Surtos de salmonelose notificados no período de janeiro de 2009 a julho de 2014 no estado do Paraná, Brasil / Salmonellosis outbreaks reported from january 2009 to july 2014 in the state of Paraná, Brazil / Brotes de salmonelosis notificados en el periodo de enero de 2009 a julio de 2014 en el estado de Paraná, Brasil

A incidência de doenças relacionadas ao consumo de alimentos vem aumentando a cada dia, o que demonstra a importância de estudos que avaliem os agentes etiológicos envolvidos para que se possa traçar estratégias de controle do aparecimento de surtos. A salmonelose é uma enfermidade de grande importância para a saúde pública, sendo importante a sua investigação, visto que seu agente etiológico, a Salmonella spp. é um dos principais micro-organismos envolvidos em surtos de toxinfecções alimentares. Sendo assim, o objetivo do trabalho foi avaliar o número de surtos alimentares ocasionados por Salmonella spp., notificados no Estado do Paraná entre janeiro de 2009 a julho de 2014. Neste período foram notificados 105 surtos de toxinfecção alimentar e desses 19 casos (18,09%) foram confirmados em laboratório como sendo Salmonella spp. No entanto, dentre os surtos de Salmonella spp. ocorridos no período não houve nenhuma notificação de morte ocasionada por este agente. Os resultados demonstram a necessidade de realização de treinamento em Boas Práticas de Fabricação (BPF) para os manipuladores, além do planejamento de ações em educação sanitária para a população consumidora, e a necessidade de um maior controle dos surtos alimentares, para que se possa contribuir efetivamente no controle desse tipo de doença por meio da redução da população exposta ao risco.(AU)

The incidence of diseases related to food consumption is increasing, which shows the importance of studies assessing the etiologic agents involved so that strategies to control outbreaks can be developed. Salmonellosis is a disease of great importance to public health, and its investigation is important, since its etiological agent - Salmonella spp. - is one of the main microorganisms involved in food poisoning outbreaks. Thus, the objective of this study was to evaluate the number of food outbreaks caused by Salmonella spp., reported in the state of Paraná from January 2009 to July 2014. During this period, a total of 105 food poisoning outbreaks were reported, and from these, 19 cases (18.09%) were confirmed in laboratory as Salmonella spp. However, among the outbreaks of Salmonella spp. occurring during the period, there was no notification of death caused by this agent. The results demonstrate the need to have training in Good Manufacturing Practices (GMP) for handlers, in addition to planning activities in health education for the consuming population, as well as the need for greater control of food outbreaks, for effectively contributing to control this disease by reducing the population exposed to the risk.(AU)

La incidencia de enfermedades relacionadas con el consumo de alimentos está aumentando a cada día, lo que demuestra la importancia de estudios que evalúen los agentes etiológicos implicados, para que se pueda trazar estrategias de control del aparecimiento de brotes. La salmonelosis es una enfermedad de gran importancia para la salud pública, es importante su investigación, puesto que su agente etiológico, la Salmonella spp. es uno de los principales microorganismos implicados en brotes de intoxicaciones alimentares. Por lo tanto, el objetivo de este estudio ha sido evaluar el número de brotes por alimentos causados por Salmonella spp., reportados en el Estado de Paraná entre enero de 2009 a julio de 2014. Durante este período se reportaron 105 brotes de intoxicación alimentar, y de esos, 19 casos (18,09%) fueron confirmados en laboratorio como Salmonella spp. Sin embargo, entre los brotes de Salmonella spp. producidos durante el período no hubo ninguna notificación de muerte causada por este agente. Los resultados demuestran la necesidad de llevar a cabo la capacitación en Buenas Prácticas de Manufactura (BPF) para los manipuladores, además de planificaciones de acciones en educación sanitaria para la población consumidora, y la necesidad de un mayor control de los brotes alimentares, para que se pueda contribuir efectivamente en el control de ese tipo de enfermedad, por medio de la reducción de la población expuesta al riesgo.(AU)

[Statistical analysis of trend of human Salmonella infections in Poland in 1995-2007]. / Statystyczna analiza trendu zakazen Salmonella u ludzi w Polsce w latach 1995-2007.

