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El Hawari K, El Khatib M, Zeineh M, Beh D, Jaber F, Mokh S. Contaminant and residue profiles in Lebanese food: a comparative analysis with global standards. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2024; 41:1077-1098. [PMID: 39038014 DOI: 10.1080/19440049.2024.2374358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 06/20/2024] [Accepted: 06/26/2024] [Indexed: 07/24/2024]
Abstract
Lebanon's agricultural sector, known for its diverse crop and livestock production, faces challenges in the international market due to the presence of chemical residues and contaminants in its food exports. Recent rejections of these exports have raised global concerns about food safety, increasingly seen as vital for public health and economic prosperity. This review focuses on examining scientific studies about the levels of various chemical residues including pesticides, and veterinary drugs and contaminants like mycotoxins, and polycyclic aromatic hydrocarbons, and heavy metals in Lebanese food products. Findings indicate that these residues and contaminants often exceed both the maximum residue limits (MRLs) and maximum limits (MLs) set by the Codex Alimentarius and the European Union. The review concludes with recommendations for reducing these contaminants and residues to enhance Lebanon's food safety and quality, aligning with international standards, and mitigating the risk of export rejections.
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Affiliation(s)
- Khaled El Hawari
- Laboratory for Analysis of Organic Compounds (LAOC), CNRSL, Lebanese Atomic Energy Commission (LAEC), Beirut, Lebanon
| | - Mohammad El Khatib
- Unit of Basic and Applied Biosciences, Department of Biosciences, Agro-Food and Environmental Technologies, University of Teramo, Teramo, Italy
| | - Mariam Zeineh
- Faculty of Public Health- I, Lebanese University, Hadath, Lebanon
| | - Daniel Beh
- Faculty of Sciences I, Lebanese University, Hadath, Lebanon
| | - Farouk Jaber
- Laboratory for Analysis of Organic Compounds (LAOC), CNRSL, Lebanese Atomic Energy Commission (LAEC), Beirut, Lebanon
- Faculty of Sciences I, Lebanese University, Hadath, Lebanon
| | - Samia Mokh
- Laboratory for Analysis of Organic Compounds (LAOC), CNRSL, Lebanese Atomic Energy Commission (LAEC), Beirut, Lebanon
- Faculty of Public Health- I, Lebanese University, Hadath, Lebanon
- Department of Biochemistry and Plant Immunology, University of Jaume I, Castellón de la Plana, Spain
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2
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Lee AWT, Ng ICF, Wong EYK, Wong ITF, Sze RPP, Chan KY, So TY, Zhang Z, Ka-Yee Fung S, Choi-Ying Wong S, Tam WY, Lao HY, Lee LK, Leung JSL, Chan CTM, Ng TTL, Zhang J, Chow FWN, Leung PHM, Siu GKH. Comprehensive identification of pathogenic microbes and antimicrobial resistance genes in food products using nanopore sequencing-based metagenomics. Food Microbiol 2024; 121:104493. [PMID: 38637066 DOI: 10.1016/j.fm.2024.104493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 04/20/2024]
Abstract
Foodborne pathogens, particularly antimicrobial-resistant (AMR) bacteria, remain a significant threat to global health. Given the limitations of conventional culture-based approaches, which are limited in scope and time-consuming, metagenomic sequencing of food products emerges as a promising solution. This method provides a fast and comprehensive way to detect the presence of pathogenic microbes and antimicrobial resistance genes (ARGs). Notably, nanopore long-read sequencing provides more accurate bacterial taxonomic classification in comparison to short-read sequencing. Here, we revealed the impact of food types and attributes (origin, retail place, and food processing methods) on microbial communities and the AMR profile using nanopore metagenomic sequencing. We analyzed a total of 260 food products, including raw meat, sashimi, and ready-to-eat (RTE) vegetables. Clostridium botulinum, Acinetobacter baumannii, and Vibrio parahaemolyticus were identified as the top three foodborne pathogens in raw meat and sashimi. Importantly, even with low pathogen abundance, higher percentages of samples containing carbapenem and cephalosporin resistance genes were identified in chicken and RTE vegetables, respectively. In parallel, our results demonstrated that fresh, peeled, and minced foods exhibited higher levels of pathogenic bacteria. In conclusion, this comprehensive study offers invaluable data that can contribute to food safety assessments and serve as a basis for quality indicators.
