An Investigation of an Acute Gastroenteritis Outbreak: Cronobacter sakazakii, a Potential Cause of Food-Borne Illness

Abstract

Whole genome sequencing (WGS) has been widely used in traceability of food-borne outbreaks nowadays. Here, an interesting connection between Cronobacter sakazakii and food-borne acute gastroenteritis (AGE) was noticed. In October 2016, an AGE outbreak affecting 156 cases occurred in a local senior high school. Case-control study including 70 case-patients and 295 controls indicated a strong association between eating supper at school canteen of the outbreak onset and AGE, as revealed by the Odds Ratio (OR: 95.32). Six recovered Cronobacter strains were evaluated and compared using pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and WGS. A phylogenetic tree of whole genomic single nucleotide polymorphisms (wgSNPs) were generated to traceback the potential contamination source in this outbreak. C. sakazakii isolates S2 from a patient’s rectal swab and S4 from leftover food sample shared identical PFGE pattern and sequence type (ST73), and clustered tightly together in the SNP phylogenetic tree. C. sakazakii isolates S5 and S6 from food delivery containers were both ST4 but with different PFGE patterns. Cronobacter isolates S1 and S3 from two patients’ rectal swab were sequenced to be C. malonaticus and shared another PFGE pattern (ST567). The interesting feature of this study was the implication of C. sakazakii as a causative agent in food-borne AGE occurring in healthy adults, although C. sakazakii is considered as an opportunistic pathogen and generally affects neonates, infants and immunocompromised adults.

Epidemiological and clinical differences between sexes and pathogens in a three-year surveillance of acute infectious gastroenteritis in Shanghai

“…This report included the following limitations: First, this report only focused on the outpatients of two sentinel hospitals, and all subjects were sporadic adult cases; thus, this study does not represent the infectious gastroenteritis epidemic in schools, although it is known that acute gastroenteritis is highly prevalent in schools and always causes outbreaks 37,38 . Second, based on our sampling rates, pathogens were only identified in 9.2% (1031/11243) of patients, and more effort should be made to improve the representative accuracy of our results.…”

Prevalence, Antibiotic Susceptibility, and Molecular Characterization of Cronobacter spp. Isolated From Edible Mushrooms in China

“…Although infants are not fed with mushroom, the elderly (or adults) will eat it, despite the potential risk (Chon et al, 2012; Aksu et al, 2016; Chitrakar et al, 2018). A recent study reported an acute gastroenteritis outbreak by the infection of C. sakazakii which occurred in a local senior high school of China, although without any specification about the food (Yong et al, 2018). In addition, China's share in global mushroom production increased from 5.7% in 1978 to 80% in 2011 (Zhang et al, 2014).…”

Cronobacter sakazakii, Cronobacter malonaticus, and Cronobacter dublinensis Genotyping Based on CRISPR Locus Diversity

“…The Cronobacter (formerly Enterobacter sakazakii ) genus including C. sakazakii, C. malonaticus, C. dublinensis, C. turicensis, C. universalis, C. muytjensii , and C. condimenti comprises opportunistic foodborne pathogens that can cause rare but life-threatening diseases in neonates and immune-compromised infants, including meningitis, necrotizing enterocolitis, and septicemia (Iversen et al, 2008; Kucerova et al, 2011; Joseph et al, 2012a; Zeng et al, 2018a). Latest study reported an acute gastroenteritis outbreak caused by C. sakazakii in a senior high school of China (Yong et al, 2018). Moreover, this genus has been isolated from the environment, food, and clinical sources (Ueda, 2017; Yong et al, 2018; Zeng et al, 2018a; Li et al, 2019).…”

“…Latest study reported an acute gastroenteritis outbreak caused by C. sakazakii in a senior high school of China (Yong et al, 2018). Moreover, this genus has been isolated from the environment, food, and clinical sources (Ueda, 2017; Yong et al, 2018; Zeng et al, 2018a; Li et al, 2019). Further, C. sakazakii , C. malonaticus , and C. dublinensis are three prevalent species and some reports have indicated that the principal sources of these organisms might be soil, water, and vegetables (Ueda, 2017; Zeng et al, 2018b).…”