Salmonella enterica is a common cause of gastrointestinal illness in Italy. S. Typhimurium accounts for approximately 40% of isolates, and most of these strains belong to the phage type DT104. We describe the investigation of an outbreak of S. Typhimurium DT104A, a subtype never observed before in Italy, which occurred in Rome during spring 2004. We conducted a matched case control study between 24 July and 9 September 2004. Controls were matched for age and area of residence. Each case had between one and four controls. Odds of exposure to potential risk factors and vehicles for the outbreak were compared between cases and controls. A multivariate analysis was conducted to estimate adjusted Odds Ratios. Sixty-three cases of S. Typhimurium DT 104A infection with onset between 1 April and 5 May 2004 were identified. Sixty-one were residents of Rome and two were residents of a neighbouring region. Twenty-six cases (43%) were enrolled in the study. Their median age was 7.5 years. Fourteen of 26 cases and 16 of 62 controls had eaten pork salami (OR= 25.5; 95% CI 1.6- 416.8). No food samples were available for testing. In northern Italy, two months prior to the outbreak, the veterinary surveillance system identified the first isolation of S. Typhimurium DT104A in a pig isolate. Both human and pig isolates showed indistinguishable PFGE patterns. It was not possible to trace the pig after the sample was taken at slaughter. The epidemiological evidence on the implication of pork salami in this outbreak suggests that pork products can also be a vehicle for salmonella in Italy and underlines the importance of good manufacturing practices for ready-to-eat foods. This investigation highlights the value of laboratory-based surveillance in identifying community-wide outbreaks of uncommon pathogens. It also underlines the need to improve surveillance timeliness, for promptly detecting outbreaks, undergoing field investigation, and implementing control measures. Moreover, our study shows the usefulness of integrated human and animal surveillance in tracing the possible source of infection.
Different methods are available to produce all-ceramic dental prosthesis. Each processing step may introduce flaws to the material, which compromises its properties and reliability. The objective of this study was to evaluate the effect of fabrication method on the fracture behavior of prosthetic crowns produced with an alumina-based glass-infiltrated zirconia-reinforced ceramic. Two groups of all-ceramic crowns were produced according to the fabrication method of the infrastructure (IS) (n=30): IZC - IS produced by CAD-CAM; IZS - IS produced by slip-casting. The IS were veneered with porcelain and cemented to fiber-reinforced composite dies with resin cement. Crowns were loaded in compression to failure using a universal testing machine, at 1 mm/min crosshead speed and 37 ºC distilled water. Fractography was performed using stereomicroscope and SEM. Data were statistically analyzed with Student’s t test (α=0.05) and Weibull analysis. There were no significant differences among the experimental groups for fracture load (p=0.481) and Weibull modulus. For both groups, the failure mode was catastrophic failure involving IS and porcelain. It was concluded that the fabrication methods evaluated resulted in all-ceramic crowns with similar fracture behavior and reliability.
Salmonella enterica serovar typhimurium (STM) con resistenza multipla agli antibiotici appartenente al fagotipo (DT) 104 è un patogeno che si è diffuso rapidamente in tutto il mondo a partire dagli anni 80. Nell'ambito del progetto di sorveglianza delle salmonellosi Enter-net Italia, gli stipiti di STM isolati dai laboratori della rete vengono inviati a campione all'Istituto Superiore di Sanità per essere caratterizzati attraverso fagotipizzazione, profilo di antibiotico resistenza e analisi molecolare mediante elettroforesi in campo pulsato (PFGE). Durante il mese di Giugno 2004, 63 ceppi di STM, sono risultati DT104A, un sottotipo di DT104 piuttosto raro, mai osservato tra i ceppi pervenuti nel corso degli ultimi tre anni. Tutti i ceppi risultavano sensibili al pannello di antibiotici previsti dal protocollo Enter-net e mostravano lo stesso profilo elettroforetico in PFGE. Tutti i ceppi, eccetto 2 provenienti dall'ospedale di Spoleto, erano stati isolati da casi di gastroenterite, apparentemente non correlati tra loro, verificatisi a Roma e provincia a partire dalla fine di marzo 2004 e per la maggior parte concentrati nel mese di Aprile. Al fine di identificare il veicolo di trasmissione delle infezioni nell'area di Roma è stato condotto uno studio caso-controllo. Per ogni caso (soggetto con coprocoltura positiva per STM DT 104A) sono stati selezionati fino a 4 controlli appaiati per età e area di residenza. L'analisi statistica è stata effettuata applicando la regressione logistica condizionata realizzata con il software EpiInfo, ver.3.2. Lo studio analitico che ha incluso 26 casi e 63 controlli ha mostrato che l'acquisizione dell'infezione è associata in modo statisticamente significativo (OR=5,9; 95% C.I.: 1,6 -22,1) al consumo di un salume tipico del periodo pasquale ("corallina"). Questo lavoro mostra ancora una volta l'importanza della sorveglianza di laboratorio e la subtipizzazione dei ceppi batterici isolati nel riconoscimento di episodi epidemici.
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