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Affiliation(s)
- Annie Wing-Tung Lee
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Iain Chi-Fung Ng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Evelyn Yin-Kwan Wong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Ivan Tak-Fai Wong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Rebecca Po-Po Sze
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Kit-Yu Chan
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Tsz-Yan So
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Zhipeng Zhang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Sharon Ka-Yee Fung
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Sally Choi-Ying Wong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Wing-Yin Tam
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Hiu-Yin Lao
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Lam-Kwong Lee
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Jake Siu-Lun Leung
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Chloe Toi-Mei Chan
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Timothy Ting-Leung Ng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Jiaying Zhang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Franklin Wang-Ngai Chow
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Polly Hang-Mei Leung
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Gilman Kit-Hang Siu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.
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3
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Serhan M, Hourieh H, El Deghel M, Serhan C. Hygienic sanitary risk and microbiological quality of meat and meat-contact surfaces in traditional butcher shops and retail establishments- lessons from a developing country. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:600-610. [PMID: 36576123 DOI: 10.1080/09603123.2022.2161487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
In this study, we determined both hygienic sanitary risk and microbiological quality of raw meat and meat-contact surfaces in butcher shops and retails from the North Governorate in Lebanon. A total of 55 samples were analyzed (36 raw meat and 19 environmental swabs). The overall counts of pathogenic bacteria indicate high levels of contamination of both minced meat and contact surfaces. Presumptive Salmonella and Listeria were found in the samples. Salmonella spp. was observed in 63.8% of all cuts, of whom 41.6% is detected from butcher shops' meat. L. monocytogenes was present in 47.2% of meat from butcher shops and 30.5% of retails. Total aerobic count followed by S. aureus and fecal coliforms were the most detected pathogens in environmental swabs. Most visited facilities presented moderate hygienic sanitary risk, with average scores of 55.25 in butchers' shops and 65.25 in retail. Findings highlight the necessity for governmental surveillance and implementation of food safety laws.
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Affiliation(s)
- Mireille Serhan
- Department of Nutritional Sciences, Faculty of Health Sciences, University of Balamand, Tripoli, Lebanon
| | - Hiba Hourieh
- Department of Nutritional Sciences, Faculty of Health Sciences, University of Balamand, Tripoli, Lebanon
| | - Maria El Deghel
- Department of Nutritional Sciences, Faculty of Health Sciences, University of Balamand, Tripoli, Lebanon
| | - Carole Serhan
- Department of Business Management and Administration, Issam Fares Faculty of Technology, University of Balamand, Tripoli, Lebanon
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Ballout R, Toufeili I, Kharroubi SA, Kassem II. Raw Meat Consumption and Food Safety Challenges: A Survey of Knowledge, Attitudes, and Practices of Consumers in Lebanon. Foods 2023; 13:118. [PMID: 38201146 PMCID: PMC10779077 DOI: 10.3390/foods13010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
A key contributor to foodborne illnesses is consuming contaminated ready-to-eat foods, including raw meats. The latter is a common practice in Lebanon, a country that suffers from widespread pollution and food safety challenges. However, studies on the safety of raw meat consumption in Lebanon are limited. In this study, an attempt was made to investigate the knowledge, attitudes, and practices (KAPs) of the Lebanese population toward the potential risk associated with the consumption of raw meats, and to identify factors that affect KAP levels. An online survey (n = 577) was administered to Lebanese adults aged 18 years and above to assess their KAPs. The results showed that 74.5% of the participants consumed raw meat, 44% had good food safety knowledge, and 30.7% exhibited good practices. However, more than half of the participants (61.9%) showed a positive attitude toward food safety. There was a significant association between knowledge and attitude (p < 0.001), attitude and practices (p < 0.001), and knowledge and practices (p < 0.001), thereby indicating that an increase in food safety education could translate into better practices in this population. Accordingly, efforts to enhance education on food safety are warranted to reduce the potential risk of food poisoning associated with raw meat consumption in Lebanon.
