Disparities in severe shigellosis among adults - Foodborne diseases active surveillance network, 2002-2014.

BACKGROUND: Shigella causes approximately 500,000 illnesses, 6000 hospitalizations, and 40 deaths in the United States annually, but incidence and populations at risk for severe shigellosis among adults are unclear. This study describes severe shigellosis among US adults. METHODS: We analyzed Foodborne Diseases Active Surveillance Network data for infections caused by Shigella among adults ≥18 years old during 2002-2014. Criteria to define severe shigellosis included hospitalization, bacteremia, or death. We estimated annual incidence of shigellosis per 100,000 among adult populations, and conducted multivariable mixed-effects logistic regression to assess associations between severe shigellosis, demographic factors and Shigella species among adults with shigellosis. RESULTS: Among 9968 shigellosis cases, 2764 (28%) were severe. Restricting to cases due to S. sonnei and S. flexneri, median annual incidence of severe shigellosis among adults was 0.56 and highest overall incidence was among black males 18-49 years old (1.58). Among adults with shigellosis, odds of severe disease were higher among males than females aged 18-49 years old (OR [95% CI] = 1.32 [1.15-1.52], p < 0.001) and among males than females with S. flexneri infections (OR [95% CI] =1.39 [1.10-1.75], p = 0.005). The odds of severe shigellosis were higher among blacks than whites (OR [95% CI] = 1.36 [1.22-1.52], p < 0.001). CONCLUSIONS: Among adults, men 18-49 years old, particularly blacks, have the highest incidence of severe shigellosis. Among adults with shigellosis, severe shigellosis was associated with being male in age group 18-49 years, with infections caused by S. flexneri, and with black race. Future research should assess associations between severe shigellosis and sexual practices, antimicrobial resistance, comorbidities, and access to care.

Erring on the side of caution: pregnant women's perceptions of consuming fish in a risk averse society.

BACKGROUND: Fish and seafood are good sources of several nutrients that are important for foetal growth and development. Despite guidelines encouraging the eating of fish during pregnancy, research indicates that pregnant women may be limiting or avoiding these foods. Possible factors contributing to this include concerns regarding levels of mercury and other contaminants and pregnant women's purported heightened risk consciousness. The present study aimed to explore pregnant women's perceptions of consuming fish and seafood during pregnancy. METHODS: Semi-structured telephone interviews were conducted with 15 pregnant women across all three trimesters in New South Wales, Australia. Questions focussed on exploring nutrition information received during pregnancy, dietary changes made during pregnancy and, more specifically, perceptions of fish and seafood, as well as views on information of fish and seafood commonly provided to pregnant women. Data were collected, then transcribed and analysed using an inductive coding process, guided by the qualitative theory grounded approach. RESULTS: Multiple inter-related themes were found to shape pregnant women's perceptions related to fish and seafood consumption during pregnancy; namely, the understanding of fish and seafood as part of a healthy diet, external factors such as cost, individual preferences such as taste, and confidence in choosing and preparing fish. The context of a risk adverse society permeated these themes. CONCLUSIONS: The present study provides insight into the inter-related factors that influence pregnant women's consumption or avoidance of fish and seafood.

A tradition and an epidemic: determinants of the campylobacteriosis winter peak in Switzerland.

Campylobacteriosis is the most frequently reported food borne infection in Switzerland. We investigated determinants of infections and illness experience in wintertime. A case-control study was conducted in Switzerland between December 2012 and February 2013. Cases were recruited among laboratory-confirmed campylobacteriosis patients. Population-based controls were matched according to age group, sex and canton of residence. We determined risk factors associated with campylobacteriosis, and help seeking behaviour and illness perception. The multivariable analysis identified two factors associated with an increased risk for campylobacteriosis: consumption of meat fondue (matched odds ratio [mOR] 4.0, 95% confidence interval [CI] 2.3-7.1) and travelling abroad (mOR 2.7, 95% CI 1.1-6.4). Univariable analysis among meat fondue consumers revealed chicken as the type of meat with the highest risk of disease (mOR 3.8, 95% CI 1.1-13.5). Most frequently reported signs and symptoms among patients were diarrhoea (98%), abdominal pain (81%), fever (66%), nausea (44%) and vomiting (34%). The median perceived disease severity was 8 on a 1-to-10 rating scale. Patients reported a median duration of illness of 7 days and 14% were hospitalised. Meat fondues, mostly "Fondue chinoise", traditionally consumed during the festive season in Switzerland, are the major driver of the epidemic campylobacteriosis peak in wintertime. At these meals, individual handling and consumption of chicken meat may play an important role in disease transmission. Laboratory-confirmed patients are severely ill and hospitalisation rate is considerable. Public health measures such as decontamination of chicken meat and improved food handling behaviour at the individual level are urgently needed.

