A large outbreak of Salmonella enteritidis phage type 4 associated with eggs from overseas

Zoonoses of ferrets, hedgehogs, and sugar gliders

With urbanization, people live in close proximity to their pets. People often share their living quarters and furniture, and this proximity carries a new potential for pathogen transmission. In addition to the change in lifestyle with our pets, new exotic pets are being introduced to the pet industry regularly. Often, we are unfamiliar with specific clinical signs of diseases in these new exotic pets or the routes of transmission of pathogens for the particular species. This article reviews zoonoses that occur naturally in ferrets, hedgehogs, and sugar gliders, discussing the occurrence and clinical symptoms of these diseases in humans.

Emergence of Salmonella serotype Enteritidis phage type 4 in Hawaii traced to locally-produced eggs

OBJECTIVES

In August 1998, the Hawaii Department of Health observed a nine-fold increase in human Salmonella Enteritidis (SE) infections. Isolates were phage type 4 (PT4). An investigation was initiated to determine the source of the outbreak.

METHODS

A matched case-control study enrolled 38 cases. Cases were Hawaii residents with diarrhea and a stool culture yielding SE.

RESULTS

Eating eggs was associated with SE illness; 28 cases (74%) ate eggs in the three days before illness compared to 34 (45%) of 76 controls (MOR=3.0, 95% CI=1.4-7.4). Eighteen (47%) of 38 case patients ate eggs from Farm A compared to 11 (14%) of 76 controls (MOR=12.0, 95% CI=3.1-78.0); the eggs were not properly handled or refrigerated. Cultures from Farm A yielded SE. Human illness subsided following selective flock depopulation.

CONCLUSIONS

This outbreak highlights the importance of proper handling and refrigeration of eggs. The egg industry must implement quality assurance programs to prevent the spread of SE PT4 and human SE illness.

Investigations into possible alternative decontamination methods for Salmonella enteritidis on the surface of table eggs

Investigations into various alternative techniques for decontamination of the surfaces of artificially contaminated shell eggs were carried out. Ionized air, exposure to ozone in a dry atmosphere and use of a commercial herbal antibacterial product were not effective. Application of ozone in a humid environment was only partially effective but a commercial ionized water anolyte was highly effective in eliminating Salmonella from egg surfaces.

[Food borne disease outbreaks caused by Salmonella enteritidis]

OBJECTIVE

It is to describe outbreaks of salmonellosis reported from July 1993 through June 1997 in the Northwest region of S. Paulo State, Brazil, one of the areas where several foodborne outbreaks of salmonellosis have been recently detected.

METHOD

Data of 19 epidemiological investigations were analysed; 87 stool specimens and 38 food samples (including 12 of shell eggs) were processed for microbiological analysis. Salmonella strains were identified by serotyping, phagetyping and antimicrobial susceptibility testing.

RESULTS

There were 906 ill persons including 295 hospitalized patients. Phage type 4 (PT 4) Salmonella Enteritidis strains were isolated from 80.5% of stool samples, from all food samples and from 41.7% of eggs. Of the outbreaks, 95.7% were associated with the consumption of food containing raw or undercooked eggs. All strains were susceptible to the 13 antimicrobials, except the strains from the nosocomial outbreak.

CONCLUSIONS

The results obtained show the need for the implementation of control measures regarding egg and storage, as well as for guidance to the public as to the risks involved in the consumption of inadequately prepared eggs.

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.

[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.

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.

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.

Use of ferrous sulphate and immunomagnetic separation to recover Salmonella enteritidis from raw eggs

Contaminated eggs or foods containing eggs have been a source of food borne salmonellosis, with a significant proportion of these outbreaks being attributed to Salmonella enteritidis. Since the level of contamination in individual eggs or a pool of such eggs may be low, enrichment to increase cell numbers can take several days. Pre-enrichment of raw blended eggs which have been supplemented with ferrous sulphate at a concentration of 35 mg/l, for 6 h at 37 degrees C, significantly enhanced the growth of Salmonella. Using Dynabeads Anti-Salmonella (Dynal, Oslo), a new commercial product for selective enrichment of Salmonella from food samples, we have defined a protocol based on immunomagnetic separation, specially for raw eggs. The application of this protocol enables definitive detection of Salmonella enteritidis from eggs within 30 h.

A national survey to estimate the prevalence of Salmonella species among Canadian registered commercial turkey flocks

In 1990-1991, a national survey was conducted to estimate the prevalence of Salmonella species among Canadian commercial turkey flocks. Two hundred and seventy flocks were randomly selected across Canada. The proportion sampled from each province was selected according to each province's share of the national turkey market. Samples, consisting of 12 pooled litter and four pooled dust samples, were used to determine the Salmonella status of the environment of each flock. Additionally, a one kilogram sample of feed was taken from each flock premise. Salmonella was recovered from environmental samples in 234/270 (86.7%) of flocks and from feed samples in 26/266 (9.8%) of flocks. Forty-eight different Salmonella serovars were isolated from flock environmental samples. The most prevalent serovars were S. anatum, S. hadar, S. agona, S. heidelberg and S. saintpaul which were isolated from 53/270 (19.6%), 49/270 (18.1%), 49/270 (18.1%), 42/270 (15.6%) and 34/270 (12.6%) flocks, respectively.

