Salmonella Enteritidis phage type 21 outbreak in Austria, 2005.

We report an outbreak of gastroenteritis due to Salmonella Enteritidis PT 21 associated with attending an annual traditional fair in a small Austrian village on 4 May 2005. The outbreak lasted from 4 to 8 May. Descriptive and analytical epidemiological investigations were conducted in order to determine the extent of the outbreak and to identify outbreak risk factors. Of the 115 persons who visited the fair, 85 persons fulfilled the criteria of an outbreak case (attack rate = 73.9%). Stool specimens from 52 patients, including two kitchen staff, were tested for salmonella, and 20 specimens were positive for Salmonella Enteritidis PT 21. The cohort study revealed mixed salad (which included potatoes) as the likely cause of the outbreak (RR: 10.4, 95%CI 2.8 - 39.1; P = < 0.001). The causative agent of the outbreak was cultured from the stock of eggs used at the fair and from all three drag swabs and one barn dust sample collected from the responsible egg laying flock. Molecular subtyping by pulsed-field gel electrophoresis of genomic DNA after XbaI digestion showed that isolates from eggs, from the flock and from humans were indistinguishable. We hypothesise that cross contamination from eggs to boiled potatoes occurred in the kitchen area, where raw eggs were handled by village residents preparing a traditional Viennese egg dressing. Unrefrigerated storage of peeled potatoes may have favoured bacterial growth. Eggs from small rural flocks of laying hens kept in a traditional 'natural' way should not be assumed to be salmonella-free.

Salmonella Enteritidis phage type 21 outbreak in Austria, 2005.

We report an outbreak of gastroenteritis due to Salmonella Enteritidis PT 21 associated with attending an annual traditional fair in a small Austrian village on 4 May 2005. The outbreak lasted from 4 to 8 May. Descriptive and analytical epidemiological investigations were conducted in order to determine the extent of the outbreak and to identify outbreak risk factors. Of the 115 persons who visited the fair, 85 persons fulfilled the criteria of an outbreak case (attack rate=73.9%). Stool specimens from 52 patients, including two kitchen staff, were tested for salmonella, and 20 specimens were positive for Salmonella Enteritidis PT 21. The cohort study revealed mixed salad (which included potatoes) as the likely cause of the outbreak (RR: 10.4, 95%CI 2.8 - 39.1; P=<0.001). The causative agent of the outbreak was cultured from the stock of eggs used at the fair and from all three drag swabs and one barn dust sample collected from the responsible egg laying flock. Molecular subtyping by pulsed-field gel electrophoresis of genomic DNA after XbaI digestion showed that isolates from eggs, from the flock and from humans were indistinguishable. We hypothesise that cross contamination from eggs to boiled potatoes occurred in the kitchen area, where raw eggs were handled by village residents preparing a traditional Viennese egg dressing. Unrefrigerated storage of peeled potatoes may have favoured bacterial growth. Eggs from small rural flocks of laying hens kept in a traditional 'natural' way should not be assumed to be salmonella-free.

Trends in antimicrobial drug resistance in Salmonella enterica serotypes Typhi and Paratyphi A isolated in Europe, 1999-2001.

Results of antimicrobial sensitivity tests for strains of Salmonella enterica serotypes Typhi and Paratyphi A isolated from patients in ten European countries between 1999 and 2001 have been transferred electronically to the Enter-net surveillance hub. For Typhi between 22 and 29% of isolates were multiresistant (to four drugs or more) with decreased susceptibility to ciprofloxacin (MIC 0.25-1.0 mg/l) increasing from 20% in 1999 to 26% in 2001. Nineteen of 169 (11%) strains with decreased ciprofloxacin susceptibility were sensitive to nalidixic acid. For Paratyphi A multiple resistance increased from 9% in 1999 to 25% in 2001 and decreased ciprofloxacin susceptibility from 6 to 17%. Clinicians should be aware of the possibility of treatment failures when fluoroquinolones are used as the first-line drug for infections with Typhi and Paratyphi A, particularly for patients recently returning from areas where drug-resistant strains are endemic.