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Affiliation(s)
- Rouba Ballout
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107-2020, Lebanon; (R.B.); (I.T.)
| | - Imad Toufeili
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107-2020, Lebanon; (R.B.); (I.T.)
| | - Samer A. Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107-2020, Lebanon; (R.B.); (I.T.)
| | - Issmat I. Kassem
- Center for Food Safety, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA 30602, USA;
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El Safadi D, Osman M, Hanna A, Hajar I, Kassem II, Khalife S, Dabboussi F, Hamze M. Parasitic Contamination of Fresh Leafy Green Vegetables Sold in Northern Lebanon. Pathogens 2023; 12:1014. [PMID: 37623974 PMCID: PMC10459145 DOI: 10.3390/pathogens12081014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
Contaminated, raw or undercooked vegetables can transmit parasitic infections. Here, we investigated parasitic contamination of leafy green vegetables sold in local markets in the Tripoli district, Lebanon, during two consecutive autumn seasons (2020-2021). The study involved the microscopic examination of 300 samples of five different types of vegetables (60 samples per type) and used standardized qualitative parasitological techniques for some protozoa and helminths. The results showed that 16.7% (95% interval for p: 12.6%, 21.4%) (50/300) of the vegetable samples were contaminated with at least one parasite. The most frequently detected parasite was Blastocystis spp. (8.7%; 26/300); this was followed in frequency by Ascaris spp. (3.7%; 11/300). Among the different vegetable types, lettuce (23.3%; 14/60) was the most contaminated, while arugula was the least contaminated (11.7%; 7/60). The statistical analysis did not reveal any significant association between the prevalence of parasitic contamination and the investigated risk factors, which included collection date, vegetable type, market storage status, and wetness of vegetables at the time of purchase (p > 0.05). The high prevalence of parasitic contamination also suggested the potential presence of other microbial pathogens. These findings are important because leafy green vegetables are preferentially and heavily consumed raw in Lebanon. Thus, implementing effective measures that target the farm-to-fork continuum is recommended in order to reduce the spread of intestinal pathogens.
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Affiliation(s)
- Dima El Safadi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L7 8XZ, UK;
- Laboratoire Microbiology, Santé et Environnement, Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli 1300, Lebanon; (A.H.); (I.H.); (F.D.); (M.H.)
| | - Marwan Osman
- Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY 14853, USA
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Angel Hanna
- Laboratoire Microbiology, Santé et Environnement, Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli 1300, Lebanon; (A.H.); (I.H.); (F.D.); (M.H.)
| | - Iman Hajar
- Laboratoire Microbiology, Santé et Environnement, Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli 1300, Lebanon; (A.H.); (I.H.); (F.D.); (M.H.)
| | - Issmat I. Kassem
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, Griffin, GA 30223, USA;
| | - Sara Khalife
- Department of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, Tripoli 1300, Lebanon;
| | - Fouad Dabboussi
- Laboratoire Microbiology, Santé et Environnement, Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli 1300, Lebanon; (A.H.); (I.H.); (F.D.); (M.H.)
| | - Monzer Hamze
- Laboratoire Microbiology, Santé et Environnement, Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli 1300, Lebanon; (A.H.); (I.H.); (F.D.); (M.H.)
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Hussein ND, Hassan JW, Osman M, El-Omari K, Kharroubi SA, Toufeili I, Kassem II. Assessment of the Microbiological Acceptability of White Cheese (Akkawi) in Lebanon and the Antimicrobial Resistance Profiles of Associated Escherichia coli. Antibiotics (Basel) 2023; 12:antibiotics12030610. [PMID: 36978477 PMCID: PMC10044863 DOI: 10.3390/antibiotics12030610] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
Dairy foods are a staple in Lebanon, a low- and middle-income country that has been experiencing serious challenges to food safety and antimicrobial stewardship among other issues. The microbiological acceptability of dairy products has been of increasing concern. This is partially due to the failing economy and prolonged power outages that affect the quality of raw material and disrupt the dairy cold chain, respectively. Therefore, we assessed the microbiological acceptability of Akkawi, a popular white-brined cheese in Lebanon. For this purpose, we quantified the densities of Escherichia coli (a fecal indicator) and Staphylococcus aureus in cheeses collected from Lebanese retail stores. Additionally, we evaluated the antibiotic resistance profiles of the E. coli isolated from the cheese. E. coli and S. aureus were detected in 40 (80%) and 16 (32%) of the 50 cheese samples, respectively. Notably, 40 (80%) and 16 (32%) of the samples exceeded the maximum permissible limit of E. coli and S. aureus, respectively. A high percentage of the 118 E. coli isolated from the cheeses showed resistance to clinically and agriculturally important antibiotics, while 89 (75%) isolates were classified as multidrug-resistant (MDR). Given that Akkawi can be consumed without cooking, our findings highlight serious food safety and antimicrobial resistance problems that require immediate interventions.