A mixed methods study of food safety knowledge, practices and beliefs in Hispanic families with young children.

Children are at a higher risk for foodborne illness. The objective of this study was to explore food safety knowledge, beliefs and practices among Hispanic families with young children (≤10 years of age) living within a Midwestern state. A convergent mixed methods design collected qualitative and quantitative data in parallel. Food safety knowledge surveys were administered (n = 90) prior to exploration of beliefs and practices among six focus groups (n = 52) conducted by bilingual interpreters in community sites in five cities/towns. Descriptive statistics determined knowledge scores and thematic coding unveiled beliefs and practices. Data sets were merged to assess concordance. Participants were female (96%), 35.7 (±7.6) years of age, from Mexico (69%), with the majority having a low education level. Food safety knowledge was low (56% ± 11). Focus group themes were: Ethnic dishes popular, Relating food to illness, Fresh food in home country, Food safety practices, and Face to face learning. Mixed method analysis revealed high self confidence in preparing food safely with low safe food handling knowledge and the presence of some cultural beliefs. On-site Spanish classes and materials were preferred venues for food safety education. Bilingual food safety messaging targeting common ethnic foods and cultural beliefs and practices is indicated to lower the risk of foodborne illness in Hispanic families with young children.

Risky consumption habits and safety of fluid milk available in retail sales outlets in Viçosa, Minas Gerais State, Brazil.

This study aimed to assess raw milk consumption habits in the urban population of Viçosa, Minas Gerais, Brazil, and the microbiological safety and quality of the fluid milk available in retail sales outlets in the same region. A simplified questionnaire regarding raw milk consumption was applied to the persons responsible for food acquisition in 411 residences. The regular consumption of raw milk was observed by 18.5% of the interviewers, and lack of knowledge of possible risks related to this food product. Microbiological safety and quality were assessed for raw (n=69), pasteurized (n=80), and ultra-high-temperature (UHT)-treated milk (n=80) by analyzing the counts of mesophilic aerobes, coliforms, and Escherichia coli, and detection of Listeria monocytogenes and Salmonella spp.; raw milk samples were also subjected to enumeration of coagulase-positive Staphylococcus. Concerning raw milk, 59.4% of the samples were considered as produced in inadequate hygienic conditions, 5.8% of the samples presented counts of coagulase-positive Staphylococcus lower than 100 colony-forming units (CFU)/mL, and no samples presented with positive results for L. monocytogenes or Salmonella spp. All pasteurized and UHT milk samples presented with low counts of mesophilic aerobes and coliforms, while L. monocytogenes and Salmonella spp. were absent. The data demonstrated that raw milk was consumed by the population studied. Despite the absence of potential hazards, raw milk was of poor hygienic quality, in contrast with the processed fluid milk available in retail sales outlets that was safe and of good hygienic quality, highlighting the suitability of pasteurized and UHT milk for human consumption.

Changing epidemiology of Yersinia enterocolitica infections: markedly decreased rates in young black children, Foodborne Diseases Active Surveillance Network (FoodNet), 1996-2009.

BACKGROUND: Yersinia enterocolitica causes an estimated 116,716 illnesses annually in the United States. Black children have historically had the highest rates of infection, with incidence peaking in the winter. METHODS: The Foodborne Diseases Active Surveillance Network (FoodNet) conducts active surveillance for laboratory-confirmed Y. enterocolitica infections, defined as the isolation of Y. enterocolitica or unspeciated Yersinia from a human clinical specimen. We calculated the average annual crude incidence rate per 100,000 persons from 1996 through 2009 and described rates by age, race, and geographic site. To account for changes in the FoodNet catchment area, we used a negative binomial model to estimate statistical changes in incidence using the average annual incidence in 1996-1998 as the baseline. RESULTS: From 1996 through 2009, 2085 Y. enterocolitica infections were reported to FoodNet. The average annual crude incidence was 0.5 per 100,000 persons and was highest in blacks (0.9 per 100,000 persons). Over time, the rate in blacks declined from 3.9 to 0.4 per 100,000 persons. Declines among other racial groups were not as pronounced. The largest decline occurred in black children <5 years old (from 41.5 per 100,000 persons in 1996 to 3.5 per 100,000 persons in 2009). From 2007 through 2009, the highest rate of infection was in Asian children (5.1 per 100,000 persons). Compared with 1996-1998, the incidence in 2009 was 66% (95% confidence interval, 51%-77%) lower among children <5 years old. CONCLUSIONS: Y. enterocolitica infections in FoodNet sites have significantly declined since 1996. These declines were greatest in young black children, the group that initially had the highest incidence, possibly as the result of educational efforts in Georgia.