The epidemiological situation of human salmonellosis in Poland in the successive years (between 1995 and 2007), presented in this study, was illustrated by using the notification rates expressed as the number of confirmed cases (of total human Salmonella infections and infections associated with chosen serovars) per 100,000 inhabitants. The notification rates were calculated basing on the published data of human salmonellosis in Poland (1995-2007) and the total population in each year. Their distribution over time was presented in a form of the specific notification rate graphs. The aim of the study was the statistical analysis of observed changes in level of human Salmonella infections in Poland in 1995-2007. Particularly, we tried to investigate whether the general decrease of Salmonella infection notification rates observed over investigated period can be recognized as significant in the statistical meaning, and whether the changes in infections caused by the most frequently isolated serovars show the clear tendency, i.e. whether it is possible to say about the permanent decrease or increase of these infections. The trends in notification rates were analysed using simultaneously three different statistical tests including chi-square for trend, linear regression, and Poisson regression. The results of all tests taken together were used for trend estimation. The decreasing/increasing tendency of evaluated rates was found to be characteristic if it showed statistical significance (p < 0.05) in all of these tests simultaneously. The results revealed statistically significant and decreasing trends in notification rates only for salmonellosis in total and for infections caused by S. Enteritidis. In the case of seven other statistically analysed serovars (i.e., S. Typhimurium, S. Hadar, S. Infatis, S. Virchow, S. Newport, S. Mbandaka, S. Agona) it is not possible to say explicitly that their notification rates do not show a certain tendency over time, however changes revealed by them in the investigated period are not essential enough or their distribution is not regular enough that there are no grounds to ascribe a definite trend to them. They are not found to be significantly increasing or decreasing over time, and their distribution shows rather features of random walk.

Molecular characterization of class 1 integrons in clinical strains of Salmonella typhimurium isolated in Slovakia.

The presence of class 1 integrons was investigated in 156 epidemiologically unrelated Salmonella Typhimurium isolates. Of these 156 isolates, 70 were of definitive phage type DT104 and 86 were strains of various phage type, RDNC and untypable, designated here as non-DT104 strains. Integrons were found in 47 of DT104 isolates (67.1%), while in all strains with characteristic pentaresistance (R-type ACSSuT) two integrons 1.0 kb and 1.2 kb in size were found. Among 86 non-DT104 strains, integrons with sizes of 1.6 kb and 1.9 kb in four multidrug-resistant strains DT193 and U302 were found. The integrons from selected strains were further sequenced and the aadA1, aadA2, dhfr1, dhfr12 and bla(PSE) genes were found embedded in cassettes.

Genetic determinants of acute inflammation regulate Salmonella infection and modulate Slc11a1 gene (formerly Nramp1) effects in selected mouse lines

Two lines of mice selected to produce maximal (AIRmax) or minimal (AIRmin) acute inflammatory reactions (AIR) differ in their susceptibility to infection by Salmonella enterica serotype Typhimurium (S. Typhimurium). The LD50 for AIRmax mice is 1000 times higher than that observed for AIRmin mice, and higher frequencies of Slc11a1 alleles (known to confer either resistance (R) or high susceptibility (S) to S. Typhimurium) were consistently found in AIRmax and AIRmin mouse lines, respectively. In order to evaluate the effect of the quantitative trait loci (QTL) segregated in AIRmax and AIRmin mice on Slc11a1 dependent susceptibility to S. Typhimurium, the R and S alleles were fixed in homozygosity in AIRmax and AIRmin backgrounds by genotype assisted breedings. These new lines were named AIRmaxRR, AIRmaxSS, AIRminRR, and AIRminSS. Acute inflammation of Slc11a1RR animals was more severe in comparison to their Slc11a1SS counterparts, implicating Slc11a1 (or other linked genes) in AIR regulation. The LD50 of S. Typhimurium was 800-times higher for AIRmaxSS than for AIRminSS, demonstrating that AIR QTL can act as modifiers of the Slc11a1SS susceptibility gene. Four microsatellite markers for S. Typhimurium susceptibility QTL described in other mouse lines showed specific allele fixation in AIRmax or AIRmin mice, suggesting that these chromosomal regions also segregate with inflammatory phenotypes.

Phage types, ribotypes and tetracycline resistance genes of Salmonella enterica subsp. enterica serovar Typhimurium strains isolated from different origins in Italy.

