Midterm II Flashcards
What were the major events of Cronobacter history?
1929: First report of a yellow-pigmented coliform
1961: Yellow-pigmented coliforms caused two cases of neonatal meningitis
1977: yellow-pigmented coliform named Enterobacter sakazakii after Japanese microbiologist
2008: Moved to new genus Cronobacter w/ 5 species
Today: Cronobacter has 11 species
What are the species of Cronobacter?
- C. dublinesis
- C. muytjensii
- C. condimenti
- C. universalis
- C. helveticus
- C. zurichenesis
- C. pulveris
- C. colletis
Involved in neonatal infection: - C. sakazakii
- C. turicensis
- C. malonaticus
What are the main characteristics of Cronobacter?
Gram - Non-spore forming Straight, rod-shaped Flagellum Originally yellow-pigmented coliform (unless repeatedly sub-cultured, then loses yellow pigment & cell morphology)
What are the growth factors of Cronobacter?
Nonhalophilic (not salt loving)
Facultative anaerobe
Grows between 6-45C
Where is Cronobacter most found?
Powdered infant formula (PIF)
- 10-15% of PIF has Cronobacter (very low chance of infection, tho)
Specifically reconstituted PIF
- Intrinsic or extrinsic contaminant during manufacturing under poor good manufacturing practices (GMP) or reconstitution of PIF
What are the statistics of Cronobacter?
Range from 3 days to 4 years old - 120 recorded cases (many thought to be undocumented) - Increases year-to-year - 19 deaths (40-80% fatality rate) - 11 countries Adults - 20 cases
Which US State has the largest Cronobacter outbreak?
Tennessee
In 2001
10 cases & 1 death
What age group is most at risk of Cronobacter?
Infants below 1 year fed PIF
- Neonates (infant below 28 weeks) at greatest risk
Increased risk with:
- Immunocompromised
- Low birth-weight neonates
- Premature infants born below 37 weeks (avg = 40 weeks)
* Most cases in developed world (most likely due to underreporting
Why are premature infants at a higher risk for Cronobacter?
They secrete less gastric acid than older infants
Increases long-term survival of Cronobacter
What is Cronobacter likely diagnosed as instead?
SIDS
What happens to survivors of Cronobacter?
Severe neurological & development disorders
What are the symptoms of Cronobacter?
Necrotizing enterocolitis (NEC) Septicemia Meningitis Neurological sequelae (aftereffects) - Brain abscess - Necrosis of brain tissue - Liquefaction of white cerebral matter
What food products that don’t cause illness contain Cronobacter?
Milk powder Cheese Herbs Spices Rice
What clinical sources can contain Cronobacter?
Cerebrospinal fluid Blood Intestinal & respiratory tracts Bone marrow Skin wounds
Why can’t Cronobacter be removed from PIF?
Would affect organoleptic & nutritional requirements
- PIF is highly regulated for nutritional requirements
Can only be irradiated
- Would deteriorate organoleptic too much
* New approaches = ultrahigh pressure, magnetic fields
What are pathogenesis factors of Cronobacter?
Manufacturer: - Survival on equipment - Biofilm formation - Temperature of processing Infant: - Higher stomach pH than adults - Lower GI microbiome complexity - Immunocompromised Organism: - Can cross blood-brain barrier (bbb) - OmpA facilitates invasion of brain cells (not all C. have this) - Enterotoxins produced (don't know how common) - Can cross GI barrier
What do the virulence factors of Cronobacter pathogenesis do?
Apical attachment (can attach to epithelial cells)
Invasion (apical & basolateral side)
Disrupt tight junction (causes diarrhea)
Disrupt adheren junction
What are the virulence factors of Cronobacter and their genes?
- Outer membrane proteins (OMPS): ompX, ompA (invade epithelial cells & bbb)
- Enterotoxin: unknown (heat stable)
- Outer membrane protease: cpa (protect from immune system
- Sialic acid utilization: nanAKT (confers in pathogenesis)
- Iron acquisition system: iuc (Encodes iron-uptake system)
- Efflux system: ibeB (facilitates invasion of brain cells)
- Proteolytic enzymes: zpx (deforms & rounds cells)
- Lipopolysaccharides: chromosomal encoded genes (disrupts epithelial cells
- Type 3 hemolysin: hly (hemolytic activity)
What are the outer membrane proteins (OMP) of Cronobacter?
Critical
On cell surface
Export extracellular virulence factors and anchor the structures that cause adhesion & motility
Gene OmpA: helps cells adhere to GI epithelial cells
- Need to breech bbb (without this gene, the Cronobacter doesn’t get to the brain)
Gene OmpX: helps invade apical side of GI epithelial cells & helps bacterium survive on basolateral side
What is the outer membrane protease (cpa) of Cronobacter?
Cronobacter plasminogen activator (cpa) Can cause serum resistance by: - Cleaving complement components - Activating plasminogen - Inactivating a plasmin inhibitor pESA3 plasmid - Encodes cpa - Encodes T6SS (interbacterial antagonists = fight other bacteria) - Encodes some adhesion factors
What is sialic acid utilization in Cronobacter?
Gene = nanAKT
Found in human milk & infant formula
- In form of sialyloligosaccharides
- Remain undigested in infants, increasing the neonate intestinal microvilli sialic acid levels
Only found in C. sakazakii
- Possible link between sialic acid metabolism & pathogenesis of C. sakazakii
How do you prevent Cronobacter?
After preparing PIF, refrigerate at 4C within 1 hr
Prepare PIF in small amounts to reduce “hang time” at room temp before consumption
- Never leave out for more than 4 hrs after prepared
Only use chilled, sterile water for preparation
Discard any remaining PIF after feeding
Use within 4 weeks of opening a can
Sterilize bottles prior to reconsitution
What are the general characteristics of Vibrio sp?
Non-spore forming Gram - Vibrio shaped (looks like a cheeto) More common in warmer waters - Increases dramatically above 17C
What are the most important Vibrio species that cause illness?
96 species total (mostly non-pathogenic)
- 40-60% of finfish/shellfish in supermarkets have Vibrio spp.
12 are causative agents in human infection
3 cause most illnesses:
- Vibrio parahaemolyticus
- Vibrio vulnificus
- Vibrio cholera (more waterborne than foodborne)