Relative risk of listeriosis in Foodborne Diseases Active Surveillance Network (FoodNet) sites according to age, pregnancy, and ethnicity.

BACKGROUND: Quantitative estimates of the relative risk (RR) of listeriosis among higher-risk populations and a nuanced understanding of the age-specific risks are crucial for risk assessments, targeted interventions, and policy decisions. METHOD: The RR of invasive listeriosis was evaluated by age, pregnancy status, and ethnicity using 2004-2009 data from the Foodborne Diseases Active Surveillance Network (FoodNet). Nonparametric logistic regression was used to characterize changes in risk with age and ethnicity. Adjusted RRs and 95% confidence intervals (CIs) were evaluated using negative binomial generalized linear models. RESULTS: Among non-pregnancy-associated cases, listeriosis incidence rates increased gradually with age (45-59 years: RR, 4.7; 95% CI, 3.3-6.8; >85 years: RR, 53.8; 95% CI, 37.3-78.9; reference: 15-44 years). The RR was significantly higher for Hispanics than for non-Hispanics (RR, 1.8; 95% CI, 1.3-2.5). Among women of reproductive age (15-44 years), pregnant women had a markedly higher listeriosis risk (RR, 114.6; 95% CI, 68.9-205.1) than nonpregnant women. The RR was higher for Hispanic than non-Hispanic women, regardless of pregnancy status, and this increased during the study period (2004-2006: RR, 1.9; 95% CI, 1.0-3.3; 2007-2009: RR, 4.8; 95% CI, 3.1-7.1). CONCLUSIONS: This study quantifies the increases in risk of listeriosis among older persons, pregnant women, and Hispanics in the United States. Additional research is needed to better describe the independent effects of age on risk while accounting for underlying conditions. These estimates are needed both to optimize risk assessment models and to inform targeted interventions and policy decisions.

Antimicrobial susceptibility patterns of Shigella isolates in Foodborne Diseases Active Surveillance Network (FoodNet) sites, 2000-2010.

BACKGROUND: Treatment of shigellosis with appropriate antimicrobial agents shortens duration of illness and bacterial shedding, but resistance to commonly used agents is increasing. METHODS: We describe resistance patterns among Shigella isolates in the United States with use of linked data from the Foodborne Diseases Active Surveillance Network (FoodNet) and National Antimicrobial Resistance Monitoring System (NARMS). FoodNet sites send every 20th Shigella isolate to the NARMS laboratory for susceptibility testing. RESULTS: During 2000-2010, the NARMS laboratory tested 1376 Shigella isolates from FoodNet sites. Of 1118 isolates (81%) linked to FoodNet, 826 (74%) were resistant to ampicillin, 649 (58%) to streptomycin, 402 (36%) to trimethoprim-sulfamethoxazole (TMP-SMX), 355 (32%) to sulfamethoxazole-sulfisoxazole, 312 (28%) to tetracycline, 19 (2%) to nalidixic acid, and 6 (0.5%) to ciprofloxacin. The proportion of Shigella isolates with resistance to TMP-SMX was 40% among white persons, 58% among Hispanic persons, and 75% among persons with a history of international travel. Resistance to at least TMP-SMX and ampicillin was present in 25% of isolate, and 5% were resistant to ampicillin, TMP-SMX, and chloramphenicol. Overall, 5% of isolates showed multidrug resistance to ampicillin, chloramphenicol, streptomycin, sulfamethoxazole-sulfisoxazole, and tetracycline, including 49 Shigella flexneri (33%) and 3 Shigella sonnei (0.3%) isolates. Male individuals were more likely than female individuals to be infected with a multidrug-resistant strain (7% versus 3%; P < .01). CONCLUSIONS: Antimicrobial resistance differed by race, ethnicity, age, travel, and species. Resistance to commonly used antibiotics is high; therefore, it is important to look at the susceptibility pattern before starting treatment.