A regional outbreak of S. Enteritidis phage type 5, traced back to the flocks of an egg producer, Austria.

In the spring and summer of 2002, the Nationale Referenzzentrale für Salmonellen (National Reference Centre for Salmonella - NRCS) in Austria noticed a cluster of human Salmonella enterica subsp. enterica ser. Enteritidis phage type 5 (S. Enteritidis PT5) infections in two neighbouring districts of Austria. Another small outbreak of S. Enteritidis PT5 infections that occurred in the same region in 1999 had been traced back to the flocks of a local egg producer (approximately 6 000 hens). Attention was therefore again directed at this farm. The results of voluntary bacteriological examinations from the farm and further epidemiological investigations identified the same egg producer as the source of the second outbreak. The 70 human isolates of S. Enteritidis PT5 ascertained in 2002 represented a minority of all infections. It is realistic to estimate that several hundred infections occurred in the course of the 2002 outbreak. The farmer had not vaccinated new flocks against Salmonella since August 2001. It is likely that the change in vaccination policy resulted in the reappearance of the S. Enteritidis PT5 infections. By the end of September 2002 the farmer had stopped selling untreated table eggs. In October 2002 only one isolate of S. Enteritidis PT5 was ascertained in the region.

Occurrence of Salmonella Enteritidis phage type 29 in Austria: an opportunity to assess the relevance of chicken meat as source of human Salmonella infections.

Assuming that the various phage types of Salmonella Enteritidis (S. Enteritidis) are largely equally virulent, the importance of certain foods as sources of infection for human salmonellosis can be deduced from differences in the distribution of phage types in human and non-human samples. In 2002, S. Enteritidis phage type 29 (PT29) was first isolated from non-human test samples in Austria. S. Enteritidis PT29 accounted for 44 (27.7%) of 159 S. Enteritidis strains, derived from veterinary samples of chicken (e.g. meat, giblets) or chicken habitations (e.g. swabs from the coop and excrement). At the food retail level (chicken meat, chicken liver), five (13.1%) of 38 S. Enteritidis isolates were PT29. The proportion of S. Enteritidis PT29 in human samples was much lower. Only 0.4% (30 human primary isolates) of all S. Enteritidis isolates in the year 2002, and 0.33% (23 human primary isolates) of all human S. Enteritidis strains in 2003 were PT29. In our opinion, the discrepancy between the high prevalence of S. Enteritidis PT29 in broilers and chicken meat and the low number of PT29 cases in humans indicates that chicken meat of Austrian origin is currently only a minor source of human S. Enteritidis infections.

Occurrence of Salmonella Enteritidis phage type 29 in Austria : an opportunity to assess the relevance of chicken meat as source of human salmonella infections.

Assuming that the various phage types of Salmonella Enteritidis (S. Enteritidis) are largely equally virulent, the importance of certain foods as sources of infection for human salmonellosis can be deduced from differences in the distribution of phage types in human and non-human samples. In 2002, S. Enteritidis phage type 29 (PT29) was first isolated from non-human test samples in Austria. S. Enteritidis PT29 accounted for 44 (27.7%) of 159 S. Enteritidis strains, derived from veterinary samples of chicken (e.g. meat, giblets) or chicken habitations (e.g. swabs from the coop and excrement). At the food retail level (chicken meat, chicken liver), five (13.1%) of 38 S. Enteritidis isolates were PT29. The proportion of S. Enteritidis PT29 in human samples was much lower. Only 0.4% (30 human primary isolates) of all S. Enteritidis isolates in the year 2002, and 0.33% (23 human primary isolates) of all human S. Enteritidis strains in 2003 were PT29. In our opinion, the discrepancy between the high prevalence of S. Enteritidis PT29 in broilers and chicken meat and the low number of PT29 cases in humans indicates that chicken meat of Austrian origin is currently only a minor source of human S. Enteritidis infections.

Salmonella enterica serotype Oranienburg infections associated with consumption of locally produced Tyrolean cheese.

