Jacqueline Tanury Macruz Peresi

Salmonella Serotypes Isolated from Nonhuman Sources in São Paulo, Brazil, from 1996 through 2000

A total of 4,581 Salmonella strains isolated from nonhuman sources, including foodstuffs associated with foodborne Salmonella outbreaks, from January 1996 through December 2000 were serotyped at the Enteropathogens Laboratory, Instituto Adolfo Lutz, São Paulo, Brazil. Among the 123 different serotypes identified, Salmonella enterica subsp. enterica serotype Enteritidis (Salmonella Enteritidis) was the most prevalent (32.7%), ranking first for almost every kind of source. The next most common serotypes were Salmonella Senftenberg (10.3%), Salmonella Hadar (6.8%), Salmonella Agona (5.1%), and Salmonella Typhimurium (2.4%). Rough strains belonging to the subspecies S. enterica subsp. enterica (4.8%), S. enterica subsp. arizonae (<1%), S. enterica subsp. diarizonae (<1%), and S. enterica subsp. houtenae (<1%) were also detected. Foodstuffs (including poultry meat for consumption) contained 38.1% of the studied Salmonella strains, poultry flocks (from several farms under salmonellosis control by the owners) contained 21.7%, the environment contained 10.6%, sewage contained 9.4%, water contained 6.6%, animal feed contained 4.4%, chill water from poultry-processing operations contained 2.2%, and other sources contained 7.0%. Foodstuffs extensively contaminated with Salmonella strains were poultry meat (40%), cow meat (11%), desserts (8%), mayonnaise (6%), sausage (5%), and unpasteurized shell eggs (4%), and there were several other food sources (26%). Homemade mayonnaise was the most common vehicle for Salmonella foodborne outbreaks, and Salmonella Enteritidis was the serotype most isolated (95%) from that source. According to these data and previously published data concerning Salmonella strains isolated in São Paulo State, almost the same serotypes have predominated among nonhuman sources for the last decade.

Food borne disease outbreaks caused by Salmonella Enteritidis

OBJECTIVE It is to describe outbreaks of salmonellosis reported from July 1993 through June 1997 in the Northwest region of S. Paulo State, Brazil, one of the areas where several foodborne outbreaks of salmonellosis have been recently detected. METHOD Data of 19 epidemiological investigations were analysed; 87 stool specimens and 38 food samples (including 12 of shell eggs) were processed for microbiological analysis. Salmonella strains were identified by serotyping, phagetyping and antimicrobial susceptibility testing. RESULTS There were 906 ill persons including 295 hospitalized patients. Phage type 4 (PT 4) Salmonella Enteritidis strains were isolated from 80.5% of stool samples, from all food samples and from 41.7% of eggs. Of the outbreaks, 95.7% were associated with the consumption of food containing raw or undercooked eggs. All strains were susceptible to the 13 antimicrobials, except the strains from the nosocomial outbreak. CONCLUSIONS The results obtained show the need for the implementation of control measures regarding egg and storage, as well as for guidance to the public as to the risks involved in the consumption of inadequately prepared eggs.

Surto alimentar por Salmonella Enteritidis no Noroeste do Estado de São Paulo, Brasil

A foodborne outbreak which affected 211 persons occurred, in a School, in 1993. The epidemiological data obtained by interviewing the affected and non affected persons sampled showed as predominant symptoms: diarrhoea, fever (77.7%), abdominal cramps (67.7%), vomiting (65.8%), hot-and-cold sensations (54.5%) and headache (44.5%). The median incubation period was of 17 hours, the limits being 3 and 29 hours. The disease period was of from 3 to 4 days. The food concerned was a kind of pate, a mayonnaise mixture prepared with fresh eggs with boiled potatoes that was consumed with bread. The biological material analysis - 3 coprocultures, and leftovers of the food revealed the presence of one and the same organism: Salmonella Enteritidis. In the food, the numbers of this bacterium per gram were sufficient to account for the manifestation of the disease (104 and 105/g). The antibiogram of all the isolates showed the same sensibility pattern. The preparation related to this outbreak suggests the endogenous contamination of the eggs; the cross contamination - the outbreak affected three school periods, as the food was prepared separately for each school period; and the conditions under which the food was kept during the time from preparation to consumption. The observation of the 3 food handlers, by successive coprocultures, for one week, indicates that they were not asymptomatic carriers nor were they affected as a result of this outbreak by the causal bacteria.Em 1993 ocorreu um surto alimentar em escola, com 211 afetados. Os dados epidemiologicos levantados por entrevista de amostragem de afetados e nao afetados mostraram que os sintomas predominantes foram diarreia, febre (77,7%), dor abdominal (67,7%), vomito (65,8%), calafrios (54,5%) e cefaleia (44,5%). A mediana de incubacao foi de 17 horas, com limites entre 3 e 29 horas. A duracao da doenca foi de 3 a 4 dias. O alimento consumido foi um tipo de pate, mistura de molho de maionese preparada com ovos crus com batata cozida, passado em pao. A analise de material biologico (3 coproculturas) e de restos de alimentos revelou a presenca do mesmo microrganismo, a Salmonella Enteritidis. No caso dos alimentos, o numero encontrado desta bacteria por gramo de produto era compativel com a quantidade de celulas necessaria para desencadear a doenca (104e 105/g). O antibiograma de todas as cepas isoladas revelou o mesmo padrao de sensibilidade. As falhas no preparo do alimento relacionadas com o levantamento indicam a possibilidade de contaminacao endogena dos ovos; contaminacao cruzada - o surto afetou tres periodos escolares, sendo que para cada um o alimento foi preparado em separado - e as condicoes de manutencao do alimento apos preparo e ate o consumo. A observacao por uma semana seguida das 3 merendeiras envolvidas, atraves de coprocultura, nao indicaram que as mesmas fossem portadoras assintomaticas desta bacteria ou que tivessem sido envolvidas no surto em questao.A foodborne outbreak which affected 211 persons occurred, in a School, in 1993. The epidemiological data obtained by interviewing the affected and non affected persons sampled showed as predominant symptoms: diarrhoea, fever (77.7%), abdominal cramps (67.7%), vomiting (65.8%), hot-and-cold sensations (54.5%) and headache (44.5%). The median incubation period was of 17 hours, the limits being 3 and 29 hours. The disease period was of from 3 to 4 days. The food concerned was a kind of paté, a mayonnaise mixture prepared with fresh eggs with boiled potatoes that was consumed with bread. The biological material analysis-3 coprocultures, and leftovers of the food revealed the presence of one and the same organism: Salmonella Enteritidis. In the food, the numbers of this bacterium per gram were sufficient to account for the manifestation of the disease (10(4) and 10(5)g). The antibiogram of all th isolates showed the same sensibility pattern. The preparation related to this outbreak suggests the endogenous contamination of the eggs; the cross contamination-the outbreak affected three school periods, as the food was prepared separately for each school period; and the conditions under which the food was kept during the time from preparation to consumption. The observation of the 3 food handlers, by successive coprocultures, for one week, indicates that they were not asymptomatic carriers nor were they affected as a result of this outbreak by the causal bacteria.

