonella serotype Dublin (S. Dublin) have been characterized by IS200 patterns, ribotyping, pulsed-field gel electrophoresis (PFGE), restriction fragment polymorphism after hybridization with five randomly cloned DNA-fragments of S. enteritidis (RFLP), and plasmid profiling in order to divide the strains into 'genomic lines'. For comparison, 20 other strains of 9 different group-D serotypes were included. The IS200 patterns were identical in all strains of S. Dublin examined. These patterns were different from those observed in other group-D Salmonella with the exception of one strain S. Enteritidis phage type 11 and a strain of S. Rostock. The insertion element IS200 was not detected in strains of S. Dar-es-Salam, S. (II) 9,12:z:-, and S. Panama. RFLP, based on probing with five random cloned chromosomal fragments gave the same pattern in all strains except for one isolate from the UK. This strain was also found to have an unique PFGE pattern and ribotype. Among the remaining strains, three different PFGE patterns and 7 different ribotypes were observed. Based on all four typing methods, 8 different 'genomic lines' of S. Dublin were identified. The same grouping could be obtained from the use of ribotyping alone, but PFGE and RFLP were found to provide valuable information on possible relationships between ribotypes. Seven different plasmid profiles and a group of strains without plasmids were observed. In several cases, the same plasmid profile was shown to be present in more than one 'genomic line'.

Molecular epidemiology of ampicillin-resistant clinical isolates of Salmonella enteritidis

During the last 6 years in Greece, there has been a significant increase in the number of ampicillin-resistant Salmonella clinical isolates reported. In this study 23 ampicillin-resistant Salmonella strains, consecutively isolated from patients with epidemiologically unrelated cases of food poisoning, were investigated. By serotyping and phage typing, 21 of these strains were identified as Salmonella enteritidis phage type 6a, 1 was identified as Salmonella typhimurium, and 1 was identified as Salmonella saintpaul. By plasmid pattern analysis, the 21 S. enteritidis strains were further differentiated into five groups. Group I consisted of 5 strains (carrying two plasmids of ca. 38 and 34 MDa), group II consisted of 10 strains (three plasmids of ca. 38, 34, and 2.5 MDa), group III consisted of 3 strains (four plasmids of ca. 38, 34, 15, and 2.5 MDa), group IV consisted of 1 strain (five plasmids of ca. 100, 38, 34, 24, and 15 MDa), and group V consisted of 2 strains (three plasmids of ca. 100, 38, and 24 MDa). Ampicillin resistance was easily transferred to Escherichia coli and was associated with the transfer of the 34-MDa plasmid, classified in the N incompatibility group for all strains of groups I to IV, and with the transfer of the 100-MDa plasmid for the group V strains. EcoRI restriction endonuclease digestions showed an extensive homology among the 34-MDa conjugative R plasmids. Hybridizations of the EcoRI restriction fragments of the 34-MDa plasmids with a TEM-type probe revealed the locus of the beta-lactamase gene to be situated on a ca. 6.6-MDa fragment, common in all plasmids. These results indicate that ampicillin resistance in Greece is due to the spread of a limited number of clones of S. enteritidis phage type 6A, carrying related 34-MDa R plasmids. Work is in progress to obtain a better understanding of ampicillin resistance in S. enteritidis.

Changes in human ecology and behavior in relation to the emergence of diarrheal diseases, including cholera

Human populations throughout the world can be found in diverse conditions. A proportion of the population of developing countries lives in deprived conditions characterized by ramshackle housing, lack of piped water and sanitation, and widespread fecal contamination of the environment. Enteric infections, particularly due to bacterial pathogenes, are readily transmitted under these circumstances. In contrast, the majority of inhabitants of industrialized countries live in a sanitary environment that generally discourages the transmission of enteric pathogenes, particularly bacteria. In both these ecologic niches, changes in human ecology and behavior are leading to the emergence of certain enteric infections. Relevant factors in developing areas include urbanization (leading to periurban slums), diminished breastfeeding, and political upheaval that results in population migrations. In industrialized areas, large-scale food production (e.g., enormous poultry farms), distribution, and retailing (e.g., fast-food chains) create opportunities where widespread and extensive outbreaks of food-borne enteric infection can ensue if a breakdown in food hygiene occurs.