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.

Variations in biochemical phenotypes and phage types of Salmonella enteritidis in Germany 1980-92

The Phene Plate system for typing Salmonella serotypes (PhP-S) is a simple automated typing method based on biochemical fingerprinting. It gives a quantitative value of the metabolism of various substrates by measuring the speed and intensity of each reaction. The 'biochemical fingerprint' of each isolate is used to calculate similarities among the tested strains with a personal computer program. We used this system to examine a collection of 86 strains of Salmonella enteritidis isolated from human sporadic cases in Germany between 1980 and 1992. Twenty-three biochemical phenotypes (BPTs) consisting of 9 common (C) and 14 single (S) BPTs were identified. BPTs C2 and C4 containing 20 and 36 strains respectively accounted for 65% of the isolates. Strains of BPT C2 were found over a wide period of time whereas strains of BPT C4 were isolated during the period between 1988 and 1992. With phage typing, 11 discrete phage types (PTs) and 18 strains designated as non-specific type (NST) were identified. PTs 4 and 8 with 39 and 17 strains respectively were the dominant PTs. Strains of PT 8 were isolated over a wide period of time whereas all (except one) strains of PT 4 were isolated between 1988 and 1992. Combination of biochemical fingerprinting and phage typing divided the strains into 25 phenotypes (BPT:PTs). Whilst phenotype C2:8 was found over a number of different years, phenotype C4:4 was isolated only between 1988 and 1992. These findings indicate the presence of one persistent and one recently emerged phenotype among S. enteritidis strains in Germany.(ABSTRACT TRUNCATED AT 250 WORDS)

The identification of Salmonella enteritidis-infected poultry flocks associated with an outbreak of human salmonellosis

In the summer of 1991 a human outbreak of Salmonella enteritidis infection occurred following a barbecue in which about 100 persons were involved. Eggs, supplied by one or more of 10 different layer farms, were the most probable source of the infection. To identify the S. enteritidis-positive flocks, an immunoassay was used to detect salmonella serogroup D-specific antibodies in the yolk of hens eggs. Antibody titres in the eggs from two layer farms, farm A and B, clearly exceeded the titres found in randomly collected eggs. Further investigation on farm A and B yielded high antibody titres in the eggs from flocks A1, A2 and B2, and low titres in the eggs from flock B1. S. enteritidis was isolated from the faecal samples of flocks A1, A2 and B2, whereas no salmonella was detected in the faecal samples of flock B1. The flocks present on both farms originated from the same breeder flock.

An outbreak of gastro-intestinal illness caused by eggs containing Salmonella enteritidis phage type 4

Seven of nine people developed gastro-intestinal symptoms between 18 and 27 h after eating a trifle with a topping containing raw eggs. Salmonella enteritidis Phage Type (PT) 4 was isolated both from the faeces of affected persons and from eggs remaining in the same box as those used to prepare the topping. The findings show that eggs being produced and sold in the U.K. still contain S. enteritidis PT4 and that this is continuing to cause human infection.

Evaluation of a chick mortality model for predicting the consequences of Salmonella enteritidis infections in laying hens

The effects of four domestic Salmonella enteritidis (SE) isolates were compared in experimentally infected chicks and laying hens. The pathogenicity of each strain for 1-day-old chicks was determined by recording postinoculation mortality. The effects of the SE strains on adult hens were measured in terms of changes in total egg production, the frequency of production of SE-contaminated eggs, the dissemination of SE to internal organs, and the elicitation of a specific antibody response. Significant differences in the consequences of infection with different SE strains were observed in mortality rates among chicks and in total egg production, the frequency of production of contaminated eggs, and the serum antibody response among laying hens. The usefulness of a chick mortality model for predicting the probable frequency of production of contaminated eggs by laying hens infected with particular SE strains was then further evaluated by infecting chicks and laying hens with four other field isolates of SE. Although significant differences between SE strains were observed in both chick mortality and the frequency of production of contaminated eggs by hens, a strong correlation between these two parameters was not evident.

Italian experience in Salmonella enteritidis 1978-1988: characterization of isolates from food and man

Salmonella enteritidis accounted for 5.45% of the 118.685 Salmonella isolates from man and for 2.65% of the 3.315 Salmonella isolates from food in Italy in the eleven year period 1978 to 1988. In the years 1978-1982 no S. enteritidis strain was isolated from eggs and poultry; in the years 1983-1988 the 53% of S. enteritidis isolates from food were from eggs and poultry. In 1989 S. enteritidis accounted for 744 isolates from man and 22 from food of which 80% were from eggs and poultry (partial data). In that year 18 outbreaks caused by S. enteritidis were reported to the National Centre of Enteric Pathogens in Rome. Characteristics of 81 S. enteritidis isolates were examined of which 27 were from sporadic cases involving humans and 40 from outbreaks in humans; 14 isolates were from food, all but one connected with the outbreaks. All the isolates studied were sensitive to the antibiotics tested; plasmid profile analysis showed a predominant profile pattern in both epidemic and non-epidemic strains; lysine decarboxylase was present in all the strains tested. Although in at least three epidemics a common supplier of eggs was proved, the source was not identified. Unfortunately it was not possible to determine the phage type of isolates because of the unavailability of specific phages.