Isolation and identification of multidrug resistance bacterial agents implicated in duck enteritis with first record of Salmonella enterica subspecies arizonae in Egypt

Background

Bacterial infections causing digestive problems are among the most serious threats to Egypt's duck industry, owing to their effects on feed utilization and body weight gain.

Aim

As a result, the goal of this study was to identify bacterial pathogens causing enteritis in ducks as well as testing their antimicrobials resistance capabilities.

Methods

Forty-two duck flocks from different localities at four Egyptian Governorates (El-Sharkia, El-Gharbia, El-Dakahlia, and El-Qaliobia) have been subjected to clinical and postmortem examination as well as bacterial isolation and identification. The liver samples have been collected aseptically from freshly euthanized ducks for bacterial isolation followed by identification using conventional biochemical tests, VITEK 2 system, and confirmatory polymerase chain reaction (PCR) for detection of the uid A gene (beta-glucuronidase enzyme) of Escherichia coli. In addition, antimicrobial sensitivity testing for the isolates against different antimicrobials by the VITEK 2 system was used.

Results

Forty-six positive bacterial isolates were identified using conventional methods and the VITEK 2 system including Staphylococcus spp. (52.17%), E. coli (41.30%), and 2.17% for each of Enterococcus casseli lavus, Salmonella enterica subspecies arizonae, and Enterobacter cloacae. PCR was positive for E. coli uid A gene at 556 bp. The antibiogram patterns of isolated pathogens from naturally infected ducks in our work demonstrated 87% multidrug resistance with varying results against different antimicrobial drugs tested. Such findings supported the fact of the upgrading multidrug resistance of Staphylococci and Enterobacteriacae.

Conclusion

The most prevalent bacterial pathogens associated with duck enteritis were Staphylococcus spp. and E. coli with the first report of S. enterica subspecies arizonae causing duck enteritis in Egypt.

Straightforward synthesis of the hexasaccharide repeating unit of the O-specific polysaccharide of Salmonella arizonae O62

A straightforward synthesis of the hexasaccharide repeating unit of the O-specific polysaccharide of Salmonella arizonae O62 was achieved in very good yield applying sequential glycosylation strategy. Successful regioselective glycosylation of the di-hydroxylated L-rhamnose moiety allowed achieving the desired compound in minimum number of synthetic steps. TEMPO catalyzed and [bis(acetoxy)iodo]benzene (BAIB) mediated late stage regioselective oxidation of a primary hydroxyl group into carboxylic acid was achieved in the hexasaccharide derivative. The glycosylation steps were high yielding with high stereochemical outcome. The desired hexasaccharide was obtained in 7% over all yield in fourteen steps starting from suitably functionalized monosaccharide intermediates.

"Message from a turtle": otitis with Salmonella arizonae in children: Case report

RATIONALE

Salmonella enterica subsp arizonae is a common gut inhabitant of reptiles (snakes are the most common reservoir, but it also occurs in turtles). Alhough human cases owing to this organism are exceedingly rare, it may occasionally infect young infants and immunocompromised individuals with a history of intimate associations with reptiles. Our case is the 20th one among the infections with S arizonae in children, but the 2nd one of otitis and the first of mastoiditis. The other cases had different anatomical locations, such as gastroenteritis, osteomyelitis, meningitis, ankle infection, wound infection, and sinusitis.

PATIENT CONCERNS AND DIAGNOSIS

We report a rare case of otitis with Salmonella in a previously healthy adolescent, which was most likely acquired after bathing in a lake. The ear infection was complicated with mastoiditis. Audiometric testing showed a moderately conductive hearing loss (60 dB on pure-tone average).

INTERVENTION

Standard therapy for S arizonae was initiated. The surgery revealed a "hidden" cholesteatoma. Surgical management comprised of canal wall up mastoidectomy with attico-antrotomy and posterior tympanotomy followed by tympanoplasty.

OUTCOMES

Daily postoperative dressing care of the incision, along with antibiotic lavage of the external auditory canal packing, ensured a favorable evolution. The functional gain was important; the 1-month postsurgical pure tone audiogram indicated nearly normal hearing (a mean of 25 dB for air conduction thresholds).

LESSON

Salmonella enterica serotype arizonae is a rare cause of human infection, being a common organism in reptiles, like snakes and turtles. Young children are at a particular risk for acquiring such infections. Our study might encourage further epidemiologic investigations into these infections to generate a more effective strategy among public health agencies.

[Pyopneumothorax caused by Salmonella choleraesuis: a case report and review of the literature]

OBJECTIVE

To improve understanding of the clinical features, diagnosis and treatment of pyopneumothorax caused by Salmonella choleraesuis.