The tetracycline resistance (tet) gene patterns of 52 tetracycline resistant Salmonella enterica subsp. enterica (S.) serovar Typhimurium isolates collected from animals, food of animal origin, and humans in Italy, were investigated to evaluate whether the tet gene patterns could be used for strain differentiation in addition to phage typing and ribotyping. The detection of tet genes was performed by specific PCR assays. Ribotyping was performed automatically using PvuII as restriction enzyme. Ten different ribotyping patterns were detected. All isolates were positive for at least one of the tet genes studied and six different tet gene patterns were observed. Ribotyping and tet gene patterns showed discriminatory indices of 0.741 and 0.812, respectively. Multiple tet genes were commonly found among tetracycline resistant S. typhimurium isolates from various sources. The resulting tet gene patterns allowed further discrimination of strains which were otherwise indistinguishable by their phage type, ribotype and origin. Thus, the analysis of tet gene patterns might represent an additional tool for the differentiation of S. typhimurium isolates.

Antimicrobial resistance in nontyphoid Salmonella serotypes: a global challenge.

Increasing antimicrobial resistance in nontyphoid Salmonella species has been a serious problem for public health worldwide. The high rate of resistance is hampering the use of conventional antibiotics, and growing resistance to newer antimicrobial agents is aggravating the situation. The circumstances of occurrence and spread of antimicrobial resistance are complex; however, a major cause is the widespread use of antimicrobial agents in food animals, particularly in animal feed. Genetic analysis has indicated that the source of resistance is frequently a transferable plasmid. Recent studies have revealed that some serotype-specific virulence plasmids form hybrid plasmids through recombination with resistance plasmids or acquire gene cassettes consisting of multiple resistance genes. Such evolutionary events provide a virulent strain the advantage of survival in an unfavorable drug environment. In view of the serious implications associated with drug-resistant Salmonella species, a more deliberate use of antibiotics in both human medicine and animal industry is warranted. Continued surveillance of antimicrobial resistance and use of antimicrobial agents in food animals is also indispensable.

Infected aortic aneurysms: imaging findings.

PURPOSE: To determine the imaging characteristics of infected aortic aneurysms. MATERIALS AND METHODS: Review of records of patients with surgical and/or microbiologic proof of infected aortic aneurysm obtained over a 25-year period revealed 31 aneurysms in 29 patients. This study included 21 men and eight women (mean age, 70 years). One radiologist reviewed 28 computed tomographic (CT) studies (22 patients underwent CT once and three patients underwent CT twice), 12 arteriograms (12 patients underwent arteriography once), eight nuclear medicine studies (six patients underwent nuclear medicine imaging once and one patient underwent nuclear medicine imaging twice), and three magnetic resonance (MR) studies (three patients underwent MR imaging once). Features evaluated included aneurysm size, shape, and location; branch involvement; aortic wall calcification; gas; radiotracer uptake on nuclear medicine studies; and periaortic and associated findings. The location of infected aortic aneurysms was compared with that of arteriosclerotic aneurysms. RESULTS: Aneurysms were located in the ascending aorta (n = 2, 6%), descending thoracic aorta (n = 7, 23%), thoracoabdominal aorta (n = 6, 19%), paravisceral aorta (n = 2, 6%), juxtarenal aorta (n = 3, 10%), infrarenal aorta (n = 10, 32%), and renal artery (n = 1, 3%). Two patients had two infected aortic aneurysms. CT revealed 25 saccular (93%) and two fusiform (7%) aneurysms with a mean diameter at initial discovery of 5.4 cm (range, 1-11 cm). Paraaortic soft-tissue mass, stranding, and/or fluid was present in 13 (48%) of 27 aneurysms, and early periaortic edema with rapid aneurysm progression and development was present in three (100%) patients with sequential studies. Other findings included adjacent vertebral body destruction with psoas muscle abscess (n = 1, 4%), kidney infarct (n = 1, 4%), absence of calcification in the aortic wall (n = 2, 7%), and periaortic gas (n = 2, 7%). Angiography showed 13 saccular aneurysms with lobulated contour in 10 (77%). Nuclear medicine imaging showed increased activity consistent with infection in six (86%) of seven aneurysms. MR imaging showed three saccular aneurysms. Adjacent abnormal vertebral body marrow signal intensity was seen in one (33%) of three patients. CONCLUSION: Saccular aneurysms (especially those with lobulated contour) with rapid expansion or development and adjacent mass, stranding, and/or fluid in an unusual location are highly suspicious for an infected aneurysm.

Clonal circulation of Salmonella enterica serotype Heidelberg in Italy?

Phenotypic and genetic characteristics of 21 strains of Salmonella serotype Heidelberg isolated in the years 1999-2003 from different sources in Italy were studied. Susceptibility patterns, plasmid analysis, and PFGE were used as epidemiological markers. Although non-homogeneous drug resistance patterns and plasmid profiles had been detected, PFGE patterns suggest the hypothesis of a nationwide clonal spread of this serotype associated with poultry.