Sixteen culture confirmed cases of enteric infection with Salmonella enterica serotype Oranienburg were detected between August 10 and September 29 1999 in Tyrol (Austria). Ten of them suffered bloody diarrhoea and six were asymptomatic carriers. Intervie

Occurrence of Salmonella enterica serovar Dublin in Austria.

In Austria, Salmonella enterica subsp. enterica serovar Dublin, a bovine-adapted serovar, rarely causes infections in humans. In 2000, Austria was within the European mean with an incidence of 0.1 per million inhabitants. Our data show that the vast majority of all serovar Dublin infections (human and non-human) can be traced epidemiologically to two districts in the Tyrol. This concentration of cases can be explained by a particularly traditional aspect of cattle farming in this area, the alpine pasture. There is an increased risk of cross infection due to the communal keeping of animals from various farms. Infected cattle are a source of infection for humans, and transmission usually occurs from eating beef and drinking cows milk. Using pulsed field gel electrophoresis and automated ribotyping, three out of five isolates from human infections could be traced to characteristic Tyrolean Dublin clones. Bacteriological screening for faecal carriage before the transfer of cattle from risk-herds to the alpine pastures and before the return from risk-pastures to the farms would be a possible starting point to prevent cross-contamination of large mixed herds and contamination of pasture through latently infected cattle. Appropriate research is necessary.

Antimicrobial drug resistance in isolates of Salmonella enterica from cases of salmonellosis in humans in Europe in 2000: results of international multi-centre surveillance.

The Enter-net surveillance system received results of antimicrobial sensitivity tests for isolates from over 27 000 cases of human salmonellosis in 2000 in 10 European countries. Almost 40% of isolates were resistant to at least one antimicrobial, with 18% multiresistant. Resistance to ampicillin, streptomycin, sulphonamides and tetracyclines was common, with over 20% of isolates resistant to at least one of these antimicrobials. Clinical resistance to ciprofloxacin was rare, with only 0.5% of isolates exhibiting such resistance (MIC >1.0 mg/l). Resistance to nalidixic acid coupled with a decreased susceptibility to ciprofloxacin (MIC 0.25-1.0 mg/l) was more common, with 14% of isolates showing these properties. Resistance to third-generation cephalosporins was rare with only 0.6% of isolates resistant to cefotaxime. In all countries multiple resistance was most common in Salmonella enterica serotype Typhimurium, with 51% of isolates multiresistant in total. In England and Wales multiple resistance was also prevalent in S. Virchow and S. Hadar, whereas in other countries multiple resistance was common in serotypes such as S. Blockley.

Relationship of pulsed-field profiles with key phage types of Salmonella enterica serotype Enteritidis in Europe: results of an international multi-centre study.

Salmonella is one of the most common causes of foodborne infection in Europe with Salmonella enterica serovar Enteritidis (S. Enteritidis) being the most commonly identified serovar. The predominant phage type for S. Enteritidis is phage type (PT) 4, although PT 8 has increased in incidence. Within these phage types, pulsed-field gel electrophoresis (PFGE) provides a method of further subdivision. The international project, Salm-gene, was established in 2001 to develop a database of PFGE profiles within nine European countries and to establish criteria for real-time pattern recognition. It uses DNA fingerprints of salmonellas to investigate outbreaks and to evaluate trends and emerging issues of foodborne infection within Europe. The Salm-gene database contains details of about 11 700 S. Enteritidis isolates, demonstrating more than 65 unique PFGE profiles. The clonal nature of S. Enteritidis is evidenced by the high similarity and distribution of PFGE profiles. Over 56% (6603/11 716) of the submitted isolates of several different phage types were profile SENTXB.0001, although this profile is most closely associated with PT 4. The next most common profiles, SENTXB.0002 and SENTXB.0005, were closely associated with PT 8 and PT 21 respectively. Studies to investigate the relationship of profile types with outbreaks and possible vehicles of infection suggest that the incidence of PFGE profile SENTXB.0002, and thus PT 8, in some countries may be due to importation of foods or food production animals from Eastern Europe, where PT 8 is amongst the most frequently identified phage types. Collation of subtyping data, especially in the commonly recognized phage types, is necessary in order to evaluate trends and emerging issues in salmonella infection.

