Cronobacter: an emerging opportunistic pathogen associated with neonatal meningitis, sepsis and necrotizing enterocolitis

Abstract

Members of the genus Cronobacter are an emerging group of opportunist Gram-negative pathogens. This genus was previously thought to be a single species, called Enterobacter sakazakii. Cronobacter spp. typically affect low-birth-weight neonates, causing life-threatening meningitis, sepsis and necrotizing enterocolitis. Outbreaks of disease have been associated with contaminated infant formula, although the primary environmental source remains elusive. Advanced understanding of these bacteria and better classification has been obtained by improved detection techniques and genomic analysis. Research has begun to characterize the virulence factors and pathogenic potential of Cronobacter. Investigations into sterilization techniques and protocols for minimizing the risk of contamination have been reviewed at national and international forums. In this review, we explore the clinical impact of Cronobacter neonatal and pediatric infections, discuss virulence and pathogenesis, and review prevention and treatment strategies.

Cronobacter spp. – opportunistic food-borne pathogens. A review of their virulence and environmental-adaptive traits

“…However, this source now seems to be unlikely, as none of the vaginally delivered infants developed signs of infection until several days after birth and it is also unlikely that Cronobacter constitute a part of the vaginal microflora (Yan et al, 2012;Hunter & Bean, 2013). In addition, Biering et al (1989) observed that infants who showed Cronobacter meningitis had all received reconstituted powdered-milk formula before falling ill.…”

“…Many meningitis-causing bacteria, such as Neisseria meningitidis, Haemophilus influenzae and P. aeruginosa utilize type IV pili to colonize intestinal tissues and to later overcome the shear forces of the capillary blood flow before crossing the BBB (Kucerova et al, 2010;Grim et al, 2013). Cronobacter have been mostly implicated in meningitis in infants following the consumption of reconstituted and temperature-abused PIF (Hunter & Bean, 2013). Hence, it is thought that the main colonization site of Cronobacter is the GIT, where it first colonizes the mucous membranes, gastric and intestinal epithelial or endothelial tissues prior to their internalization within enterocytes, or translocation through the lamina propria into the systemic blood flow and then invasion of the brain.…”

“…Although Cronobacter spp. have been detected in this wide assortment of foods, only contaminated powdered infant formula (PIF) has been linked epidemiologically with infant infections and outbreaks caused by Cronobacter (Himelright et al, 2002;Hunter & Bean, 2013). The source of this contamination is thought to be PIF manufactured under poor Good Manufacturing Practice; however, extrinsic contamination of opened cans and human carriage may also be possible.…”

Contribution of the thermotolerance genomic island to increased thermal tolerance in Cronobacter strains

“…Recently the genus Cronobacter has undergone a number of revisions and currently contains seven species (Iversen et al 2008;Forsythe et al 2014;Stephan et al 2014). Cronobacter strains are opportunistic pathogens that can cause serious infections in neonates, including meningitis, necrotising enterocolitis and sepsis with low frequency, but high lethality rate (Hunter and Bean 2013;Holy and Forsythe 2014). Infections in adults also have been reported, in particular among the elderly and immunocompromised patients (Patrick et al 2014;Alsonosi et al 2015).…”

Characterizing the Rogues and Smooth Pairs of Cronobacter sakazakii Involved in Biofilm Formation and Long-Term Survival

“…Although the epidemiology and reservoir of Cronobacter are still not understood very well, powdered infant formula has been considered as the principal route of transmission among infants (Beuchat et al, 2009;Himelright et al, 2002;Hunter and Bean, 2013;Tall et al, 2015). Cronobacter also cause urinary tract infections, septicemia, and catheter-associated wound infections in people of all ages, especially in the elderly and those with other diseases or immune-compromised individuals (Joseph et al, 2012).…”