METHODS

One case of pyopneumothorax caused by Salmonella choleraesuis diagnosed and treated in our hospital in 2010 was reported and the related literatures were reviewed. As of May 2011, the literature review was carried out with "Salmonella choleraesuis" and "thoracic empyema" as the search terms in Wanfang Med Online and Pubmed Database.

RESULTS

A 43-year-old Chinese woman presenting with fever and chest pain for 4 days was admitted to our hospital. A CT scan of the chest revealed a massive shadow with mixed density in the right hemithorax, from the top of thorax to diaphragmatic surface, and there was air inside or surrounding the mass irregularly but without an air-fluid level. Blood culture and bronchial secretion culture by bronchoscope both showed some serotypes of Salmonella strains. At first intravenous antibiotic therapy (piperacillin-tazobactam, ceftazidime, and then imipenem-cilastatin) was ineffective. Open chest surgery was performed, and chest tube placed. Salmonella choleraesuis was isolated from the drained pleural fluid. Chest tube drainage remained in place for more than 6 weeks, and with prolonged antibiotic therapy, which contributed to a good outcome. Literature review found no related reports in Wanfang Med Online, while 3 literatures were found in Pubmed, including 2 of case report and 1 of retrospective study. Among 973 patients with empyema thoracis in the retrospective study, 12 of these patients, including 9 men and 3 women, were infected with Salmonella species. The median age was 49 years, and 10 patients were immunocompromised, including malignancy, liver cirrhosis, and diabetes mellitus. Seven patients were infected with Salmonella choleraesuis, and 4 (57%) of them died.

CONCLUSIONS

Pyopneumothorax or thoracic empyema is a rare complication of Salmonella choleraesuis infection. Higher rates of death were noted in this disease. Salmonella choleraesuis infection is even more serious in adult patients with underlying diseases. Early diagnosis, appropriate antimicrobial drug therapy, and aggressive drainage are necessary to improve the outcome of patients with pyopneumothorax or thoracic empyema due to Salmonella choleraesuis.

Endocarditis due to Salmonella enterica subsp. arizonae in a patient with sickle cell disease: a case report and review of the literature

Human cases due to Salmonella enterica subsp. arizonae are especially rare, but it may affect immunocompromised patients and infants. We present a case of endocarditis in a patient with sickle cell disease and a review of earlier cases caused by this rare human pathogen. The patient was successfully treated with ceftriaxone and ciprofloxacin. There are only few cases of salmonella endocarditis reported in the last six decades and it is the first case of Salmonella enterica subsp. arizonae endocarditis in the literature to the best of our knowledge.

Gene expression profiling in Salmonella Choleraesuis-infected porcine lung using a long oligonucleotide microarray

Understanding the transcriptional response to pathogenic bacterial infection within food animals is of fundamental and applied interest. To determine the transcriptional response to Salmonella enterica serovar Choleraesuis (SC) infection, a 13,297-oligonucleotide swine array was used to analyze RNA from control, 24-h postinoculation (hpi), and 48-hpi porcine lung tissue from pigs infected with SC. In total, 57 genes showed differential expression (p < 0.001; false discovery rate = 12%). Quantitative real-time PCR (qRT-PCR) of 61 genes was used to confirm the microarray results and to identify pathways responding to infection. Of the 33 genes identified by microarray analysis as differentially expressed, 23 were confirmed by qRT-PCR results. A novel finding was that two transglutaminase family genes (TGM1 and TGM3) showed dramatic increases in expression postinoculation; combined with several other apoptotic genes, they indicated the induction of apoptotic pathways during SC infection. A predominant T helper 1-type immune response occurred during infection, with interferon gamma (IFNG) significantly increased at 48 hpi. Genes induced by IFNs (GBP1, GBP2, C1S, C1R, MHC2TA, PSMB8, TAP1, TAP2) showed increased expression during porcine lung infection. These data represent the first thorough investigation of gene regulation pathways that control an important porcine respiratory and foodborne bacterial infection.

A comprehensive review of disseminated Salmonella arizona infection with an illustrative case presentation

Salmonella arizona is known to cause infection in reptiles and other animals. Disseminated human infection is rare, except in the setting of a deficient immune system. The following is a unique account of disseminated infection including pericardial involvement. Unusual features include nonreptile vector transmission and eastern seaboard (rather than southwestern) locale. A comprehensive literature review of disseminated S arizona infections is presented describing the types of infection, sources of exposure, underlying conditions, locale, treatments, and outcomes.