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Affiliation(s)
- Nasri Daher Hussein
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon
| | - Jouman W. Hassan
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223, USA
| | - Marwan Osman
- Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY 14853, USA
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Khaled El-Omari
- Quality Control Center Laboratories at the Chamber of Commerce, Industry & Agriculture of Tripoli & North Lebanon, Tripoli 1300, Lebanon
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli 1300, Lebanon
| | - Samer A. Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon
| | - Imad Toufeili
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon
| | - Issmat I. Kassem
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223, USA
- Correspondence:
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Ariyawansa S, Gunawardana KN, Hapudeniya MM, Manelgamage NJ, Karunarathne CR, Madalagama RP, Ubeyratne KH, Wickramasinghe D, Tun HM, Wu P, Lam TTY, Chan OSK. One Health Surveillance of Antimicrobial Use and Resistance: Challenges and Successes of Implementing Surveillance Programs in Sri Lanka. Antibiotics (Basel) 2023; 12:antibiotics12030446. [PMID: 36978313 PMCID: PMC10044479 DOI: 10.3390/antibiotics12030446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/09/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Background: Sri Lanka is a low-income country, as defined by the World Bank. The country suffered further economic downturn during the COVID-19 pandemic. This situation adversely affected the prioritization of policies and programs around healthcare and public health. In particular, inflation, fuel prices, and shortage of food supplies increased struggles to implement antimicrobial resistance (AMR) programs. However, in the long run, it is crucial to gather data and evidence to plan AMR policies and track interventions. (1) Aim: To establish and reiterate the importance of prioritizing AMR programs in the One Health framework, the Fleming Fellows collected and studied antimicrobial use/consumption (AMU/AMC) and resistance (AMR) in humans, food-producing animals, and the environment. (2) Methods: A systematic and cross-sectional study was conducted between 2019 and 2021. By way of coordinating an AMU/AMC and AMR prevalence study across six agencies from human health and food-producing animal sectors, the authors established a field epidemiology study, laboratory testing, and data processing at their institutions. AMU/AMC patterns were surveyed using questionnaires and interviews, while AMR samples were collected for antibiotic susceptibility tests and genomic tests. Samples were tested for phenotypic and genotypic resistance. (3) Results: In human samples, resistance was highest to beta-lactam antibiotics. In non-human samples, resistance was highest to erythromycin, a highest-priority, critically important antibiotic defined by the World Health Organization. From government records, tylosin was sold the most in the food-producing animal sector. (4) Conclusions: Sri Lanka AMU and AMR trends in human and non-human sectors can be ascertained by a One Health framework. Further coordinated, consistent, and sustainable planning is feasible, and can help implement an AMU/AMR surveillance system in Sri Lanka.
