Outbreak of Shiga toxin-producing Escherichia coli (STEC) O26 paediatric haemolytic uraemic syndrome (HUS) cases associated with the consumption of soft raw cow's milk cheeses, France, March to May 2019.

We report an outbreak of Shiga toxin-producing Escherichia coli (STEC) associated paediatric haemolytic uraemic syndrome linked to the consumption of raw cow's milk soft cheeses. From 25 March to 27 May 2019, 16 outbreak cases infected with STEC O26 (median age: 22 months) were identified. Interviews and trace-back investigations using loyalty cards identified the consumption of raw milk cheeses from a single producer. Trace-forward investigations revealed that these cheeses were internationally distributed.

Melamine-induced urinary calculi in infants--sonographic manifestations and outcomes 1 year after exposure.

BACKGROUND: In 2008, the melamine-tainted-milk incident started with reports of increased incidence of urolithiasis in infants in China. Affected children were screened for urolithiasis. OBJECTIVE: The purpose of this study was to analyze sonographic characterization of infant melamine-induced urolithiasis. MATERIALS AND METHODS: Transabdominal US examination was done in 603 infants with melamine-induced calculi. The imaging characteristics of calculi and hydronephrosis were analyzed. Follow-up US imaging was performed. RESULTS: Comet-tail sign was seen behind the calculus of <4 mm. Calculi of ≥ 4 mm were found in 299 inpatients with clear posterior border and with or without light shadowing. Solitary and multiple stones had similar incidence. Incidence of calculi in the inferior renal calyx was the highest (55.2%) in inpatients. Calculus size in inpatients age 2-3 years was smaller than that of children younger than 2 years old (P < 0.05). Inpatients age 2-3 years had the highest incidence rate (48.0%) of hydronephrosis. CONCLUSION: Calculi of <4 mm manifested as hyperechoic foci near the renal papillae, while calculi of ≥ 4 mm usually manifested as echogenic foci with visible inferior edge in the renal calyx. Hydronephrosis was a common imaging finding in inpatients ages 2-3 years.

Bell's palsy presenting after a case of Campylobacter enteritis.

BACKGROUND: A case of unilateral facial paralysis following infection with Campylobacter jejuni is presented. CASE REPORT: A 37-yr-old U.S. Army Reserve aviator presented with complaints consistent with an infectious gastroenteritis. This presentation was quickly followed by acute right-sided facial hemiparesis with sparing of sensation. He had no other neurological symptoms. Complete neurological evaluation showed no evidence of underlying neurological pathology and the patient was diagnosed with Bell's palsy. He was later notified by the state Department of Health that he and his family had likely been exposed to organic milk contaminated with Campylobacter jejuni. DISCUSSION: This case depicts a previously unreported reaction likely due to C. jejuni infection and the direct impact on aviation duties for a flyer.

Mycoestrogen pollution of Italian infant food.

OBJECTIVE: To determine the concentrations of zearalenone and its metabolites in the leading brands of infant formula milks and meat-based infant foods commonly marketed in Italy, and to assess their repercussion in the provisional tolerable daily intakes of these estrogenic mycotoxins. STUDY DESIGN: A total of 185 cow's milk-based infant formulas and 44 samples of meat-based infant foods samples were analyzed. The analysis of mycotoxins was performed by immunoaffinity column clean-up and high-pressure liquid chromatography with fluorescence detection. RESULTS: Zearalenone was detected in 17 (9%) milk samples (maximum 0.76 µg/L). The α-zearalenol was detected in 49 (26%) milk samples (maximum 12.91 µg/L). The ß-zearalenol was detected in 53 (28%) milk samples (maximum 73.24 µg/L). The α-zearalanol and ß-zearalanol were not detected in milk samples. Although α-zearalenol was detected in 12 (27%) meat samples (maximum 30.50 µg/kg), only one meat-based sample was contaminated by α-zearalanol (950 µg/kg). Zearalenone, ß-zearalenol, and ß-zearalanol were not detected in meat samples. CONCLUSIONS: This study shows the presence of mycoestrogens in infant (milk-based and meat-based) food, and this is likely to have great implications for subsequent generations, suggesting the need to perform occurrence surveys in this type of food.