[Outbreak of foodborne disease at a mass event of indigenous peoples in Cuiaba, Mato Grosso, Brazil, in 2013]. / Surto de doença transmitida por alimento em evento de massa de populações indígenas em Cuiabá, Mato Grosso, Brasil, no ano de 2013.

OBJECTIVE: to report the experience of investigating the outbreak of acute diarrhoea (AD) at the XII Indigenous Games in Cuiabá, Mato Grosso, Brazil, 2013. METHODS: data were collected from the Advanced Medical Post's service records of the AD cases, which were defined as 'individual Games participant referring episode of diarrhoea and/or vomiting'; AD attack rates, relative frequencies and measures of the central tendency of sociodemographic and clinical variables, sanitary inspections and results of bromatological samples were calculated. RESULTS: 384 (37%) cases met the definition of AD; the epidemic peaks of the outbreak occurred on the 4th and 7th day of the event and the disease attack rate was 33.5%; sanitary inspection showed evidence of food contamination by coagulase-negative Staphylococci, Bacillus cereus and heat resistant coliforms. CONCLUSION: there an outbreak of AD caused by food contamination.

Aflatoxin B1 and total fumonisin contamination and their producing fungi in fresh and stored sorghum grain in East Hararghe, Ethiopia.

Natural contamination of sorghum grains by aflatoxin B1 and total fumonisin and their producing toxigenic fungi has been studied. A total of 90 sorghum grain samples were collected from small-scale farmers' threshing floors and 5-6 months later from underground pits during 2013 harvest from three districts of East Hararghe, Ethiopia. Mycotoxin analysis was done using enzyme-linked immunosorbent assay (ELISA). The limits of detection were in the range 0.01-0.03 µg kg-1. The results revealed that all sorghum grain samples were contaminated with both Aspergillus and Fusarium species. Aflatoxin B1 was detected at levels ranging from

Konzo outbreak among refugees from Central African Republic in Eastern region, Cameroon.

Konzo is a spastic paraparesis of sudden onset, linked to the exclusive consumption of insufficiently processed bitter cassava as staple food combined with low protein intake. Around 60,000 refugees from the Central African Republic sought refuge in villages in eastern Cameroon between 2005 and 2007. Médecins Sans Frontières was providing nutritional and medical assistance in the villages affected by displacement. We describe cases of konzo seen at the mobile clinics organized in these villages. Basic information including demographic data, history and clinical presentation was recorded for each konzo patient. All patients were given nutritional supplements, and selected cases were referred for physiotherapy to a rehabilitation center. A total of 469 patients were diagnosed with konzo. The majority (80%) were refugees. Children and women of reproductive age predominated. Most of the patients developed symptoms after 2007 in a seasonal pattern with most of the cases occurring during the dry winter season. Most of the patients complained about walking difficulties and weight loss and had exaggerated lower limb reflexes and muscle wasting on observation. Eastern Cameroon is an area with konzo. More effort needs to be put into preventive and educational measures. In addition, timely balanced food rations have to be provided to refugees.

Caracterización fenotípica y genotípica de Salmonella Typhimurium variante 5- asociada a un brote de enfermedad transmitida por alimentos en el municipio de Paz de Río, Boyacá, 2010 / Phenotypic and genotypic characterization of Salmonella Typhimurium variant 5- isolates associated with an outbreak of food-borne disease in Paz de Rio, Boyacá, Colombia, in 2010

Introducción: Salmonella enterica serotipo Typhimurium variante 5- es un patógeno muy relacionado con animales, especialmente con palomas, y asociado en pocos casos con infecciones esporádicas en humanos. Sin embargo, los sistemas de vigilancia epidemiológica han permitido detectarla en brotes en humanos. Objetivo: caracterizar por técnicas fenotípicas y genotípicas los aislamientos de Salmonella Typhimurium variante 5- asociados a un brote de enfermedad transmitida por alimentos (ETA) en el municipio de Paz de Río, Boyacá, en el 2010. Materiales y métodos: doce aislamientos de Salmonella spp., fueron remitidos para confirmación bioquímica, identificación del serotipo y perfil de susceptibilidad antimicrobiana. Se analizaron genotípicamente por electroforesis en gel de campo pulsado (PFGE) con las enzimas Xbal y Blnl. Resultados: todos los aislamientos se confirmaron como Salmonella spp., y presentaron resistencia a tetraciclina y estreptomicina y sensibilidad a los demás antibióticos ensayados; 11/12 se identificaron como Salmonella Typhimurium variante 5- y mostraron en la PFGE el patrón COIN10.JPX.X01.0168 con la enzima XbaI y dos aislamientos de este mismo grupo se confirmaron con la enzima BlnI obteniendo el patrón de PFGE COIN10.JPX.A26.0002. El aislamiento restante se identificó como Salmonella Typhimurium con patrón de PFGE con la enzima Xbal COIN10.JPX.X01.0221. Conclusión: se reporta por primera vez en Colombia un brote de ETA asociado epidemiológicamente con aislamientos de Salmonella Typhimurium variante 5- que estuvieron relacionados fenotípica y genéticamente.

