milk borne disease 2 (eng)-2012
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MILK BORNE DISEASES
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Review
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Milk and DairyProducts
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Milk and Dairy Products
Raw Milk
Pathogens associated:
E. coli O157:H7 Salmonella typhimurium
Campylobacter jejuni Listeria monocytogenes
Staphylococcus aureus (mastitis)
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Why is raw milk consumed?
Easy access to raw but less access topasteurized
Drinking raw milk has been practiced
over time A notion that raw milk is better thanpasteurized
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Spoilage bacteria
Bacteria that limits the shelf life:
Total Psychrotrophic counts in raw milk
Needs to be
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Post-Pasteurization Contamination
Pseudomonas spp.
Bacillus cereus
Lactic acid bacteria
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Standards for Pasteurized Milk and Milk Products
Temperature cooled to 10o
C or less Bacterial counts < 20, 000 cfu/ml
Coliform counts < 10 cfu/ml
Antibiotic presence: negative
Phosphatase < 1 g
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Dried Milk
Low water activity prevents growth of pathogensand spoilage bacteria
Largest foodborne illness outbreak associated withStaphylococcus aureus was in Japan 2000, 13,000cases
The incident was the result of post-pasteurizationcontamination with Staph aureus toxin that is notdestroyed by drying
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Fermented milk products : produced by bacterial orfungal transformation for carbohydrate (lactose-lactate)
Fermented products are preserved by acidsand alcohol produced by the beneficialbacteria that inhibits spoilage bacteria and
pathogens
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Cheese
Product made from the curd of the milk of cowsor other animals
Casein coagulated by rennin and acid
Subsequent heating, salting, pressing, aging
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SalmonellaSalmonella : two distinct species : Salmonella enterica and Salmonella bongori .
S. enterica subspecies I contains 1367 serotypes, is mainlyisolated from warm-blooded animals (mammals and birds),and accounts for _99% of all clinical isolates.
The remaining subspecies (II, IIIa, IIIb, IV, VI, and VII) aremainly isolated from coldblooded animals and account for
_1% of clinical isolates.
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Salmonella continues to be a majorcause of food poisoning throughoutthe world. Salmonellosis sickens asmany as 3.84 million Americansand costs billions of dollars in lostproductivity and medical costs peryear
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DISEASE
the most prevalent recognized communicable diseasescaused by bacteria in the United States today.transmitted from animals to humans through food andoccasionally from person to person through the fecal-
oral routeSalmonellosis in the human occurs in a variety of forms,presenting a broad clinical spectrum.
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A. Gastroenteritis
The incubation period 6 72 hours. There isabdominal pain and loose, watery diarrhea,occasionally with mucous or blood. Nausea andvomiting are frequentFever of 38 39C is common, and there may be aninitial chill. Abdominal pain is frequent and may causemild to severe discomfort. In uncomplicated cases,the acute stage usually resolves within 48 hours.However, illness is occasionally more protracted, with
persistent diarrhea and low-grade fever for 10 14days. In severe cases, dehydration may lead tohypotension, cramps, oliguria, and uremia. Symptomsare likely to be more severe in infants and older adults(>60 years
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Bacteremia
Salmonella enterica serotypes :prolonged fever and a positive bloodculture, Gastroenteritis + / - ,sweats, anorexia, and weight loss.The characteristic symptoms of
typhoid fever, which include rosespots, leukopenia, and sustainedfever, are absent.
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Enteric or Paratyphoid Fever S. cholerae-suis and S. enterica serotypesparatyphi A and paratyphi B. have symprom liketyphoid Fever : prolonged fever, rose spots,splenomegaly, leukopenia, gastrointestinalsymptoms, and positive blood and stool cultureMilder than S. typhi infections, but differentiationon clinical grounds is not possible in the individualcase.
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Local Infections Meningeal localization of infections is common innewborns and infantsPolyarthritis
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Escherichia coli In 1945, Bray and other researchersdemonstrated that E.coli involvement ingastroenteritis. E. coli involve in gastroenteritiscategorized into five major groups according totheir virulence mechanisms:enteropathogenic (EPEC), enterotoxigenic(ETEC), enteroinvasive (EIEC),enterohemorrhagic (EHEC), andenteroaggregative (EAEC). Other strains, namelydiffusely adherent E. Coli (DAEC), are less wellestablished as pathogens
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Enterotoxigenic E. coli ETEC produces a watery diarrhea, cramps and alow-grade or no fever,has a lot in common with cholera; both result
from ingestion of large inocula of bacteria, whichthen colonize the small intestine and producetoxins that cause net secretion into intestinallumen.
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Enteroinvasive E. coli EIEC infection produces a disease similar to thatcaused by Shigella .The diarrhea is initially acute and watery,accompanied by fever and abdominal cramps,and then may progress to a colonic phase withbloody and mucoid stools.EIEC infection has been traced to contaminatedfoods and water also spread from person toperson.
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Enterohemorrhagic E. coli The EHEC group causes severe bloody diarrhea(hemorrhagic colitis), hemolytic uremic syndrome(HUS), and thrombotic thrombocytopenic purpurasometimes the infection causes only diarrhea or
no symptoms.In the United States, hemolytic uremic syndromeis the principal cause of acute kidney failure inchildren.