Salmonella serovars and phage types in humans and animals in Australia 1987-1992

This report summarises the range of Salmonella serovars and phage types found in humans in Australia during the years 1987 to 1992 inclusive, and compares them with serovars from food animals and raw meats for the same period. It also compares the major serovars found from different animal sources with their frequency from humans. The common serovars from animal feeds are compared with their frequency from animals.

The characterization of Danish isolates of Salmonella enterica serovar Enteritidis by phage typing and plasmid profiling: 1980-1990

Plasmid profiling, phage typing and antimicrobial resistance typing have been carried out on 736 isolates of Salmonella enterica serovar Enteritidis collected in Denmark during the period 1980 to 1990. Strains originated from cases of human salmonellosis, broiler poultry flocks, layer poultry flocks, quarantined imported poultry, environmental samples from hatchery units, and from bovines. Phage type (PT) 1 was found to be the most common type among isolates of poultry origin (57.6%) followed by PT4 (28.8%). Isolates belonging to PT8 were found exclusively in imported birds. Phage typing of a representative sample of human isolates revealed the predominance, as in most other Western European countries, of PT4 (61.8%). PT1, however, was found in 17.0% of human strains, a much higher incidence than expected. Antibiotic resistance was observed in 4 out of 107 human isolates (3.7%) and 2 out of 205 non-human isolates (1%) tested.

Dose-response effects in an outbreak of Salmonella enteritidis

The effects of ingested Salmonella enteritidis (SE) dose on incubation period and on the severity and duration of illness were estimated in a cohort of 169 persons who developed gastroenteritis after eating hollandaise sauce made from grade-A shell eggs. The cohort was divided into three groups based on self-reported dose of sauce ingested. As dose increased, median incubation period decreased (37 h in the low exposure group v. 21 h in the medium exposure group v. 17.5 h in the high exposure group, P = 0.006) and greater proportions reported body aches (71 v. 85 v. 94%, P = 0.0009) and vomiting (21 v. 56 v. 57%, P = 0.002). Among 118 case-persons who completed a follow-up questionnaire, increased dose was associated with increases in median weight loss in kilograms (3.2 v. 4.5 v. 5.0, P = 0.0001), maximum daily number of stools (12.5 v. 15.0 v. 20.0, P = 0.02), subjective rating of illness severity (P = 0.0007), and the number of days of confinement to bed (3.0 v. 6.5 v. 6.5, P = 0.04). In this outbreak, ingested dose was an important determinant of the incubation period, symptoms and severity of acute salmonellosis.

Phylogenetics of Salmonella enteritidis

The phylogenetics of Salmonella enteritidis is reviewed. Data from RFLP typing with cloned chromosomal DNA, rRNA genes and insertion sequence probes are described. Human isolates of this serovar exhibit a high degree of genotypic homogeneity. Multilocus enzyme electrophoresis defines S. enteritidis as a polyphyletic serovar closely related to S. dublin, S. gallinarum and S. pullorum. Two main classes of virulence plasmids are found in S. enteritidis. We report a comparative study of genotype for three principal clones of S. enteritidis, six other serovars carrying the g flagellar antigen, and S. pullorum. It is suggested that S. enteritidis occupies an ancestral and pivotal position among these Salmonellae.

A salmonella data bank for routine surveillance and research

A salmonella data bank has been established in the State of Brandenburg, Germany, with due steps being taken to ensure the protection of personal data. The system of data collection and rapid return of information to the local health and veterinary services have become essential elements in intersectoral cooperation in case investigation, disease prevention, and epidemiological research. A number of issues, particularly those concerning the pathways of infection, characteristics of clusters of cases, and the infection of different population strata can now be examined and monitored. An important feature of the data bank is its accessibility by local as well as central state services using a PC-based program and the wide interdisciplinary circulation of regular reports. Preliminary results on the data volume, age distribution of cases, and salmonella isolation rates in different population strata are presented. The data bank supports studies on marketing and purchasing patterns of agricultural products representing potential vehicles of infection, and it should encourage investigations to trace the reservoirs of infection and contamination points along the food chain.