[A rare case of emphysematous gastritis by Salmonella arizonae]

Gas within the wall of the stomach (emphysematous gastritis) is a rare condition associated with systemic toxicity and very often mortal end. The etiology includes firstly infections with gas-foaming organisms, other predisposing causes are the ingestion of corrosive substances, alcohol abuse and immunosuppression. But aplastic anemia hemodialysis even guzzling excessive amounts of carbonated beverage have being reported. Diagnosis is based on radiological techniques. There is no definitive treatment for emphysematous gastritis but the conservative approach with broad spectrum antibiotics seems always to be the first step. In this case, the guilty organism was Salmonella Arizonae.

Case report: Salmonella infection following total hip arthroplasty

A case of a total hip arthroplasty infection with Staphylococcus aureus, co-infected with Salmonella choleraesuis was treated with two-stage exchange and administration of vancomycin and ciprofloxacin. No signs of re-infection have appeared fourteen months after surgery. Cases of salmonella infection of hip prostheses are quite rare, with only a handful of reports in the literature.

[Systemic Salmonella Arizona infection: description of a rare surgical case]

Salmonella arizona enteritis has been described in patients resident in the southern states of the USA and in Mexico, whereas in Europe it is rarer. The virulence of this bacillus is, however, still little known and we have few descriptions of severe systemic infections, which are all present in patients with immune system impairment. Only two cases have been reported in Italy where the infection has occurred as severe sepsis with the pathogenic agent being isolated in the blood. Here we report what is, on the basis of our knowledge, the third case in Italy of a systemic Salmonella arizona infection.

A report of 2 cases and a review of the literature]

Systemic infections induced by Salmonella arizonae have been described in patients with underlying cell-mediated immunodeficiencies, usually resident in southern countries of U.S. and in Mexico. This peculiar geographic distribution is probably due to the ingestion of meat or drugs from rattlesnakes, that Salmonella arizonae colonize in the intestinal tract and that live in the above areas. In this article we describe two cases of systemic Salmonella arizonae infections, that represent, to our knowledge, the first report in European literature.

[Idiopathic CD4+ T-lymphocyte deficiency: the clinical evolution of a case]

The case of a patient with Salmonella arizonae sepsis, esophageal candidiasis, and a low CD4+ T lymphocyte count is presented. Follow-up continued for over 2 years after the patient was discharged from the hospital, and his clinical course and clinical-immunological examinations are described. After a period of several years during which the patient had recurrent acute infectious episodes, he improved markedly after cholecystectomy and toilette of the gingival inlets for severe parodontopathy. His CD4+ T cell count increased although it remained below normal values. This case points to possible hypothesis that chronic infective foci may further compromise the immune system when a congenital functional or numerical CD4+ T cell deficit is present.

Salmonella enterica subspecies diarizonae bacteremia in an infant with enteritis--a case report

The septicemia caused by the Arizona group organism is rare and usually observed in adults with underlying diseases. In Korea, Salmonella infection is common, but a report of Arizona infection is unknown. We isolated S. entercia subsp. diarizonae from blood of a 6-month-old infant. The serovar was determined as 28:z10:-, a rare one in America. The isolate was susceptible to ampicillin, chloramphenicol, cotrimoxazole and others. The patient rapidly recovered with ampicillin and gentamicin therapy. Clinical laboratories should consider that the infection exists in Korea and should attempt to isolate and identify Arizona organism in certain patients.

Spontaneous Salmonella infection of high-protein noncirrhotic ascites

Spontaneous bacterial peritonitis rarely complicates high-protein (greater than 2.5 g/dl) ascites. The relatively high endogenous antimicrobial (opsonic) activity of the ascitic fluid in this setting appears to protect the patient from infection. We report two patients with high-protein, noncirrhotic ascites complicated by spontaneous peritonitis due to Salmonella species. One patient had ascites due to heart failure, whereas the other patient's ascites was due to peritoneal carcinomatosis. The ascitic fluid total protein concentrations were 3.1 and 3.3 g/dl, respectively, and the opsonic activity of the ascitic fluid specimens were 2.03 and 2.00 log kill, respectively, indicating a high degree of bacterial killing. We hypothesize that the virulence of the Salmonella species was able to overcome the high opsonic activity in the ascitic fluid, resulting in infection in these two patients. Fever, abdominal pain, or encephalopathy in a patient with high-protein ascites may suggest the presence of an unusual organism causing spontaneous bacterial peritonitis.

