Microbiological Analysis of Rice Cake Processing in Korea.

This study was conducted to evaluate the microbial contamination in rice cake materials and products during processing and in the operation environment in nonhazard analysis [and] critical control point factories. Furthermore, the environmental health of the processing facilities and the bacterial and fungal contamination on the workers' hands were investigated. Pour plate methods were used for enumeration of aerobic plate count (APC), yeast and molds (YM), Bacillus cereus, Staphylococcus aureus, and Clostridium perfringens, whereas Petrifilm count plates were used for enumeration of coliforms and Escherichia coli. The respective microbial levels of APC, coliforms, YM, and B. cereus were in the range of 2.6 to 4.7, 1.0 to 3.8, not detected (ND) to 2.9, and ND to 2.8 log CFU/g in the raw materials and in the range of 2.3 to 6.2, ND to 3.6, ND to 2.7, and ND to 3.7 log CFU/g during processing of the rice cake products. During the processing of rice cakes, APC, coliforms, YM, and B. cereus increased during soaking and smashing treatments and decreased after steaming treatment. E. coli, S. aureus, and C. perfringens were not detected in any of the raw materials and operating areas or during processing. B. cereus was detected on the operators' hands at microbial contamination levels of 1.9 ± 0.19 to 2.0 ± 0.19 log CFU/g. The results showed that B. cereus in the end product is presumably the main concern for rice cakes. In addition, the high contamination level of B. cereus during manufacturing processes, including soaking, smashing, and molding, and the absence of B. cereus from the air sampling plates indicated that the contaminated equipment showed the potential risk to cause cross-contamination.

Axillary arch: detailed ultrasonographic images with multiplanar CT correlation.

The axillary arch is a common but rarely recognized anatomical variant of the axillary musculature. We report the first detailed presentation of the ultrasonographic features of the axillary arch and a correlation of these findings with multiplanar reformation CT images incorporating a schematic anatomical diagram in a 44-year-old woman complaining of a palpable non-tender mass in the axillary region due to a unilateral axillary arch. The clinical significance of the axillary arch is discussed.

Bacteriological quality of vegetables from organic and conventional production in different areas of Korea.

Foods grown in organic production systems have been described as representing an increased risk to public health compared with foods from conventional production. Leafy vegetables (spinach, romaine lettuce, and green sesame leaves) grown in organic and conventional systems were collected from various areas in Korea and examined using standard culture methods to compare the microbiological quality of the produce grown in the two agricultural systems. The 354 samples of these leafy vegetables were analyzed for levels of indicator bacteria (aerobic bacteria, coliforms, and Escherichia coli) and the prevalence of the pathogens Staphylococcus aureus, E. coli O157:H7, Listeria monocytogenes, Bacillus cereus, and Salmonella. Aerobic bacteria and coliforms were detected in all vegetable types, but nonpathogenic E. coli was below the limit of detection in all samples. B. cereus was the most prevalent pathogen, found on 7 (11.1%) of the 63 organic spinach samples. The prevalence of S. aureus was highest in organic sesame leaves; it was found on 5 (8.0%) of the 63 samples. The prevalence of L. monocytogenes was highest on organic romaine lettuce and spinach; it was found in 4 (6.4%) of 63 samples of each type of vegetable. E. coli O157:H7 found on only 1 (1.58%) of 55 conventional spinach samples. These results suggest that farming type at most only slightly affects the hygienic quality of leafy vegetables, and no effect was found for sample collection area. Salmonella was not isolated from any of the conventional or organic leafy vegetables. These results do not support the hypothesis that organic produce poses a substantially greater risk of pathogen contamination than does conventional produce.

Ruptured endometrial cysts as a rare cause of acute pelvic pain: can we differentiate them from ruptured corpus luteal cysts on CT scan?

PURPOSE: To evaluate the usefulness of CT in the differentiation of ruptured endometrial cysts and corpus luteal cysts. METHODS: Sixteen patients (mean age, 26 years) with a surgically proven ruptured endometrial cyst and 19 patients (mean age, 28 years) with a surgically proven corpus luteal cyst were included in this study. All patients had undergone portal phase contrast-enhanced computed tomographic (CT) scans. We retrospectively analyzed the CT findings on the ovarian cysts for the size and shape of the ovarian cyst, the thickness of the cyst wall, the attenuation of the cyst content, the presence of a discontinuity of the cyst wall, and on the peritoneum for the amount and attenuation of the ascites and the presence of hazy infiltration in the peritoneal fat. We compared the CT imaging characteristics in patients with ruptured endometrial cysts and corpus luteal cysts, using the Mann-Whitney U test. RESULTS: Ruptured endometrial cysts tend to show larger, multilocular cysts with a thicker wall compared to ruptured corpus luteal cysts (P < 0.05). A distorted shape of the cyst was more commonly seen in ruptured endometrial cyst, but direct CT findings that can suggest a rupture of an ovarian cyst, such as a discontinuity of the cyst wall and hemoperitoneum, were more commonly seen in ruptured corpus luteal cysts than in endometrial cysts (P < 0.05). CONCLUSIONS: Computed tomography is useful in the differentiation of ruptured endometrial cysts and corpus luteal cysts in a patient with acute pelvic pain.

The phenotypic and genotypic characterization of Korean isolates of Cronobacter spp. (Enterobacter sakazakii).