[Methanol poisoning in a 61-year old male with recently diagnosed diabetes--a case report]. / Zatrucie metanolem u 61-letniego mezczyzny ze swiezo wykryta cukrzyca--opis przypadku.

The aim of this paper is to present a case of a 61-year-old male transferred to the Regional Center of Clinical Toxicology from the Department of Endocrinology with suspected methanol poisoning. The patient presented symptoms of diabetes with extreme hyperglycemia >1600 mg/dl and nonketotic hyperosmolar coma. Laboratory tests showed metabolic/respiratory acidosis, methanol 80 mg/dl, ethanol 0.47 g/l, creatinine 3.5 mg/dl, urea 140 mg/dl, lactic acid 4.11 mmol/l, myoglobin >1000 ng/ml, HbA1C >14.5%. During a few days prior to the hospitalization the patient was drinking a great amount of fruit juices and milk (a dozen or so litres per twenty four hours). The eventuality of metabolizing glucose and aspartame into methanol is known from professional literature. The possibility of excessive consumption of aspartame and its metabolites causing methanol poisoning in the presented patient was considered.

Case studies in Bayesian microbial risk assessments.

BACKGROUND: The quantification of uncertainty and variability is a key component of quantitative risk analysis. Recent advances in Bayesian statistics make it ideal for integrating multiple sources of information, of different types and quality, and providing a realistic estimate of the combined uncertainty in the final risk estimates. METHODS: We present two case studies related to foodborne microbial risks. In the first, we combine models to describe the sequence of events resulting in illness from consumption of milk contaminated with VTEC O157. We used Monte Carlo simulation to propagate uncertainty in some of the inputs to computer models describing the farm and pasteurisation process. Resulting simulated contamination levels were then assigned to consumption events from a dietary survey. Finally we accounted for uncertainty in the dose-response relationship and uncertainty due to limited incidence data to derive uncertainty about yearly incidences of illness in young children. Options for altering the risk were considered by running the model with different hypothetical policy-driven exposure scenarios. In the second case study we illustrate an efficient Bayesian sensitivity analysis for identifying the most important parameters of a complex computer code that simulated VTEC O157 prevalence within a managed dairy herd. This was carried out in 2 stages, first to screen out the unimportant inputs, then to perform a more detailed analysis on the remaining inputs. The method works by building a Bayesian statistical approximation to the computer code using a number of known code input/output pairs (training runs). RESULTS: We estimated that the expected total number of children aged 1.5-4.5 who become ill due to VTEC O157 in milk is 8.6 per year, with 95% uncertainty interval (0,11.5). The most extreme policy we considered was banning on-farm pasteurisation of milk, which reduced the estimate to 6.4 with 95% interval (0,11). In the second case study the effective number of inputs was reduced from 30 to 7 in the screening stage, and just 2 inputs were found to explain 82.8% of the output variance. A combined total of 500 runs of the computer code were used. CONCLUSION: These case studies illustrate the use of Bayesian statistics to perform detailed uncertainty and sensitivity analyses, integrating multiple information sources in a way that is both rigorous and efficient.

Pediatric health aspects of PBBs.

Many Michigan farm children are viewed as having suffered a deterioration in health coincident with contamination of dairy cattle by PBBs. Among Wisconsin dairy farm children such a deterioration was a rare event. There is a suggestion that Michigan farm children who had multiple symptoms during the 1973-76 period are getting better. A discrete syndrome of ill health has not been identified among Michigan farm children. The symptoms complained of indicate a disruption of various physiological functions, including neurobehavioral, gastrointestinal and immunological. Children from quarantined farms do not have a higher prevalence of multiple symptoms than those from nonquarantined farms.

Effects of processing and cooking on PBB residues.