Introduction: Salmonella enterica serotype Typhimurium variant 5- is a pathogen closely related to animals, especially pigeons, which has been also associated in rare cases with sporadic infections in humans. However, epidemiological surveillance systems have enabled the detection of this variant in human outbreaks. Objective: To characterize by means of phenotypic and genotypic techniques the isolates of Salmonella Typhimurium variant 5- associated with an outbreak of food-borne disease in Paz de Rio, Boyacá, Colombia (2010), in order to establish their molecular relationships. Materials and methods: Twelve isolates of Salmonella spp., were analyzed by biochemical, serotyping and antimicrobial susceptibility tests. Pulsed-field gel electrophoresis (PFGE) with XbaI and Blnl enzymes was used to establish their molecular relationships. Results: All isolates were confirmed as Salmonella spp. They were resistant to tetracycline and streptomycin and sensitive to the rest of antibiotics tested. Eleven isolates were identified as Salmonella Typhimurium variant 5- and grouped in COIN10.JPX.X01.0168 pattern using the enzyme XbaI; two isolates in this group were confirmed using the enzyme BlnI with the COIN10. JPX.A26.0002 pattern. One isolate was identified as Salmonella Typhimurium with COIN10.JPX.X01.0221 pattern with the enzyme XbaI. Conclusion: This is the first outbreak in Colombia of foodborne illness epidemiologically associated with isolates of Salmonella Typhimurium variant 5 -, which were phenotypically and genetically related.

[Acute life-threatening bradycardia: food poisoning by Turkish wild honey]. / Akute lebensbedrohliche Bradykardie: Nahrungsmittelintoxikation durch türkischen Waldhonig.

HISTORY AND FINDINGS: A 49-year-old Turkish man, previously well, suddenly developed severe vertigo and a feeling of retrosternal compression. The symptoms had set in within one hour of eating Turkish wild honey. The patient was in a poor general state with a heart rate of 38/min after administration of atropine by the general practitioner who had been called. Arterial blood pressure was 90/45 mmHg. INVESTIGATION: All routine biochemical tests were normal. The electrocardiogram merely showed sinus bradycardia of 38 beats/ min. TREATMENT AND COURSE: Under purely symptomatic treatment the heart rate and blood pressure returned to normal within 24 hours. The history of eating wild honey and typical symptoms indicated acetylandromedol poisoning. CONCLUSION: Turkish honey from the Black Sea coast occasionally contains concentrations of acetylandromedol (formerly called andromedotoxin) high enough to cause poisoning. The substance is obtained by bees from some species of Rhododendron which they then incorporate into their honey. Typical of the poisoning are gastrointestinal symptoms and marked, even life-threatening, bradycardia and arterial hypotension.

Polar hysteria: an expression of hypervitaminosis A.

Isotretinoin (Accutane) is a drug closely related to the chemical structure of Vitamin A. The pharmacology and toxicology of these two retinoids is similar enough to warrant comparison. Accutane is a powerful drug which its manufacturer, Roche, indicates is limited for severe recalcitrant nodular acne. This potency is also reflected in Accutane's well-known ability to produce severe birth defects if taken during pregnancy. Less well-known is the risk of this lipid soluble chemical to affect the Central Nervous System. Reports of intracranial hypertension, depression, and suicidal indeation with Accutane use have prompted an examination of this serious and life threatening potential. Though Roche has added a warning to its product label for signs of depression and suicidal ideation, this product is being overprescribed for all forms of acne, including mild cases and moderate acne that have not been treated with alternative medications, which have a lesser risk of depression and suicide. There is no contesting that this drug is effective at clearing up the most severe forms of acne, but the public must be informed of its proper, limited indication for use; depression and suicide can follow in patients with no prior history of psychiatric symptoms or suicide attempts.