This study was conducted to investigate the phenotypic and genotypic characteristics of Korean isolates of Cronobacter spp. (Enterobacter sakazakii). A total of 43 Cronobacter spp., including 5 clinical isolates, 34 food isolates, 2 environmental isolates, and 2 reference strains (C. sakazakii ATCC 29004 and C. muytjensii ATCC51329) were used in this study. Korean isolates of Cronobacter spp. were divided into 11 biogroups according to their biochemical profiles and 3 genomic groups based on the analysis of their 16S rRNA gene sequences. Biogroups 1 and 2 contained the majority of isolates (n=26), most of which were contained in 16S rRNA cluster 1 (n=34). Korean isolates of Cronobacter spp. showed diverse biochemical profiles. Biogroup 1 contained C. sakazakii GIHE (Gyeonggido Research Institute of Health and Environment) 1 and 2, which were isolated from babies that exhibited symptoms of Cronobacter spp. infection such as gastroenteritis, sepsis, and meningitis. Our finding revealed that Biogroup 1, C. sakazakii, is more prevalent and may be a more pathogenic biogroup than other biogroups, but the pathogenic biogroup was not represented clearly among the 11 biogroups tested in this study. Thus, all biogroups of Cronobacter spp. were recognized as pathogenic bacteria, and the absence of Cronobacter spp. in infant foods should be constantly regulated to prevent food poisoning and infection caused by Cronobacter spp.

Toxin genes profiles and toxin production ability of Bacillus cereus isolated from clinical and food samples.

Bacillus cereus can cause diarrheal and emetic type of food poisoning but little study has been done on the main toxins of food poisoning caused by B. cereus in Korea. The objective of this study is to characterize the toxin gene profiles and toxin-producing ability of 120 B. cereus isolates from clinical and food samples in Korea. The detection rate of nheABC, hblCDA, entFM, and cytK enterotoxin gene among all B. cereus strains was 94.2, 90.0, 65.8, and 52.5%, respectively. The ces gene encoding emetic toxin was not detected in all strains. Bacillus cereus strains carried at least 1 of the 8 enterotoxin genes were classified into 12 groups according to the presence or absence of 8 virulence genes. The 3 major patterns, I (nheABC, hblCDA, entFM, and cytK gene), II (nheABC, hblCDA and entFM gene), and VI (nheABC and hblCDA gene), accounted for 79.2% of all strains (95 out of 120 B. cereus isolates). Non-hemolytic enterotoxin (NHE) and hemolysin BL (HBL) enterotoxins were produced by 107 and 100 strains, respectively. Our finding revealed that NHE and HBL enterotoxins encoded by nhe and hbl genes were the major toxins among B. cereus tested in this study and enterotoxic type of B. cereus was predominant in Korea.

Emetic toxin producing Bacillus cereus Korean isolates contain genes encoding diarrheal-related enterotoxins.

Bacillus cereus can cause the diarrheal and emetic type of food poisoning but the symptoms of emetic food poisoning caused by B. cereus occasionally include emesis and diarrhea. The enterotoxin characteristics of emetic toxin (cereulide) producing B. cereus were needed to be determined. Therefore, forty B. cereus strains isolated from various sources in Korea were investigated for the presence of enterotoxin genes. All strains were confirmed to produce the emetic toxin using HPLC-MS methods. The rates of the nheABC, hblCDA, entFM and cytK genes amongst emetic toxin producing B. cereus strains were 82.5, 7.5, 50.0 and 27.5%, respectively. Pattern III harbored nheABC and entFM genes and pattern V processed entFM gene and were shown to be the major patterns, being present in 55.0% (21 of 40) of the emetic toxin producing B. cereus strains. Our findings revealed that 34 (85.0%) of 40 emetic toxin producing B. cereus strains isolated in Korea have the potential to cause diarrheal and emetic type of food poisoning, simultaneously. Thus, emetic toxin and enterotoxin genes should be constantly screened to provide insight into B. cereus food poisoning.

Comparison of enterotoxin production and phenotypic characteristics between emetic and enterotoxic Bacillus cereus.

Bacillus cereus was divided into emetic toxin (cereulide)- and enterotoxin-producing strains, but emetic toxin-producing B. cereus is difficult to detect immunochemically. Screening methods for emetic toxin-producing B. cereus are needed. The objectives of this study were to identify and detect emetic toxin-producing B. cereus among 160 B. cereus strains, and to compare enterotoxin production and phenotypic characteristics between the emetic toxin-producing and enterotoxin-producing strains. Forty emetic toxin-producing B. cereus strains were determined with high-pressure liquid chromatography-mass spectrometry analysis. Among the emetic toxin-producing strains (n = 40), 31 (77.5%) and 3 (7.5%) strains produced nonhemolytic enterotoxin (NHE) and hemolysin BL (HBL) enterotoxins, respectively. In addition, 107 (89.2%) and 100 (83.3%) strains produced NHE and HBL enterotoxins among the enterotoxin-producing strains (n = 120). The number of strains positive for starch hydrolysis, salicin fermentation, and hemolysis among the emetic toxin-producing strains were 3 (7.5%), 3 (7.5%), and 26 (65.0%), respectively, and among enterotoxin-producing strains, these numbers were 101 (84.2%), 100 (83.3%), and 111 (92.5%), respectively. In particular, the three emetic toxin-producing B. cereus strains (JNHE 6, JNHE 36, and KNIH 28) produced the HBL and NHE enterotoxins and were capable of starch hydrolysis and salicin fermentation. The absence of HBL enterotoxin and certain phenotypic properties, such as starch hydrolysis and salicin fermentation, indicates that these properties were not critical characteristics of the emetic toxin-producing B. cereus tested in this study.