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Affiliation(s)
- Sujeewa Ariyawansa
- National Aquatic Resources Research and Development Agency, Crow Island, Colombo 01500, Sri Lanka
| | | | | | - Nimal J. Manelgamage
- Department of Animal Production and Health, No. 13, Getambe, Peradeniya, Kandy 20400, Sri Lanka
| | - Chinthana R. Karunarathne
- Department of Animal Production and Health, Veterinary Investigation Centre, Court Road, Wariyapola 60400, Sri Lanka
| | | | | | | | - Hein M. Tun
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Peng Wu
- The School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Tommy T. Y. Lam
- The School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Olivia S. K. Chan
- The School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Correspondence: or
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Osman M, Kassem II, Dabboussi F, Cummings KJ, Hamze M. The indelible toll of enteric pathogens: Prevalence, clinical characterization, and seasonal trends in patients with acute community-acquired diarrhea in disenfranchised communities. PLoS One 2023; 18:e0282844. [PMID: 36913372 PMCID: PMC10010529 DOI: 10.1371/journal.pone.0282844] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND There is little information on the epidemiology of enteric pathogens in Lebanon, a low- and middle-income country that suffers from a myriad of public health challenges. To address this knowledge gap, we aimed to assess the prevalence of enteric pathogens, identify risk factors and seasonal variations, and describe associations between pathogens among diarrheic patients in the Lebanese community. METHODOLOGY AND PRINCIPAL FINDINGS A multicenter cross-sectional community-based study was conducted in the north of Lebanon. Stool samples were collected from 360 outpatients suffering from acute diarrhea. Based on fecal examination using the BioFire® FilmArray® Gastrointestinal Panel assay, the overall prevalence of enteric infections was 86.1%. Enteroaggregative Escherichia coli (EAEC) was the most frequently identified (41.7%), followed by enteropathogenic E. coli (EPEC) (40.8%) and rotavirus A (27.5%). Notably, two cases of Vibrio cholerae were identified, while Cryptosporidium spp. (6.9%) was the most common parasitic agent. Overall, 27.7% (86/310) of the cases were single infections, and the majority, 73.3% (224/310), were mixed infections. Multivariable logistic regression models showed that enterotoxigenic E. coli (ETEC) and rotavirus A infections were significantly more likely to occur in the fall and winter compared to the summer. Rotavirus A infections significantly decreased with age but increased in patients living in rural areas or suffering from vomiting. We identified strong associations in the co-occurrence of EAEC, EPEC, and ETEC infections and a higher percentage of rotavirus A and norovirus GI/GII infections among EAEC-positive cases. CONCLUSIONS Several of the enteric pathogens reported in this study are not routinely tested in Lebanese clinical laboratories. However, anecdotal evidence suggests that diarrheal diseases are on the rise due to widespread pollution and the deterioration of the economy. Therefore, this study is of paramount importance to identify circulating etiologic agents and prioritize dwindling resources to control them and limit outbreaks in the future.
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Affiliation(s)
- Marwan Osman
- Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY, United States of America
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States of America
| | - Issmat I. Kassem
- Center for Food Safety and Department of Food Science and Technology, University of Georgia, Griffin, GA, United States of America
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Kevin J. Cummings
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States of America
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
- * E-mail:
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9
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Hassan H, Iskandar CF, Hamzeh R, Malek NJ, El Khoury A, Abiad MG. Heat resistance of Staphylococcus aureus, Salmonella sp., and Escherichia coli isolated from frequently consumed foods in the Lebanese market. INTERNATIONAL JOURNAL OF FOOD PROPERTIES 2022. [DOI: 10.1080/10942912.2022.2143521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hussein Hassan
- Nutrition Program, Department of Natural Sciences, Lebanese American University, Beirut, Lebanon
| | - Christelle F. Iskandar
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Reem Hamzeh
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Nathalie J. Malek
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Andre El Khoury
- Centre d’Analyses Et de Recherche (CAR), Unité de Recherche Technologies Et Valorisation agro-Alimentaire (UR-TVA), Faculty of Sciences, Saint-Joseph University of Beirut, Campus of Sciences and Technologies, Mar Roukos, Lebanon
| | - Mohamad G. Abiad
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
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10
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Dabbousi AA, Dabboussi F, Hamze M, Osman M, Kassem II. The Emergence and Dissemination of Multidrug Resistant Pseudomonas aeruginosa in Lebanon: Current Status and Challenges during the Economic Crisis. Antibiotics (Basel) 2022; 11:687. [PMID: 35625331 PMCID: PMC9137902 DOI: 10.3390/antibiotics11050687] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 12/30/2022] Open
Abstract
Pseudomonas aeruginosa is a common cause of healthcare-associated infections and chronic airway diseases in non-clinical settings. P. aeruginosa is intrinsically resistant to a variety of antimicrobials and has the ability to acquire resistance to others, causing increasingly recalcitrant infections and elevating public health concerns. We reviewed the literature on multidrug-resistant (MDR) P. aeruginosa isolated from humans (nosocomial and community-associated), animals, and the environment in Lebanon, a country that has been suffering from a surge in antimicrobial resistance (AMR). We identified 24 studies that described the epidemiology and antimicrobial susceptibility profiles of P. aeruginosa. Our analysis showed that the bacterium was predominant in lesions of patients on mechanical ventilation and in burn patients and those with diabetic foot infections and hematological malignancies. We also found that carbapenem resistance in P. aeruginosa isolates in Lebanon involved both enzymatic and non-enzymatic mechanisms but depended predominantly on VIM-2 production (40.7%). Additionally, MDR P. aeruginosa was detected in animals, where a recent study reported the emergence of carbapenemase-producing P. aeruginosa in livestock in Lebanon. Notably, no studies evaluated the contribution of MDR P. aeruginosa in the environment to human infections. Taken together, our findings highlight the need for AMR surveillance programs and a national action plan to combat resistance in Lebanon.
