Outbreak of hospital-acquired gastroenteritis and invasive infection caused by Listeria monocytogenes, Finland, 2012.

During one week in July 2012, two patients from the same ward at the municipal hospital in Vaasa, Finland, were diagnosed with septicaemia caused by Listeria monocytogenes. An outbreak investigation revealed eight concomitant cases of febrile gastroenteritis caused by L. monocytogenes on the same ward. Median age of the cases was 82 years and median incubation time for listerial gastroenteritis was 21 h (range 9-107). An additional 10 cases of invasive listeriosis caused by the same outbreak strain were identified across the whole country during the summer of 2012. Environmental investigation at the affected municipal hospital ward revealed ready-sliced meat jelly as the suspected source of the infection. During inspection of the meat jelly production plant, one pooled sample taken from a floor drain and a trolley wheel in the food processing environment was positive for the outbreak strain of L. monocytogenes. After the producer stopped the production of meat jelly, no further cases of listeriosis with the outbreak strain were identified via nationwide surveillance.

Investigation of increased listeriosis revealed two fishery production plants with persistent Listeria contamination in Finland in 2010.

In 2010, a marked increase in listeriosis incidence was observed in Finland. Listeria monocytogenes PFGE profile 96 was responsible for one-fifth of the reported cases and a cluster of PFGE profile 62 was also detected. Investigations revealed two fishery production plants with persistent Listeria contamination. It appears likely that the plants were at least partly responsible for the increase of listeriosis. Epidemiological investigation revealed that 57% (31/54) of cases with underlying immunosuppressive condition or medication reported eating gravad or cold-smoked fish. Two public notices were issued by THL and Evira informing which groups were most at risk from the effects of listeriosis and should therefore be cautious in consuming certain products. Systematic sampling of foods and adequate epidemiological investigation methods are required to identify the sources of Listeria infections. Continuous control measures at fishery production plants producing risk products are essential.

Virulence genes of bovine Staphylococcus aureus from persistent and nonpersistent intramammary infections with different clinical characteristics.

AIMS: To screen putative virulence genes in Staphylococcus aureus causing persistent and nonpersistent bovine intramammary infections (IMI) with different clinical characteristics. To examine, whether a possible relationship exists between genetic profile and infection persistence, clinical signs of infection, clonal type determined by pulsed-field gel electrophoresis (PFGE), and antimicrobial resistance. METHODS AND RESULTS: One-hundred and sixty-one S. aureus isolates derived from bovine IMI, consisting of 17 different PFGE types, were screened by conventional and multiplex-polymerase chain reaction (PCR) for 24 virulence genes for haemolysins (hla-hlg), leukocidins (lukED, lukM), exfoliative toxins (eta, etb), enterotoxins (sea-seo, seu), toxic-shock syndrome toxin (tst), and genes encoding penicillin (blaZ) and methicillin resistance (mecA). The majority of S. aureus isolated at the onset of mastitis carried haemolysin genes (76.7-97.4%), lukED (96.6%), and at least one gene for pyrogenic toxin superantigen (PTSAg) (69.0%). Strains carrying PTSAg-encoding genes were more common among predominant PFGE types and in persistent IMI. Strains concomitantly possessing sed, sej, and blaZ, putatively plasmid-encoded, were typically found in connection with persistent IMI. CONCLUSIONS: Our results suggest that certain genetic elements are over-representative in S. aureus isolates especially from persistent bovine mastitis. This phenomenon seems to be in connection with clonal type and is often concomitant with penicillin resistance. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first study to investigate associations between a large number of bacterial factors and outcome of S. aureus mastitis. The finding that widespread clonal types of S. aureus causing bovine mastitis of low treatment response may harbour characteristic genes could be improved for strain-specific diagnostic purposes.

Comparison of phenotypic and genotypic detection of penicillin G resistance of Staphylococcus aureus isolated from bovine intramammary infection.

Resistance of Staphylococcus aureus to penicillin G is common among isolates from bovine mastitis. We determined phenotypic resistance to penicillin G for 151 S. aureus isolates derived from dairy cows with intramammary infection by two methods. The methods were determination of minimum inhibitory concentration (MIC) by a standard agar dilution technique and direct testing of beta-lactamase production using a chromogenic cephalosporin, nitrocefin. The results from these tests were compared with the presence of the beta-lactamase (blaZ) gene in the isolates, which was detected by polymerase chain reaction (PCR). Testing beta-lactamase production with nitrocefin was more predictive for the presence of the blaZ gene than the agar dilution method and the results of the former agreed highly with the presence of the blaZ gene in the isolates. In contrast, the resistance breakpoint generally used in the agar dilution method may be too high for prediction of penicillin resistance in S. aureus isolates with borderline MICs. Using this method, 40% of the isolates possessing the blaZ gene were classified as susceptible; however, majority of these isolates produced beta-lactamase when tested with nitrocefin.

Fatigue resistance of removable orthodontic appliance reinforced with glass fibre weave.