Intervention strategies for Salmonella enteritidis in poultry flocks: a basic approach

Poultry laying flocks can become infected with Salmonella enteritidis by several routes. In this study a model is presented of the cumulative infection curve of S. enteritidis in laying flocks. Based on this model and practical results the contribution of different routes to the infection can be estimated providing a basis for an effective intervention strategy. For illustration, the cumulative infection curve of S. enteritidis in Dutch laying flocks is analysed. This curve shows a low level of infection at the start of the laying period which indicates that the contribution of the vertical infection route (from infected breeding flocks to progeny) is small. The course of the infection curve indicates that there is a high probability of infection in the first part of the laying period. The result suggests that the laying flocks become infected mainly from the farm environment including not properly cleaned and disinfected poultry houses and infected vermin present on the farm. As a consequence, intervention in The Netherlands should be directed to trace S. enteritidis-contaminated laying farms and eradicate the contamination.

Serological diagnosis of Salmonella serotype enteritidis infections in poultry by ELISA and other tests

Serological methods have increasingly been used for the detection of invasive Salmonella serotypes including enteritidis in poultry. Different types of ELISA, particularly indirect or double antibody-blocking assays using a variety of antigens such as lipopolysaccharide, flagella and SEF14 fimbrial antigen are used as part of control programmes in a number of countries. There are many advantages to using such assays for preliminary screening of flocks prior to using bacteriological culture methods.

Contamination of egg shell and contents with Salmonella enteritidis: a review

Salmonella enteritidis can contaminate the contents of clean, intact shell eggs as a result of infections of the reproductive tissue of laying hens. The principal site of infection would appear to be the upper oviduct. In egg contents the most important sites of contamination are either the outside of the vitelline membrane or the albumen surrounding it. In fresh eggs, only few salmonellas are present and as albumen is an iron-restricted environment, growth will only occur once storage-related changes to vitelline membrane permeability, which allow salmonellas to invade yolk contents, have taken place. When this happens high populations are achieved in both yolk contents and albumen. Some eggs from naturally infected hens have been found to contain large numbers of S. enteritidis. The rate of change in membrane permeability is temperature-dependent. In eggs stored at 20 degrees C, yolk invasion is uncommon until eggs have been stored for 3 weeks. In stimulated kitchen conditions where temperatures reached 30 degrees C, salmonellas could grow rapidly after a few days.

Salmonella enteritidis in Canada

During the last few years the prevalence of Salmonella enteritidis in people in Canada has increased slightly from 9 to 12% of all Salmonella isolates. Nation-wide surveys showed a low prevalence of S. enteritidis in poultry flocks: S. enteritidis was isolated from environmental samples of 2.7% of layer flocks and of 3% of broiler flocks. The overall prevalence of S. enteritidis-contaminated eggs from two flocks with infected hens was less than 0.06%. With the exception of S. enteritidis phage type (PT) 4, which has not been isolated from poultry in Canada, the phage types that occur most commonly in poultry (PT 8, 13 and 13a) are also the most prevalent in people. Phage typing was the most effective method for subdividing S. enteritidis strains. Eighty-three percent of the S. enteritidis isolates from poultry and its environment were sensitive to antimicrobial agents. The reasons why strains of the same phage type differ in virulence need to be elucidated.

Abscess of the submandibular gland caused by Salmonella typhimurium biotype 10

From an abscess of the submandibular gland, Salmonella typhimurium biotype 10 was isolated in pure culture. The patient had no history of gastroenteritis, and Salmonella could not be isolated from faeces.

