Cronobacter spp. in Powdered Infant Formula

Abstract

<jats:p>Cronobacter species are opportunistic pathogens, and a mortality rate of 40 to 80% is associated with infections. This pathogen can cause a range of serious diseases such as meningitis, septicemia, necrotizing enterocolitis, and brain abscesses and has been responsible for a variety of sequelae such as quadriplegia. Although Cronobacter can cause disease in both adults and infants, infant infections associated with powdered formula are the focus of this review. Since the first reported Cronobacter infection outbreak in 1958, powdered infant formula has been identified as a major source of these outbreaks, resulting in many recalls of powdered infant formula worldwide. This contamination has created an immense problem for the powdered infant formula industry. In this review, we discuss the taxonomy of Cronobacter species, the natural habitat of Cronobacter and its presence in foods, the physiology, pathogenicity, and virulence of Cronobacter species, and available detection methods. We also discuss reported cases of Cronobacter infection linked to powdered infant formula consumption and then focus specifically on the official World Health Organization guidelines for preparation of powdered infant formula.</jats:p>

Development of a rapid detection system for opportunistic pathogenic Cronobacter spp. in powdered milk products

“…These colonies should be streaked on tryptic soy agar and resulting yellow colonies are indicatory for C. sakazakii. This method is time-and laborconsuming, as it usually requires five to six days to obtain a positive result (Norberg et al, 2012;Seo and Brackett, 2005).…”

“…One of these methods was based on the most-probable-numbertechnique (Norberg et al, 2012). The US Food and Drug Administration recommended in 2002 a method based on a pre-enrichment step in buffered peptone water, followed by inoculation of Enterobacteriaceae enrichment broth, plating on violet red bile agar and finally transfer of colonies to tryptic soy agar to analyze yellow pigmented colonies (Anonymous, 2002).…”

“…(Norberg et al, 2012), but not all of these methods included an internal amplification control and were validated in the food matrix. For example, these methods used as target sequences the macromolecular synthesis operon sequence (Seo and Brackett, 2005), the 16S rRNA gene (Malorny and Wagner, 2005;Ruan et al, 2013), the 16S e 23S rRNA internal transcribed spacer (Liu et al, 2006a(Liu et al, , 2006b or the outer membrane protein A (ompA) gene (Nair and Venkitanarayanan, 2006;Ruan et al, 2013).…”

Quality and Safety Aspects of Infant Nutrition

“…In recent years, there have been numerous recurrences of invasive infections with Cronobacter sakazakii that led to bacteremia, necrotizing enterocolitis and meningitis – predominantly in premature infants – which were related to the consumption of infant formula reconstituted from powder contaminated with these bacteria [37,38,39,40]. Occurrence of invasive infections occurred after prolonged storage of reconstituted formula at warm temperatures which can lead to a marked increase in bacterial numbers and hence reach an infective dose [41,42].…”

Structure-Activity Relationship of Synthetic Variants of the Milk-Derived Antimicrobial Peptide α s2 -Casein f(183–207)

“…Cronobacter sakazakii is a Gram-negative microorganism that has been identified as the causative agent of serious disease episodes in humans, especially infants, including meningitis, hydrocephalus, necrotizing enterocolitis, septicemia, and brain abscesses (17). C. sakazakii has been isolated from a wide variety of food sources, with powdered infant formula (PIF) being the most common vehicle involved in newborn infections (18)(19)(20)(21).…”