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Affiliation(s)
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli 1300, Lebanon; (F.D.); (M.H.)
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli 1300, Lebanon; (F.D.); (M.H.)
| | - Marwan Osman
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Issmat I. Kassem
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223-1797, USA
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11
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Arienzo A, Gallo V, Fanali C, Antonini G. Introduction to the Special Issue: Microbiological Safety and Quality of Foods. Foods 2022; 11:foods11050673. [PMID: 35267306 PMCID: PMC8909403 DOI: 10.3390/foods11050673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Alyexandra Arienzo
- National Institute of Biostructures and Biosystems (INBB), Viale delle Medaglie d’Oro 305, 00136 Rome, Italy;
| | - Valentina Gallo
- Department of Science, Roma Tre University, Viale Guglielmo Marconi 446, 00146 Rome, Italy;
| | - Chiara Fanali
- Department of Science and Technology for Humans and the Environment, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
- Correspondence: (C.F.); (G.A.)
| | - Giovanni Antonini
- National Institute of Biostructures and Biosystems (INBB), Viale delle Medaglie d’Oro 305, 00136 Rome, Italy;
- Department of Science, Roma Tre University, Viale Guglielmo Marconi 446, 00146 Rome, Italy;
- Correspondence: (C.F.); (G.A.)
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12
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Alsayeqh AF, Baz AHA, Darwish WS. Antimicrobial-resistant foodborne pathogens in the Middle East: a systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:68111-68133. [PMID: 34668139 DOI: 10.1007/s11356-021-17070-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
Foodborne pathogens are known as significant public health hazards worldwide, particularly in the Middle East region. Antimicrobial resistance (AMR) among foodborne pathogens becomes one of the top challenges for the environment, public health, and food safety sectors. However, less is known about antimicrobial-resistant foodborne pathogens in the Middle East region. Possibly because of the lack of surveillance, documentation, and reporting. This review focuses on the current status of antimicrobial resistance profiling among foodborne pathogens in the Middle East. Therefore, PubMed and other relevant databases were searched following PRISMA guidelines. Subject heading and texts were searched for "antimicrobial resistances," "foodborne," and "Middle East" to identify observational studies on AMR foodborne pathogens published during the last 10 years (2011 to 2020). Article retrieval and screening were done using a structured search string and strict inclusion/exclusion criteria. Median and interquartile ranges of percent resistance were calculated for each antibiotic-bacterium combination. A total of 249 articles were included in the final analysis from ten countries, where only five countries had more than 85% of the included articles. The most commonly reported pathogens were Escherichia coli, Salmonella spp. Staphylococcus aureus, and Listeria spp. An apparent rise in drug resistance among foodborne pathogens was recorded particularly against amoxicillin-clavulanic acid, ampicillin, nalidixic acid, streptomycin, and tetracycline that are commonly prescribed in most countries in the Middle East. Besides, there is a lack of standardization and quality control for microbiological identification and susceptibility testing methods in many of the Middle East countries.
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Affiliation(s)
- Abdullah F Alsayeqh
- Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, 662251452, Saudi Arabia
| | | | - Wageh Sobhy Darwish
- Food Control Department, Faculty of Veterinary Medicine, Zagazig University, Zagazig, 44519, Egypt.