To study the effect of processing on polybrominated biphenyl (PBB) levels, milk from four dairy herds containing less than 0.3 ppm (fat basis) of physiologically incorporated PBBs was presented individually into cream, skim milk, butter, and stirred curd cheese. Pasteurized and freeze-dried whole milk, skim milk, and cream, spray-dried whole milk and skim milk, and condensed whole milk were also made. PBBs were concentrated in the high-fat products. Spray-drying reduced PBBs in whole milk and skim milk while pasteurization, freeze-drying, aging of cheese, and condensation were not effective. To study the effect of cooking on PBB levels, thigh meat, thigh skin, drumstick and breast (with skin) from half of chickens fed PBBs were analyzed raw, and pieces from the other halves were analysed following separate pressure cooking. The level of PBBs expressed as parts per million on a solids basis was lower in the cooked sample than in the corresponding raw piece and part of the PBBs lost were found in the drip. Recoveries of PBBs in cooked tissue and broth ranged from 68.1% in the thigh skin to 84.6% in the drumstick, with approximately two-thirds of the recovered PBBs found in the cooked meat itself. Therefore, pressure cooking resulted in a loss ranging from 36% for the drumstick to 53% for the thigh skin.

Food poisoning, listeriosis, and febrile gastroenteritis.

Outbreaks of foodborne disease owing to contamination with Listeria monocytogenes bacteria have usually been associated with the development of severe invasive disease. A recent report has provided clear documentation showing that outbreaks of L. monocytogenes also present as gastroenteritis and fever. Further studies of this foodborne organism are needed to determine its infectious dose and the characteristics of the host that are associated with noninvasive febrile gastroenteritis.

Communicable disease associated with milk and dairy products in England and Wales: 1983-1984.

During the period 1983-1984 32 outbreaks of disease (II in 1983 and 21 in 1984) associated with consumption of milk and dairy products and affecting at least 714 people were reported from England and Wales. Twenty-seven of the outbreaks were attributed to raw milk, two to contaminated pasteurised milk and one each to cheese, cream and ice-cream. Twenty-two were due to salmonellas, seven to campylobacters and one each to Staphylococcus aureus, Yersinia enterocolitica and Streptococcus zooepidemicus. Two sporadic cases of Corynebacterium ulcerans infection associated with raw milk were also reported. There were eight deaths, all associated with the S. zooepidemicus outbreak. The continuing occurrence of milk-borne outbreaks, and an increasing number of incidents affecting rural communities, emphasises the urgent need for enforcing pasteurisation of milk and dairy products in England and Wales.

Effects of milk from animals fed locoweed on kittens, calves, and lambs.

Calves, lambs, and kittens given milk from cows fed locoweeds developed microscopic lesions typical of locoweed poisoning. Serum aspartate aminotransferase activities increased markedly during the feeding period in both the cows given the locoweed and the animals receiving their milk. The results of this experiment indicate that the toxin in locoweed can be secreted in the milk.

Effect of feeding milk from goats fed tansy ragwort (Senecio jacobaea) to rats and calves.

Dried tansy ragwort, which contains pyrrolizidine alkaloids (PA), was fed to lactating dairy goats. Milk containing 7.5 ng of PA/g (dry weight basis) from these goats was fed to rats and calves. Rats fed a goats' milk diet for 180 days with a calculated total PA intake of 0.96 mg/rat had swollen hepatocytes of centrilobular distribution, and biliary hyperplasia, indicating PA involvement. Rats fed tansy ragwort at dietary levels of 1%, 0.1%, 0.01% and 0.001% (corresponding to PA intakes of 39.77, 5.04, 0.52, and 0.05 mg/rat) showed swollen hepatocytes, megalocytosis, biliary hyperplasia, and fibrosis. The histopathologic changes in the milk-fed rats and those given 0.001% tansy ragwort in the diet were similar. Definitive changes in 2 calves fed goats' milk were not detected. The results with rats indicate that PA are transferred in goats' milk and may produce hepatoxic effects.

[Criminal contamination by metallic mercury of cow's silage]. / Kryminalne skazenie rtecia metaliczna paszy dla krów.

This paper presents an unsuccessful homicidal attempt on 23 persons by means of metallic mercury added in large amount to cow's silage. Thirteen adults and twelve children used milk from these cows for 4.5 months. The mercury concentration in the milk of these cows as well as in serum and daily urine of consumers of the milk were examined by atomic absorption spectrophotometry. Despite the increased level of mercury in the milk (average 0.023 mg/kg), the concentrations of mercury in daily urine of only three persons were raised about 50%. These people had been working in a cowshed without ventilation every day for many months and thus had been exposed to vaporised mercury.