The aim of this study was to measure the fatigue resistance of fibre-reinforced composite (FRC) reinforced polymeric parts of a removable orthodontic appliance beside the clasp. The effect of quantity and position of FRC-reinforcement were investigated. In addition, the influence of water storage on the fatigue properties was determined. The test specimens for eight groups (n=6) were manufactured from autopolymerizing acrylic resin. Polymethylmethacrylate pre-impregnated woven glass fibre was used as reinforcement of acrylic resin specimens at the region of steel wire clasp. The test specimens of the control group were not reinforced. In the second group, the test specimens were reinforced with one fibre layer (thickness: 0.06 mm) on the tension side, and in the third and fourth group with two fibre layers. Fatigue resistance was measured by applying repeated bending force to the clasp. The highest fatigue resistance values were achieved when the test specimens were fibre-reinforced with two fibre layers. The lowest fatigue resistance values resulted when the test specimens were not reinforced (P=0.046, anova). Water storage had a tendency to decrease the fatigue resistance in all fibre reinforced test specimen groups. The results suggest that use of the woven polymer pre-impregnated glass FRC-reinforcement increases the fracture resistance of orthodontic appliance made of acrylic polymer.

Use of phenotyping and genotyping to verify transmission of Escherichia coli O157:H7 from dairy farms.

A total of 80 human infections by Escherichia coli O157:H7 were documented in Finland in 1997 and 1998. Most were sporadic and their sources undetermined. Five cases not associated with one another, one of which led to secondary transmission within a family, could be traced to five different dairy farms. These five case patients (age range 2-17 years, median age 3 years) were hospitalised with bloody diarrhoea; two of them developed haemolytic uraemic syndrome. All nine human isolates obtained were sorbitol negative, carried the verocytotoxin 2 and eae genes, and produced verocytotoxin and enterohaemolysin. The phage and pulsed-field gel electrophoresis types of the human and bovine isolates from the corresponding farms were indistinguishable. The cattle (20-70 animals per farm) were monitored for up to 2 years after the human cases. The proportion of cattle excreting the type that caused the human infections varied from 3.2 to 66.7% when sampled soon after the human cases, and from 0.0 to 5.3% about a year or so later. On most of the farms, the animals excreted the pathogen intermittently. On one farm, Escherichia coli O157 isolates with other characteristics were also occasionally isolated. Although the infections were traced back to the farms, it could not be established whether the source was unpasteurised milk or direct or indirect contact with cattle. The results of this study emphasise the need for special recommendations for children visiting or living on a farm to prevent these infections.

Occurrence of Escherichia coli O157 in Finnish cattle.

Bovine faecal samples were collected during June-December 1997 at 14 major abattoirs slaughtering cattle in Finland. Escherichia coli O157 was isolated from 19 of the 1448 samples (1.31%) after enrichment and immunomagnetic separation (IMS). The positive faecal isolates originated from 16 farms and eight abattoirs. The occurrence of E. coli O157 was highest in July (8/204; 3.92%) and September (6/244; 2.46%). No E. coli O157 was detected in November and December, nor from the faecal samples from the northernmost region where cattle density is low. All of the isolates carried the eae gene and showed the enterohaemolytic phenotype. All except one were motile and had the flagella antigen H7. Seventeen of the isolates were positive for stx(2) gene and one carried both the stx(1) and stx(2) genes. Of the 17 isolates with stx genes, 16 were verocytotoxin-positive in a reversed passive latex agglutination test after polymyxin extraction but only eight without extraction. The isolates belonged to 10 different pulsed-field gel electrophoresis (PFGE) patterns. The most common PFGE pattern (1.42) was detected in eight isolates (42.1%). Four PFGE patterns (1.1; 1.6; 1.12; 1.14) were identical with those isolated from humans in Finland, suggesting that at least some human E. coli O157 infections may be of bovine origin.

Effects of sound amplification on teachers' speech while teaching.

Voice problems are common among teachers. This is most likely due to the heavy vocal load of their profession. The present study investigated one possible method to decrease the vocal load. The effects of amplification on classroom speech were studied on five Icelandic teachers (three females, two males, mean age 51 years). Classroom speech was recorded with a portable DAT recorder and a head-mounted microphone, first under ordinary conditions and in the next week while using electrical sound amplification. The average fundamental frequency (F0), sound pressure level (SPL) and phonation time were measured. According to the results, amplification significantly lowered both F0 (average 8.6 Hz for the females and 11.3 Hz for the males, p = 0.002 and 0.0001, respectively) and SPL (about 1 dB for both genders, p < 0.05), while phonation time was not significantly affected. The results suggest that electric amplification is likely to reduce vocal load.

An outbreak of Listeria monocytogenes serotype 3a infections from butter in Finland.