Prevalence of infections of the Salmonella strains in the Lublin voivodeship and in Poland in the years 1980-2000.

The aim of the paper is presentation of the prevalence of infections of the Salmonella strains in the Lublin voivodeship in the years 1980-2000 in comparison with their nationwide prevalence in the same period. The analysed material comprised epidemiological data concerning the incidence rates of salmonelloses registered in Poland in the studied period. Since the beginning of the 1980s there was observed a constantly increasing trend in incidence rates of salmonelloses. After 1988 throughout Poland and after 1990 in the Lublin voivodeship there was noted gradual decline in incidence of infections caused by Salmonellas. Administrative decisions and recent improvements in sanitary situation in our country caused appearance of that favourable, decreasing trend of incidence rates of salmonelloses. The statistics concerning extraintestinal infections with Salmonellas are still unreliable, especially in the Lublin voivodeship.

A review of the Salmonellosis surveillance systems in Italy: evolution during the course of time within the international framework.

This paper focuses on the history of the two systems that have been adopted in Italy for the surveillance of Salmonellosis and describes their respective characteristics. Both systems have been subsequently modified: (1) The National Laboratory-based Surveillance System (NLSS) which was created in 1967 for Enteropathogenic Bacteria and subsequently, in 1992, became part of the European computerised Laboratory-based Surveillance System of Salmonellae isolates, the SALM-NET (Salmonella network); (2) The National Infectious Disease Reporting System (NIDRS) which was set up in the 1930s, revised in 1990 and has been used, since 1994, along with the Infectious Disease Informative System (IDIS). The results obtained with the different surveillance systems are presented: (1) The number of isolates from the laboratory surveillance from 1973 to 1997 are described. Total Salmonellae isolates have a slope with an increasing trend from 4372 isolates in 1973 to 15,041 isolates in 1988 drastically dropping to 5479 isolates in 1990 and increasing again to 13,596 isolates in 1993. Attention is given particularly to the epidemiology of S. enteritidis in Italy which increased progressively since 1982 (225 isolates) to 5435 isolates in 1994. S. typhimurium showed a slightly increasing trend in the period 1973-1988 (from 1694 to 3383 isolates) then decreased for reaching again previous levels. S. typhi showed a marked reduction from 573 isolates in 1973 to 33 isolates in 1996. On the contrary, other less frequent serotypes increased. (2) The number of cases of Salmonellosis reported during 1971-1997 are also presented. Other Infections by Salmonellae increased from 12,516 cases in 1976 (renamed Non Typhoidal Salmonellosis in 1990) to more than 20,000 cases in 1992. The number of cases of Typhoid Fever and Infections by S. paratyphi are also described. Particular attention has to be paid to the parallel trends of Salmonellosis using both surveillance systems: number of isolates and number of cases, particularly comparing Other Infections by Salmonellae and total Salmonellae isolates: after the 1992-1993 peak, an initial decrease was observed.

Typing of Salmonella enterica serotype paratyphi C isolates from various countries by plasmid profiles and pulsed-field gel electrophoresis.

Pulsed-field gel electrophoresis (PFGE) of 61 Salmonella enterica serotype Paratyphi C isolates from six countries gave five distinct clusters. Twenty-four isolates from five countries were susceptible to 10 antimicrobials tested and gave similar restriction endonuclease digest patterns of the 38-MDa plasmid. In contrast, plasmid and PFGE profiles of 37 multidrug-resistant isolates from Zaire were different from those from other countries.

Iguanas and Salmonella marina infection in children: a reflection of the increasing incidence of reptile-associated salmonellosis in the United States.

OBJECTIVE: To investigate clinical aspects and risk factors for Salmonella serotype Marina infection in the United States. METHODS: We identified all isolates of S Marina reported in 1994 to the National Salmonella Surveillance System. Patients were interviewed about demographic information, clinical course, diet, travel history, and contact with reptiles before illness. RESULTS: Twenty-six (81%) of 32 patients were infants (<1 year of age) and 24 (75%) were male. This differs from other Salmonella isolates reported to the Centers for Disease Control and Prevention in 1994, of which 14% were from infants and 49% from male patients. Eleven patients (34%) were hospitalized for a median of 3.5 days (range: 2 to 21 days), and 1 died. Of 28 patients (88%) with reported iguana exposure, only 4 (14%) touched the reptile, and only 12 respondents (43%) realized that it might have been the source of infection. Seven (32%) of 22 families who owned an iguana at the time of illness continued to own an iguana when contacted a median of 28 weeks later. Persons who thought that the iguana was the source of infection were more likely to have given away or sold the pet than those who did not. Four isolates (13%) were from blood. Bacteremia was associated with taking antibiotics during the 30 days before S Marina infection (odds ratio: 24; 95% confidence interval: 1.2-1309). CONCLUSION: S Marina infection is a potentially serious illness associated with iguana exposure, and it reflects the larger problem of reptile-associated salmonellosis. Many parents do not know that owning an iguana puts their children at risk for Salmonella infection. Pediatricians, veterinarians, and pet store owners should inform their patients and customers of the potential risks of owning reptiles and provide appropriate preventive education.

