Two outbreaks of campylobacteriosis associated with the consumption of raw cows' milk.

The present paper summarises the investigation of two different outbreaks of milk-associated Campylobacter enteritis in the Netherlands. In 2005, after a school trip to a dairy farm, 22 out of a group of 34 children developed diarrhoeal illness and Campylobacterjejuni was cultured from the stool samples of 11 of the cases. The illness was found to be epidemiologically associated with drinking raw milk during the farm visit; 86% of the cases could be explained by drinking raw milk. C.jejuni was also isolated from three of 10 faecal samples from dairy cattle collected at the farm. The human isolates and C.jejuni isolates from one of these three samples of cattle faeces revealed identical restriction patterns by both pulsed-field gel electrophoresis (PFGE) and flagellin (fla) typing by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Both epidemiological and bacteriological evidence implicated contaminated raw milk as the vehicle of transmission, though C.jejuni was not isolated from the bulk tank milk or the milk filter collected during the farm investigation. In 2007, an outbreak of enteritis was notified among people who had attended a lunch at a dairy farm where bulk tank milk was served. Of the 19 persons who had consumed raw milk, 16 (84%) had become ill. Of the persons who did not drink the raw milk, none became ill. A significant association was found between tasting the raw milk and being ill (risk difference=0.84, p=0.0011). C.jejuni was cultured from four of seven cases who had submitted a stool specimen. C. jejuni was also isolated from a sample of bulk tank milk and the isolate had an identical flaA PCR-RFLP genotype to isolates obtained from patients. Also in this outbreak both the epidemiological and bacteriological findings support raw milk as the vehicle for the enteritis. These two outbreaks highlight the health risks associated with the consumption of raw milk. As long as legislation allows the sale and distribution of untreated milk these risks will continue. Therefore, consumers need to be continuously informed about the dangers inherent in consuming unpasteurised milk or products made from raw milk. Farmers need to be strongly discouraged from serving raw milk to their visitors.

Multiple Mycobacterium tuberculosis infections in an HIV-infected patient.

Mycobacterial colonies of two different morphologies were isolated from one sputum sample of a HIV-positive patient. One morphological type was resistant to streptomycin (STR) and susceptible to isoniazid (INH), while the other isolate with different colony morphology was resistant to both of these anti-TB drugs. A mycobacterial isolate of one pus from a lymph node sample was resistant to these two anti-TB drugs, while the other isolate from another pus sample was resistant to STR but susceptible INH. IS6110 RFLP based finger printing revealed that the HIV-positive patient was infected with different strains of Mycobacterium tuberculosis. A subculture of isolates on solid medium is useful to examine mixed infection.

Characterization of Mycobacterium africanum subtype I among cows in a dairy farm in Bangladesh using spoligotyping.

Acid-fast bacilli (AFB) were detected in the autopsy lung tissue homogenate samples of four cows (variety Frisian cross) in a dairy farm in Bangladesh. Histopathological examination of the lung tissue demonstrated prominent granulomas, caseating necrosis and calcification indicative of tuberculosis (TB) infection. Mycobacteria could not be cultured from the tissue homogenate samples by Lowenstein-Jensen based conventional culture method though AFB were evident by Ziehl-Neelsen (ZN) staining of the smears of tissue homogenate and in paraffin embedded tissue slices. Spoligotyping performed on DNA extracts of paraffin embedded lung tissue samples confirmed the AFB as a member of the M. tuberculosis complex (MTBC) with a pattern assigned to M. africanum subtype I. This characterization by spoligotyping was confirmed by subjecting M. africanum subtype I isolates from other parts of the world to an alternative identification method based on DNA polymorphism in the gyrB gene (Hain Life Science, GmbH, Nehren, Germany). Since M. africanum is believed to be a human pathogen, general infection in cattle may be a public health threat. The presence of these bacteria in the animal reservoir most likely originated from a caretaker.