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13
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Dagher LA, Hassan J, Kharroubi S, Jaafar H, Kassem II. Nationwide Assessment of Water Quality in Rivers across Lebanon by Quantifying Fecal Indicators Densities and Profiling Antibiotic Resistance of Escherichia coli. Antibiotics (Basel) 2021; 10:antibiotics10070883. [PMID: 34356804 PMCID: PMC8300662 DOI: 10.3390/antibiotics10070883] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/02/2021] [Accepted: 07/16/2021] [Indexed: 11/23/2022] Open
Abstract
The use of contaminated water has been associated with severe disease outbreaks. Due to widespread pollution with untreated sewage, concerns have been raised over water quality in Lebanon, a country with well-documented challenges in infrastructure. Here, we evaluated the water quality of major rivers in Lebanon by quantifying the densities of fecal indicator bacteria (fecal coliforms and Escherichia coli). Additionally, we assessed the dissemination of antibiotic-resistant E. coli in river water. Composite water samples (n = 132) were collected from fourteen rivers, and 378 E. coli were isolated and analyzed. Fecal coliforms and E. coli were detected in 96.29% and 95.5% of the samples, respectively. Additionally, 73.48–61.3% and 31.81% of the samples exceeded the microbiological acceptability standards for irrigation and the fecal coliform limit for recreational activities, respectively. The E. coli exhibited resistance to ampicillin (40% of isolates), amoxicillin + clavulanic acid (42%), cefepime (4%), cefotaxime (14%), cefalexin (46%), cefixime (17%), doripenem (0.3%), imipenem (0.5%), gentamicin (6%), kanamycin (9%), streptomycin (35%), tetracycline (35%), ciprofloxacin (10%), norfloxacin (7%), trimethoprim-sulfamethoxazole (32%), and chloramphenicol (13%). Notably, 45.8% of the isolates were classified as multidrug resistant (MDR). Our results highlight the need to urgently address fecal pollution and the dissemination of antibiotic resistance in Lebanese rivers.
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Affiliation(s)
- Lea A. Dagher
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon; (L.A.D.); (S.K.)
| | - Jouman Hassan
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223, USA;
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon; (L.A.D.); (S.K.)
| | - Hadi Jaafar
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon;
| | - Issmat I. Kassem
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon; (L.A.D.); (S.K.)
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223, USA;
- Correspondence:
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Kharroubi S, Nasser NA, El-Harakeh MD, Sulaiman AA, Kassem II. First Nation-Wide Analysis of Food Safety and Acceptability Data in Lebanon. Foods 2020; 9:foods9111717. [PMID: 33266478 PMCID: PMC7700422 DOI: 10.3390/foods9111717] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022] Open
Abstract
The challenges to food safety in Lebanon are numerous and have coalesced to pose a serious public health concern. This is evident in well-documented food poisoning outbreaks and adulteration cases. In response, the Lebanese government initiated an unprecedented food safety campaign (2015–2017) that aimed to test food samples that were randomly collected from foodservices and industries across the country. The data were made available publicly, but they were never analyzed to prioritize and determine high risk foods and most prevalent contaminants nationally or across governorates. To answer these questions, we performed an in-depth statistical analysis of the data, which included 11,625 individual food samples. Our analysis showed that water (55% of tested water samples), spices (49.3%), red meat (34.4%), poultry (30.9%) and dairy (28.3%) were the main foods associated with the highest rejection rates. The most common biological contaminants detected in rejected foods were sulfate-reducing bacteria (34.7%), Escherichia coli (32.1%), coliforms (19.6%), Staphylococcus aureus (12.8%), and Salmonella (11.6%). We conclude that Lebanon needs rigorous and sustainable programs to monitor the quality and safety of foods. Given the lack of resources, we recommend putting emphasis on extensive outreach programs that aim at enhancing food safety knowledge from farm to fork.
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Affiliation(s)
- Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon; (S.K.); (M.D.E.-H.); (A.A.S.)
| | - Nivin A. Nasser
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223-1797, USA;
| | - Marwa Diab El-Harakeh
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon; (S.K.); (M.D.E.-H.); (A.A.S.)
| | - Abdallah Alhaj Sulaiman
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon; (S.K.); (M.D.E.-H.); (A.A.S.)
| | - Issmat I. Kassem
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon; (S.K.); (M.D.E.-H.); (A.A.S.)
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223-1797, USA;
- Correspondence: or
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