Distribution of molecular subtypes within Salmonella enterica serotype Enteritidis phage type 4 and S. Typhimurium definitive phage type 104 in nine European countries, 2000-2004: results of an international multi-centre study.

This study investigates the distribution of pulsed-field gel electrophoresis (PFGE) profiles within Salmonella enterica serotype Enteritidis phage type (PT) 4 and S. Typhimurium definitive phage type (DT) 104, from cases of human infection in nine European countries from 2000 to 2004. Isolates were subtyped using standardized methods and gel images submitted by each participating country to the coordinating centre (Health Protection Agency Centre for Infections, London, UK), where they were entered into a central database, developed within BioNumerics software, and designated using an agreed nomenclature. S. Enteritidis PT4 (n=3637) was differentiated into 38 different profiles. Simpson's index of diversity (D) of profiles ranged from 0.2 to 0.4. Profile SENTXB.0001 represented at least 80% of all profiles in each country. S. Typhimurium DT104 (n=1202) was differentiated into 28 different profile types. Simpson's D was at least 0.6 in all countries except in Austria and Italy. In both these countries over 74% of S. Typhimurium DT104 profiles were STYMXB.0013. Profile STYMXB.0061, was predominant in Denmark, Spain, Finland and England and Wales where it represented between 36% and 45% of profiles. Profile STYMXB.0001 represented nearly half of all profiles in Scotland and 23% in England and Wales. PFGE is proving useful for further discrimination within S. Enteritidis PT4 and S. Typhimurium DT104. Ascertainment of international outbreaks involving common serotypes and phage types may be increased by the timely pooling of PFGE profiles within a central database readily accessible to all participating countries.

Importance of environmental transmission in cases of EHEC O157 causing hemolytic uremic syndrome.

A local outbreak of Shiga toxin (Stx)-producing enterohemorrhagic Escherichia coli (EHEC) O157:H7 causing severe hemolytic-uremic syndrome (HUS) was found to be caused by environmental transmission. Automated ribotyping and pulsed-field gel electrophoresis revealed that four stx2-positive EHEC isolates obtained from two unrelated children, one mother and one cow were identical. Results of an epidemiological investigation strongly suggest that both children were infected via a meadow strewn with manure containing EHEC-positive feces from the infected cow a few days prior to the onset of illness. The cow belonged to a cattle farm neighboring the meadow. This report highlights the risk of acquiring EHEC O157 through indirect contact with a farm environment.

Treatment of invasive pulmonary aspergillosis in severely neutropenic children with malignant disorders using liposomal amphotericin B (AmBisome), granulocyte colony-stimulating factor, and surgery: report of five cases.

Five children with malignancies developed invasive pulmonary aspergillosis during chemotherapy-induced neutropenia. All patients were treated with liposomal amphotericin B and human recombinant granulocyte colony-stimulating factor. Two patients did not recover from bone marrow aplasia and died from organ-infiltrating fungal invasion. Two patients who recovered from bone marrow aplasia survived after surgery of the pulmonary lesions. The fifth patient had a complete resolution of invasive pulmonary aspergillosis after neutrophil recovery without surgical intervention. We conclude that not only the antifungal treatment but also the recovery of granulocytes are important in localizing invasive forms of Aspergillus infections in patients with profound immunosuppression.

Arthritis without grains caused by Pseudallescheria boydii.

Severe infection of the knee joint by Pseudallescheria boydii in a 23-year-old female resulted in complete destruction of the cartilaginous surface. The possibility of entry of the fungus through mild abrasions of unperforated skin is discussed. The clinical appearance is compared with that of Scedosporium prolificans. Antimycotic miconazole-itraconazole treatment, applied during a period of 4 months, was successful; no side-effects were noted.