Differentiation of Salmonella enteritidis phage type 8 strains: evaluation of three additional phage typing systems, plasmid profiles, antibiotic susceptibility patterns, and biotyping

Three additional phage typing systems for Salmonella enteritidis, plasmid analysis, biochemical tests, and antimicrobial susceptibility tests, were used in an attempt to subdivide 30 phage type 8 (phage typing system used by the WHO International Center for Enteric Phage Typing, London, England) isolates. These isolates represented 18 different egg-related outbreaks (21 strains) and 9 reference strains or strains that were not egg-associated. Only 7 of the 30 strains (28%) were subdivided by one or more of the methods used; this included 3 of the 21 strains from egg-related outbreaks. Twenty-seven strains contained a 55-kb plasmid that is associated with S. enteritidis. Of 65 additional phages tested, 2 from the phage typing system obtained from the Pasteur Institute, Paris, France, were useful in differentiating the three strains that lacked the 55-kb plasmid. Although the results obtained for the 21 strains from egg-related outbreaks showed that the strains had minor phenotypic differences, the overall results suggested that the strains may represent a single clone. Studies are planned to test additional phages and other typing methods to see whether strains of phage type 8 can be further differentiated.

Molecular typing methods for S. enteritidis

The predominance of certain phage types of Salmonella enteritidis in various countries makes further epidemiological subgrouping necessary. Today this is achieved by using molecular typing methods. For various bacterial species, plasmid profiling, the pattern of outer membrane proteins and lipopolysaccharides, the fingerprinting of total genomic DNA including ribotyping, and multilocus enzyme electrophoretic typing, have proven very useful. When such methods have been applied to S. enteritidis, they revealed a homogeneous, clonal structure in contemporary PT4 isolates. Furthermore they indicate that the clone observed today emerged from a heterogeneous population before the onset of the epidemic.

Salmonella enteritidis in Argentina

A significant increase in the number of isolations of Salmonella enteritidis has been observed in Argentina since 1986. Outbreaks of foodborne diseases in humans were associated with the consumption of raw or undercooked hens' eggs. Between 1986 and the first 6 months of 1993 there were 150 outbreaks reported, affecting more than 6000 persons. A total of 71.3% of these outbreaks were confirmed by stool cultures, and 47.3% by bacteriological study of the food implicated in the outbreak. A permanent surveillance of salmonellosis is imperative, taking into account the persistence of Salmonella enteritidis isolations in sporadic cases and in new outbreaks.

The socio-economic impact of human Salmonella enteritidis infection

Recent government and public concern about the recorded increase in human salmonellosis in the UK and abroad has stimulated investigations of both the causes and consequences of these infections. This paper discusses the framework for economic analysis of food-borne disease and problems associated with the estimation of costs. A brief review of the literature in this area is given and the results of a national study of the costs of human salmonellosis in England and Wales are presented and used to estimate the likely costs of S. enteritidis infection.

Pathogenicity of Salmonella enteritidis in poultry

Salmonella enteritidis is a common pathogen of all species of mammals and fowls. The recent increase in the number of outbreaks of food poisoning due to S. enteritidis in man was epidemiologically analysed, and it was considered that contaminated eggs or egg products were the major source of this infection. To assist in prevention and eradication of human food poisoning many investigators have studied the pathogenicity of S. enteritidis in poultry. Gross pathological observations after natural and experimental infections with S. enteritidis in poultry revealed that this organism may cause systemic infection in chicks and laying hens accompanied by prolonged faecal shedding. Some variations in the mortality rates, clinical symptoms, faecal shedding and frequency of production of contaminated eggs were observed in the chicks and hens experimentally infected with S. enteritidis isolates. Choice of bacterial strain, phage type, age of bird and inoculum size may affect the outcome of an infection. Moreover, isolation of the organisms from the ovaries, oviducts and egg contents indicates the possibility of transovarian infection of S. enteritidis in chickens. Some virulence factors associated with S. enteritidis are also reviewed in the present paper.