Phytotoxins eliminated by milk: a review / Fitotoxinas eliminadas através do leite: uma revisão

Milk is a complex emulsion of lipids suspended in aqueous protein solution that can be a carrier of various contaminants, but generally it is not an important route of toxic excretion. The main problem is chronic repetitive exposure, as it occurs with ingestion of toxic plants and its potential danger to animals that consume the milk. Previously reported hazardous phytotoxins eliminated by milk include: indolizidine alkaloids, causing oligosaccharide storage disease; piperidine alkaloids, causing acute poisoning or malformations; pyrrolizidine alkaloids, which cause hepatic lesions; quinolizidine alkaloids, as a cause of skeletal defects; glucosinolates, which cause changes in the thyroid; tremetol (or tremetone), which causes a disease characterized by tremors in animals and milk sickness in humans; sodium monofluoracetate, which causes the death of kids after ingestion of colostrum from goats that have ingested Amorimia septentrionalis during gestation; ptaquiloside, which induces carcinogenesis in animals that ingest milk or derivatives produced by animals that have ingested Pteridium spp. Ipomoea asarifolia, which contains indole diterpenes causing tremors in suckling pups. Chrysocoma ciliata causes alopecia in suckling pups, but its toxic compound is still unknown. Knowledge about the risk of exposure to these substances via milk and its dissemination are important for veterinary and human health.(AU)

O leite é uma mistura complexa de lipídeos suspensos em solução aquosa de proteínas e pode ser veículo de diversos contaminantes, mas, geralmente, não é uma importante via de excreção de tóxicos. O principal problema é a exposição repetida, como ocorre com a ingestão de plantas tóxicas, e seu potencial perigo para os animais que consomem o leite. As fitotoxinas já descritas, que são eliminadas através do leite e podem causar danos à saúde incluem: alcaloides indolizidínicos, causam a doença do armazenamento de oligossacarídeos; alcaloides piperidínicos, que causam intoxicação aguda, pela sua capacidade de dessensibilizar os receptores nicotínicos da acetilcolina, ou malformações; alcaloides pirrolizidínicos, que provocam alterações hepáticas; alcaloides quinolizidínicos, que causam defeitos esqueléticos; glucosinolatos, que provocam alterações na tireoide; tremetol (ou tremetone), que provoca, em animais, uma doença caracterizada por tremores, e em humanos, a doença conhecida como doença do leite; monofluoracetato de sódio, que causa a morte de filhotes após a ingestão do colostro de fêmeas que ingeriram Amorimia septentrionalis durante a gestação; ptaquilosídeo, que induz a carcinogênese em animais que ingerem leite ou derivados, produzidos por animais que ingeriram Pteridiumspp. Ipomoea asarifolia contem indol diterpenos que causam tremores em filhotes lactentes. Chrysocoma ciliata causa alopecia em filhotes lactentes, porém seu princípio ativo tóxico ainda é desconhecido. O conhecimento e a divulgação sobre o risco da exposição a essas substâncias eliminadas através do leite são importantes tanto para a saúde animal quanto para a saúde humana.(AU)

Consumption of raw or unpasteurized milk and milk products by pregnant women and children.

Sales of raw or unpasteurized milk and milk products are still legal in at least 30 states in the United States. Raw milk and milk products from cows, goats, and sheep continue to be a source of bacterial infections attributable to a number of virulent pathogens, including Listeria monocytogenes, Campylobacter jejuni, Salmonella species, Brucella species, and Escherichia coli O157. These infections can occur in both healthy and immunocompromised individuals, including older adults, infants, young children, and pregnant women and their unborn fetuses, in whom life-threatening infections and fetal miscarriage can occur. Efforts to limit the sale of raw milk products have met with opposition from those who are proponents of the purported health benefits of consuming raw milk products, which contain natural or unprocessed factors not inactivated by pasteurization. However, the benefits of these natural factors have not been clearly demonstrated in evidence-based studies and, therefore, do not outweigh the risks of raw milk consumption. Substantial data suggest that pasteurized milk confers equivalent health benefits compared with raw milk, without the additional risk of bacterial infections. The purpose of this policy statement was to review the risks of raw milk consumption in the United States and to provide evidence of the risks of infectious complications associated with consumption of unpasteurized milk and milk products, especially among pregnant women, infants, and children.