In February 1999, an outbreak of listeriosis caused by Listeria monocytogenes serotype 3a occurred in Finland. All isolates were identical. The outbreak strain was first isolated in 1997 in dairy butter. This dairy began delivery to a tertiary care hospital (TCH) in June 1998. From June 1998 to April 1999, 25 case patients were identified (20 with sepsis, 4 with meningitis, and 1 with abscess; 6 patients died). Patients with the outbreak strain were more likely to have been admitted to the TCH than were patients with other strains of L. monocytogenes (60% vs. 8%; odds ratio, 17.3; 95% confidence interval, 2.8-136.8). Case patients admitted to the TCH had been hospitalized longer before cultures tested positive than had matched controls (median, 31 vs. 10 days; P=.008). An investigation found the outbreak strain in packaged butter served at the TCH and at the source dairy. Recall of the product ended the outbreak.

Occurrence and typing of Listeria monocytogenes strains in retail vacuum-packed fish products and in a production plant.

One hundred and ten samples of ready-to-eat, vacuum-packed, smoked and cold-salted fish products were collected from retail outlets in southern Finland during 1996 for examination of the occurrence and level of Listeria monocytogenes. The samples originated from 12 producers. Positive samples with levels exceeding 100 CFU/g were encountered mainly in one of the producers (no. 8). Therefore, 200 samples from the plant and the products of this producer were studied during August-September 1996 and May-September 1997, as well as 55 samples from the six fish farms providing raw material fish to this plant, during September 1997-January 1998. The isolates were characterised by serotyping and pulsed-field gel electrophoresis (PFGE). L. monocytogenes was isolated in 20% (22/110) of the samples from the retail market, originating from 6 producers. Ten of these positive samples contained L. monocytogenes at > 100 CFU/g (maximum 1.37 X 10(4) CFU/g). Seventeen percent (5/30) of cold-smoked and 50% (16/32) of cold-salted rainbow trout samples were contaminated. Only one hot-smoked fish product (2%) was found to be positive by enrichment. Nineteen (86%) of the strains isolated from the retail samples belonged to serovar 1/2a and three (14%) to serovar 4b. In further studies the production line of plant no. 8 was found to be contaminated. All of isolates from up until autumn, 1997 both the products and the production plant were serovar 1/2a; thereafter one strain of 4b and one of 1/2 (H-antigen untypeable) were isolated from the plant. The samples from raw material fish were all negative for L. monocytogenes. The samples from retail market fell into seven PFGE types. Five and nine PFGE types, respectively, were found from the products and the plant of producer no. 8. PFGE type A was detected from the retail products of four producers and was also dominant among the isolates from production plant no. 8. PFGE type A was the only one found repeatedly from skinning, salting and slicing units as well as from products throughout the whole period. PFGE proved to be a powerful tool for studying contamination points and routes in the production plant. The measures based on hazard analysis critical control points (HACCP) program resulted in L. monocytogenes negative samples at production plant no. 8 from the beginning of January 1998.

Relationship between subjective voice complaints and acoustic parameters in female teachers' voices.

The aim of the study was to identify the acoustic correlates of female teachers' subjective voice complaints by recording their voices in their working environment. The subjects made recordings during lessons (N = 10) and breaks (N = 11). The subjects were divided into 2 groups: those with few voice complaints (FC group) and those with many voice complaints (MC group). The speech sample made in the breaks was maximally sustained /a/, from which fundamental frequency (F0), jitter, and shimmer were analyzed. The classroom samples were analyzed for F0, sound pressure level (SPL), and F0 time (the active vibration time of the vocal folds). Additionally, an index for assessing voice loading is presented. The results revealed a tendency of the MC group to have higher F0 and lower SPL and perturbation values than the FC group. The index values correlated moderately with the subjective vocal complaints.

Working-day effects on the spectral characteristics of teaching voice.

Ten teachers made recordings during one normal working day using a portable DAT recorder and a head-mounted microphone. In addition, the subjects filled in a questionnaire of signs of vocal fatigue. The speech samples were selected from the first and last lesson from three points representing the beginning, middle and end part of the lesson, respectively. To standardize the samples, 30 [a] vowels from stressed syllables were chosen for spectral analysis. The level of the fundamental and second formant regions (L1), the level of frequency ranges 2-5 kHz (L2) and 5-10 kHz (L5) were measured. From these measurements the parameters L1-L0, L1-L2 and L1-L5 were formed and used in the analyses as well as the energy levels below and above 1 kHz (alpha). Statistically significant changes were observed in the following parameters: the L1-L2 and L1-L5 differences, and the alpha ratio. In general, there was an increase in the energy content of the high frequency components due to vocal loading. The subjective reports revealed a statistically significant relationship with the spectral characteristics.

Measuring voice under teachers' working circumstances: F0 and perturbation features in maximally sustained phonation.

This study is part of a larger project, the aim of which is to develop a method for collecting voice data in working places. In this part, maximally sustained phonation was studied to assess its stability in this kind of uncontrolled circumstances. The subjects were 11 female schoolteachers. Different portions of a sustained /a/ and two consecutively produced samples were measured. The acoustic variables measured were fundamental frequency (F0), jitter and shimmer. The results showed that two consecutively produced phonations were quite similar, but the place of the sample within the sustained vowel had a very small but statistically significant effect on the values of F0 and shimmer. Jitter varied quite a lot, and could perhaps be considered to be dependent on the recording circumstances.