Salmonella Alachua: causative agent of a foodborne disease outbreak

OBJECTIVES The aim of this study is to report the occurrence of the first outbreak of food poisoning caused by Salmonella Alachua in Brazil, as well as the antimicrobial susceptibility and the genetic relatedness of Salmonella Alachua strains isolated from clinical and food samples. MATERIAL AND METHODS To elucidate the outbreak, an epidemiological investigation was carried out, and two samples of common food were tested--mayonnaise salad and galinhada (a traditional Brazilian dish of chicken and rice)--according to the Compendium of methods for the microbiological examination of foods. Five stool samples were tested employing classic methods for the isolation and identification of enterobacteria. Strains of Salmonella were characterized for antibiotic susceptibility according to the Clinical and Laboratory Standards Institute guidelines (2013), and submitted to pulsed-field gel electrophoresis analysis, performed according to the Centers for Disease Control and Prevention PulseNet protocol. RESULTS A total of 94 people were interviewed after ingesting the food, 66 of whom had become ill. A 60-year old female patient who was hospitalized in a serious condition, developed septic shock and died two days after consuming the food. The presence of Salmonella Alachua was confirmed in all the analyzed stool samples, and in the two types of food. The five strains showed higher than minimum inhibitory concentration values of nalidixic acid (≥256 μg/mL) and reduced ciprofloxacin susceptibility (minimum inhibitory concentration=0.5 μg/mL). The pulsed-field gel electrophoresis analysis revealed indistinguishable patterns in Salmonella Alachua strains isolated from clinical and food samples. CONCLUSION The data presented herein confirm the foodborne disease outbreak. They also allowed for the identification of the source of infection, and suggest that products from poultry are potential reservoirs for this serotype, reinforcing the importance of warning consumers about the danger of possible contamination.

PROFISSIONAIS DE UM LABORATÓRIO DE SAÚDE PÚBLICA ESTIMULAM ESTUDANTES NA PREVENÇÃO DE DOENÇAS TRANSMITIDAS POR ALIMENTOS

Introduction: Educational activities focused on prevention are important tools to reduce outbreaks of foodborne illness. Objective: To verify whether, after educational lectures, students changed their habits to prevent foodborne diseases. Patients and Methods: Over four years, the staff and students of the Institute Adolfo Lutz, through the project “Itinerant Circuit of Lectures”, presented 41 talks and distributed a folder detailing the etiological agents, symptoms, and measures of prevention, conservation and handling of food to 1906 students in 12 private schools. Two months after the lectures an assessment tool comprising ten statements was applied to the students to see if they had changed their daily habits. Results: A total of 1555 students answered the questionnaire, with 81.5% having changed their habits, in particular students of the 6th, 7th and 8th grades of elementary school compared to students of the 9th grade, and 1st and 3rd grade of high school (p-value <0.05). The mean number of changes in habits related to the four personal hygiene items was 2.42 (SD 1.07), and for the six items on food care the mean number was 3.37 (SD 1.41). Conclusion: Popularization of science with educative actions proved to be effective, as 81.5% of young people changed their daily habits of personal hygiene and food care. Descriptors: Foodborne Diseases; Health Education; Food Contamination.

HISTÓRIA EM QUADRINHOS PARA ENSINO E PREVENÇÃO DAS DOENÇAS TRANSMITIDAS POR ALIMENTOS

Doencas transmitidas por alimentos (DTA) representam um problema de saude publica, contudo, sao passiveis de prevencao. Os surtos alimentares ocorrem em grande parte nas residencias, devido manipulacao ou armazenagem inadequada dos alimentos; assim, estrategias de educacao em saude voltadas a populacao podem colaborar na diminuicao dos riscos relacionados. Considera-se que a criacao de um material impresso voltado para o publico infanto-juvenil pode colaborar para o interesse e facil disseminacao do conhecimento.