First Report of a Foodborne Providencia alcalifaciens Outbreak in Kenya

Abstract

Abstract. Providencia alcalifaciens is an emerging bacterial pathogen known to cause acute gastroenteritis in children and travelers. In July 2013, P. alcalifaciens was isolated from four children appearing for diarrhea at Kiambu District Hospital (KDH) in Kenya. This study describes the outbreak investigation, which aimed to identify the source and mechanisms of infection. We identified seven primary and four secondary cases. Among primary cases were four mothers who had children and experienced mild diarrhea after eating mashed potatoes. The mothers reported feeding children after visiting the toilet and washing their hands without soap. P. alcalifaciens was detected from all secondary cases, and the isolates were found to be clonal by random amplified polymorphic DNA (RAPD) fingerprinting. Our study suggests that the outbreak was caused by P. alcalifaciens, although no fluid accumulation was observed in rabbit ileal loops. The vehicle of the outbreak was believed to be the mashed potato dish, but the source of P. alcalifaciens could not be confirmed. We found that lack of hygiene, inadequate food storage, and improper hand washing before food preparation was the likely cause of the current outbreak. This is the first report of a foodborne infection caused by P. alcalifaciens in Kenya.

Prevalence, seasonal variation, and antibiotic resistance pattern of enteric bacterial pathogens among hospitalized diarrheic children in suburban regions of central Kenya

“…For example, a multidrug-resistant enteroaggregative Escherichia coli ( E. coli ) O44, which is associated with acute and persistent diarrhea, has been reported in Kenya [7]. Recently, Providencia alcalifaciens was published for the first time as the etiological cause of diarrhea outbreaks in Kiambu [8], and E. coli O157 as a cause of significant outbreaks in Swaziland [9]. However, there is limited information on the surveillance of diarrheagenic pathogens and their antimicrobial resistance pattern.…”

<i>Providencia</i> in retail meats from Guangzhou, China and Osaka, Japan: prevalence, antimicrobial resistance and characterization of classes 1, 2 and 3 integrons

“…P. alcalifaciens has been associated with diarrhea and gastroenteritis in children and travelers from developing countries [ 1 , 2 , 19 , 20 , 47 ]. Furthermore, three large outbreaks of food poisoning attributed to P. alcalifaciens were reported in Japan, the Czech Republic and Kenya [ 6 , 29 , 35 ]. In addition to P. alcalifaciens , P. rettgeri and P. heimbachae are also suggested to be etiological agents of diarrhea [ 28 , 47 ].…”

The C. difficile toxin B membrane translocation machinery is an evolutionarily conserved protein delivery apparatus

“…In addition to species with known pathogenic potential, homologs were found in a range of host-associated microbes, which may be suggestive of cryptic pathogenic potential. Of the known pathogenic species, 11% are associated with human pathogenicity, including Pseudomonas fluorescens, Photorhabdus asymbiotica, Serratia marcescens and several species of Providencia (P. alcalifaciens, P. rettgeri, and P. stuartii); these bacteria are generally opportunistic pathogens, and are associated with severe diseases in immunocompromised individuals [38][39][40][41][42][43] . Interestingly, the majority of remaining LCT-T homolog sequences occurred in species associated with pathogenicity in non-human hosts, including species of Vibrio, Pseudomonas, Xenorhabdus, and Photorhabdus, which are known pathogens of aquatic organisms, insects and fungi 44,45 .…”