Endogenous endophthalmitis due to Salmonella arizonae and Hafnia alvei

Enteric pathogens rarely involve organs other than those of the gastrointestinal system. We have reported the case of a woman with rheumatoid arthritis who had endogenous endophthalmitis due to Salmonella arizonae and Hafnia alvei. The infection probably resulted from the use of snake powder as a food seasoner. After appropriate intravenous, intraocular, subconjunctival, topical, and oral antibiotic therapy based on laboratory susceptibility studies, the patient's condition clinically improved, but complications resulted in therapeutic enucleation. Because of the ubiquitous nature of these and other potentially pathogenic organisms, great care must be taken in evaluation, management, and education of immunocompromised patients.

Disseminated Salmonella arizona infection associated with rattlesnake meat ingestion

Salmonella arizona is an uncommon enteric pathogen. We report a case of a woman with systemic lupus erythematosus, receiving prednisone therapy, who developed fatal disseminated S. arizona infection after ingesting raw dried rattlesnake meat as a form of treatment for her illness. S. arizona was isolated from stool, blood, peritoneal fluid, and cerebrospinal fluid. The importance of being aware of the Mexican-American folk remedy involving the ingestion of rattlesnake meat in the forms of dried snake, snake powder, or snake powder capsules, and the risk of acquiring S. arizona enteric infections is discussed.

Rattlesnake capsule-associated Salmonella arizona infections

Three Hispanic patients at our institution developed extragastrointestinal Salmonella arizona infection associated with the ingestion of rattlesnake capsules. All patients had underlying chronic medical illnesses, including the acquired immunodeficiency syndrome, systemic lupus erythematosus, and congestive heart failure. Rattlesnake capsules were obtained from both local pharmacies and patients. Salmonella arizona, as well as various other enteric organisms, was grown on cultures obtained from all capsules tested. Review of the literature disclosed three additional cases of extragastrointestinal S arizona infection linked to rattlesnake capsule ingestion, all associated with underlying medical illness. We postulate that rattlesnake capsules may be frequently ingested by chronically ill Hispanic individuals and serve as a vehicle for serious S arizona infection.

Eradication of Arizona hinshawii from artificially infected turtle eggs

Turtle eggs, 24 h old, were infected with Arizona hinshawii and treated 48 h later with gentamicin sulfate (Garasol; Shering Corp., Allantown, N.J.) by pressure differential egg dip treatment to ascertain the concentration of this reagent required to eradicate this pathogen from eggs. Infected eggs treated with 1,000 or 1,500 micrograms of gentamicin per ml of dip solution eliminated detectable A. hinshawii from eggs as determined by testing shells and embryo-yolk homogenates of 12-day-old eggs and the gastrointestinal tracts, kidneys, livers and gall bladders, and yolks of 50-day-old embryos. Treated eggs produced hatchlings which did not excrete detectable A. hinshawii at 72 h or 30 days after hatching, nor was this organism recovered from the visceral organs of these hatchlings when necropsied 30 days after hatching. Bacteriological assays on infected nontreated eggs showed that greater than 70% of the eggs harbored A. hinshawii, and eggs in this group produced hatchlings which actively excreted and harbored A. hinshawii. Eggs not infected or treated also produced turtles which excreted and systemically carried A. hinshawii and Salmonella spp. though not at the same level as did the turtles produced from infected, nontreated eggs.

Arizona hinshawii infection of an atherosclerotic abdominal aorta

A patient with Arizonae hinshawii infection of an atherosclerotic abdominal aortic aneurysm is described to emphasize the similarity of the nonenteric infections of man by Arizona and Salmonella organisms. These genera are similar bacteriologically, ecologically, and clinically. This case emphasizes the need for thoroughly considering the differential diagnosis when encountering cryptic bacteremia with either organism.

Arizona hinshawii bacteraemia and meningitis in a child: a case report

An 8-week-old infant presented with Arizona hinshawii meningitis and bacteraemia. The child responded well to the administration of parenteral ampicillin and chloramphenicol. However, chloramphenicol was discontinued after one day of therapy, and A. hinshawii was recultured from the cerebrospinal fluid on the fifth day. Chloramphenicol therapy was restarted and the patient had an uneventful recovery. This report is the first description of A. hinshawii meningitis and should alert clinicians to the possible occurrence of this infection in endemic areas.

[Epidemiological remarks on the "S. Arizonae" strains isolated from various animals in tuscany during 1969-1978 (author's transl)]

After a review of the taxonomic history of the genus Arizona culminated in the insertion of these bacteria in the Kauffmann-White schema, the most significant references concerning their pathogenicity and occurrence are related. In this paper, the outbreaks and sporadic cases by S. arizonae which occurred in Tuscan area during 1969-1978 are reported; between several animal species, turkeys were found frequently infect and the same serotype (S. arizonae 18:Z4,Z32:-) was identified. The epidemiological connections with the infection of turkeys and of other animals, humans inclusive, are discussed.