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Enteroaggregative E. coli
Acute, persistent, and bloody diarrhea disease inchildren and nosocomial and communityoutbreaks worldwide
EAEC as the causative agent of diarrhealdisease in HIV-infected adults in the developedworld
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Enterobacter sakazakii
Fam. Enterobacteriaceae, genus Enterobacter .In the past as a yellow-pigmented Enterobacter cloacae .In 1980 E. sakazakii was designated as aunique species, based on differences from E.cloacae in DNA relatedness, pigmentproduction, and biochemical reactions.A mortality rate of 40 80%, in many casesneonates die within days of birth. In survivingpatients severe neurological sequelae such ashydrocephalus, quadraplegia,Contaminated dry infant formulas as the sourceof E. sakazakii
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E. sakazakii has been isolated from insects collectedat a dairy farm. Could not isolate from surface water,soil, mud, rotting wood, grain, bird faeces, rodents,domestic animals, cattle, or raw cow s milk.E. sakazakii strains have been isolated from clinicalsources, blood, or cerebrospinal fluid.
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DISEASES Enterobacter spp. ( E. Sakazakii) are frequentlythe cause of nosocomial diseases, E. sakazakii is usually a rare opportunistic pathogen causingsevere meningitis in neonates and prematurebabies, the most common gastrointestinalemergency in newborns.In a few cases the symptoms were limited to
septicemia only.
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E. sakazakii overcomes the gastrointestinal barrier,gaining access to the blood stream and finally to the
cerebrospinal fluid. Severe symptoms of the diseasesuch as ventriculitis, brain abscess, infarction, and cystformationThe mortality rate is usually high, E. sakazakii seems
to be more susceptible to commonly used antibacterialagents than other Enterobacteriaceae, and treatmentwith ampicillin/gentamicin is effective in most cases
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Risk comes from the list of pathogens possiblein the raw milk:
Enterotoxigenic Staphylococcus aureus Campylobacter jejuni Salmonella species E. coli (EHEC) (ETEC)
Listeria monocytogenes Mycobacterium tuberculosis Mycobacterium bovis Brucella species (abortus cattle) (melitensis- goats)Coxiella burnetii Yersinia enterocolitica
(Sheehan, 2005)
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Salmonella
Several forms
Symptoms include:Diarrhea, fever, abdominal cramps
May cause hospitalization
Death can occur if not treated
(CDC, 2008)
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E. Coli 0157:H7Symptoms include:Bloody diarrhea, severe abdominal cramps,
vomiting
Potentially fatal
Can cause hemolytic uremic syndrome(HUS)
Sensitive to heatKilled by cooking and proper pasteurization
(Vasavada, 1988) , (Karns et al., 2007)
Camp lobacter jej ni
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Campylobacter jejuni
Gram-negative, nonsporeforming bacteriumSymptoms include:
Mild enteritis or severe enterocolitis, nausea,abdominal cramps, bloody diarrhea
Sensitive to heat, oxygen, drying, and acidic pHKilled with normal pasteurization
(Vasavada, 1988)
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Listeria monocytogenes Gram-positive, nonsporeformingFound in:
Soil, manure, unpasteurized raw milk
Symptoms include:Meningitis, infectious abortion, perinatalsepticemia, encephalitisCan cause stillbirths or deaths of infants
Sensitive to heat / pasteurization
(Vasavada, 1988)
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StudiesPrevalence of Foodborne Pathogens in BulkTank Milk
Of dairy producers consuming raw milk:21 of 79 (26.6%) had 1 or more pathogenic bacteria inmilk
35 of 131 (26.7%) bulk tank samplesFound:
Campylobacter jejuni (9.2%)Shiga-toxin producing E. coli (3.8%)
Listeria monocytogenes (4.6%)Salmonella spp. (6.1%)Yersinia enterocolitica (6.1%)
(Jayarao et al., 2001)
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StudiesPrevalance of Salmonellae, Listeria monocytogenes , and Fecal Coliforms in BulkTank Milk on US Dairies
861 samples collected, 21 statesColiforms detected in 95% of samplesFound:
Salmonella (2.6%)Listeria monocytogenes (6.5%)
(Kessel et al., 2003)
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Bulk Tank Sample
Tests used:TSA tests for bacterial growthBlood agar tests for bacterial growth
Violet Red Bile Glucose (VRBG) agar used fornumerating coliform organisms in dairy productsMacConkey (MAC) agar used for isolating anddifferentiating coliforms based on fermentation
Xylose Lysine Deoxycoagulate (XLD) agar usedfor isolating and differentiating gram-negative andenteric bacteria from the gut
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Who are affected the most?Children
Rely on us for guidance and protectionEducate children about the bad bugs
Immunocompromised
Elderly
Pregnant Women
(Bren, 2004)
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OutbreaksAccording to the USFDA:
Outbreaks differ depending on type of pathogen,geographic location, and species of milk
Not all outbreaks are recognized
Not all get reported to the Centers for DiseaseControl (CDC)
(Sheehan, 2005)
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OutbreaksE. coli O157:H7
September 28, 2006
Washington dairy causes illness in 2 unrelatedchildren8 year-old boy5 year-old girl
Hospitalized
(Sheehan, 2005)
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OutbreaksSalmonella typhimurium
2002-2003
62 people infected40 - IL, IN, OH, TN
After investigation:Raw milk only product associated with illnesses
(Sheehan, 2005)
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OutbreaksSalmonella dublin
1971 1975CA infections increased 5 times
44 of 113 from raw milk exposure35 from 1 single dairy
89 of 113 hospitalized
22 died
(Sheehan, 2005)
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OutbreaksListeria monocytogenes
Cause of 2500 illnesses each year
~500 die
Only 0.02% of foodborne illnesses, but 27.6%of deaths from foodborne infection
(Sheehan, 2005)
Disease Outbreaks From Milk
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Disease Outbreaks From MilkProducts
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