The role of Public Health Laboratory in the problem of salmonellosis in Sao Paulo, Brazil

No periodo de 1950-90 foram identificadas 45.862 cepas de Salmonella, sendo 31.517 provenientes de infeccoes humanas e 14.345 de materiais de origem nao humana. O objetivo deste trabalho foi analisar as alteracoes ocorridas quanto a frequencia dos sorotipos isolados neste periodo. No periodo 1950-66, nao houve predominio evidente de nenhum sorotipo; entretanto, no perido 1970-76, com inicio em 1968, a S. Typhimurium passou a ser o sorotipo predominante, representando 77,7 por cento dos sorotipos isolados. Observou-se um aumento significativo da S. Agona, bem como de uma grande variedade de sorotipos. Quanto as salmonelas de origem nao humana, chama a atencao o grande numero (mais de 100) de sorotipos...

Human infection caused by Salmonellae of subspecies II to VI in Germany, 1977-1992.

Human infections by Salmonella (S.) are usually caused by S. enterica strains belonging to the subspecies I (subsp.). Strains of subsp. II-VI and S. bongori are mostly isolated from animals or environmental specimens, and they are therefore considered as less pathogenic for humans. Out of 90,201 S. isolates examined at the German National Reference Centre for Enteric Pathogens between 1977 to 1992, 89,798 (99.55%) belonged to S. subsp. I, while 403 (0.45%) of strains belonged to S. subsp. II-VI and S. bongori (formerly called subsp. V). 108 strains belonged to subsp. II, 241 isolates to subsp. IIIa and IIIb (formerly called Arizona), 49 to subsp. IV, 4 to S. bongori and one isolate to subsp. VI. 215 of the 403 isolates (53.4%) were from humans, 101 (25.1%) from reptiles, 52 (12.9%) from various warm-blooded animals, 11 (2.7%) from foodstuffs and 12 (3.0%) from environmental specimens. The origin of 12 (3.0%) strains was unknown. According to the clinical diagnosis reported by the laboratories, intestinal disease was associated with 176 (81.9%) out of 215 strains of human origin. 11 (5.1%) strains had been isolated from extraintestinal infections (sepsis, atypical pneumonia, urinary tract and wound infections), and 28 (13.0%) strains from stool specimens of healthy persons. A slightly higher incidence was observed in children of 0-5 years of age (49 cases; 22.8%). Male persons were twice as often affected than females. The seasonal incidence of infections was highest in October and in February. In 53 cases (24.6%), travel to a foreign country was reported.

Classifying extraintestinal non-typhoid Salmonella infections.

Non-typhoid Salmonella infection in man has been divided into five clinical groups: gastroenteritis, enteric fever, bacteraemia, chronic carrier state and localized infection. This classification has neither pathogenic nor prognostic significance. We retrospectively reviewed the charts of 183 patients with extraintestinal salmonellosis who presented to our institution during a period of 32 years. Patients were classified into four groups: primary bacteraemia (PB), enteritis-associated bacteraemia (secondary bacteraemia) (SB), digestive focal infection (DI) and non-digestive focal infection (NDI). Sex, age, acquisition, underlying disease and outcome were compared between patients with bacteraemia and diseases with focal infection. The differences found between PB and SB were: community acquisition (66% in PB and 85% in SB, p = 0.06) severe immunosuppression (53% in PB and 15% in SB, p < 0.001) and mortality (37% in PB and 3% in SB, p < 0.001). The differences found between NDI and DI were: age over 60 years (45% in NDI and 18% in DI, p < 0.05), severe immunosuppression (51% in NDI and 12% DI, p < 0.001) and associated bacteraemia (38% in NDI and 6% in DI, p < 0.001). This classification of extraintestinal salmonellosis may have pathogenic and prognostic implications, and could help us to understand the clinical significance of this disease.