Notes from the Field: <i>Cronobacter sakazakii</i> Infection Associated with Feeding Extrinsically Contaminated Expressed Human Milk to a Premature Infant — Pennsylvania, 2016

Bowen, Anna; Wiesenfeld, Harold C.; Kloesz, Jennifer L; Pasculle, A. William; Nowalk, Andrew; Brink, LuAnn L.; Elliot, E.; Martin, Haley; Tarr, Cheryl L.

doi:10.15585/mmwr.mm6628a5

Cited by 50 publications

(38 citation statements)

References 5 publications

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“…Friedemann had also reported similar observations [20]. To underscore this point, Bowen et al [21] and McMullan [22] recently reported infantile cases of C. sakazakii septicemia/meningitis where these infants only consumed expressed maternal milk (EMM) during the first weeks after birth. Contaminated personal breast pumps were found to be the source of the contamination.…”

Section: Introductionmentioning

confidence: 88%

The Secretion of Toxins and Other Exoproteins of Cronobacter: Role in Virulence, Adaption, and Persistence

et al. 2020

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Cronobacter species are considered an opportunistic group of foodborne pathogenic bacteria capable of causing both intestinal and systemic human disease. This review describes common virulence themes shared among the seven Cronobacter species and describes multiple exoproteins secreted by Cronobacter, many of which are bacterial toxins that may play a role in human disease. The review will particularly concentrate on the virulence factors secreted by C. sakazakii, C. malonaticus, and C. turicensis, which are the primary human pathogens of interest. It has been discovered that various species-specific virulence factors adversely affect a wide range of eukaryotic cell processes including protein synthesis, cell division, and ion secretion. Many of these factors are toxins which have been shown to also modulate the host immune response. These factors are encoded on a variety of mobile genetic elements such as plasmids and transposons; this genomic plasticity implies ongoing re-assortment of virulence factor genes which has complicated our efforts to categorize Cronobacter into sharply defined genomic pathotypes.

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Section: Introductionmentioning

confidence: 88%

The Secretion of Toxins and Other Exoproteins of Cronobacter: Role in Virulence, Adaption, and Persistence

et al. 2020

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“…From 2003 to 2009, 544 cases of Cronobacter spp. infection were identified in 6 states of the United States, especially among children <5 years of age ( Patrick et al, 2014 ), indeed, Cronobacter is the genus that is the most commonly involved in cases of illness associated mainly with the consumption of contaminated powdered infant formula (PIF) rehydrated ( Food Agriculture Organization of the United Nations [FAO] and World Health Organization [WHO], 2004 , 2006 ) although, additional possible reservoirs from preparation utensils and the environment have been recognized ( Friedemann, 2008 ; Siqueira-Santos et al, 2013 ; Holy and Forsythe, 2014 ) and contaminated expressed breast milk, where C. malonaticus strain was isolated from a breast abscess ( Bowen et al, 2017 ). Additionally, C. sakazakii has been isolated from the enteral feeding tubes of neonates not fed reconstituted infant formula ( Hurrell et al, 2009 ).…”

Section: Introductionmentioning

confidence: 99%

Virulence and Antibiotic Resistance Profiles of Cronobacter sakazakii and Enterobacter spp. Involved in the Diarrheic Hemorrhagic Outbreak in Mexico

et al. 2018

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Cronobacter spp. are bacterial pathogens that cause neonatal meningitis, septicemia, and necrotizing enterocolitis in infants with a lethality rate of 40–80%. Powdered infant formulas (PIF) have been implicated as the main vehicles of transmission. This pathogen can also cause infection through contaminated expressed breast milk, and it has been recovered from neonatal feeding tubes of neonates not fed reconstituted PIF and milk kitchen areas. This study analyzed antibiotic resistance profiles and the tissue virulence tests of Cronobacter sakazakii and Enterobacter spp. recovered from PIF, infant fecal matter‘s, and milk kitchen environment involved in a diarrheic hemorrhagic outbreak in 2011 in Mexico. The strains isolated from the outbreak had similar antibiotic resistance profiles and pathogenicity irrespective of isolation site, however, C. sakazakii strains isolated from PIF showed significantly higher invasive profiles than Enterobacter spp. (p = 0.001) and 83% were resistant to more than one antibiotic. The findings of this study can be used to complement existing information to better control Cronobacter and Enterobacter spp. contamination in PIF production, prevent its transmission, and improve infant food safety.

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“…Notably, these organisms can cause rare but life-threatening diseases in neonates and immunocompromised infants, including meningitis, necrotizing enterocolitis, and septicemia (4,5). The bacterium has been isolated from the environment, food, and clinical sources (2,(6)(7)(8)(9)(10)(11)(12)(13). To date, three species, C. sakazakii, C. malonaticus, and C. turicensis, have been reported to cause clinical infection (14).…”

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confidence: 99%

Reconstituting the History of Cronobacter Evolution Driven by Differentiated CRISPR Activity

Zeng¹,

Zhang²,

Wu³

et al. 2018

Appl Environ Microbiol

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strains harboring the CRISPR-Cas system are important foodborne pathogens causing serious neonatal infections. However, the specific role of the CRISPR-Cas system in bacterial evolution remains relatively unexplored. In this study, we investigated the impact of CRISPR-Cas in evolution and obtained 137 new whole-genome sequences of by next-generation sequencing technology. Among the strains examined (n=240), 90.6% (193/213) of prevalent species ,, and strains had intact CRISPR-Cas systems. Two rare species, (n=2) and (n=6), lacked and preserved the CRISPR-Cas system at a low frequency (1/6), respectively. These results suggest that the presence of one CRISPR-Cas system in is important for the species to maintain genome homeostasis for survival. The ancestral strain was likely to harbored both subtype I-E and I-F CRISPR-Cas systems, during the long evolutionary process, subtype I-E was retained, while subtype I-F selectively degenerated in species and was even lost in the major pathovars. Moreover, significantly higher CRISPR activity was observed in plant-associated species than in the virulence-related species and Similar spacers of CRISPR arrays were rarely found among species, suggesting intensive change through adaptive acquisition and loss. Differentiated CRISPR activity appears to be the product of environmental selective pressure and might contribute to the bidirectional divergence and speciation of This study reports the evolutionary history of under the selective pressure of the CRISPR-Cas system. One CRISPR-Cas system in is important for maintaining genome homeostasis, whereas two types of systems may be redundant and not conducive for acquiring beneficial DNA for environmental adaption and pathogenicity. Differentiated CRISPR activity has contributed to the bidirectional divergence and genetic diversity of This perspective makes a significant contribution to the literature by providing new insights into CRISPR-Cas systems in general, while further expanding the roles of CRISPR beyond conferring adaptive immunity and demonstrating a link to adaptation and species divergence in a genus. Moreover, our study provides new insights into the balance between genome homeostasis and the uptake of beneficial DNA related to CRISPR-based activity in the evolution of .

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Notes from the Field: Cronobacter sakazakii Infection Associated with Feeding Extrinsically Contaminated Expressed Human Milk to a Premature Infant — Pennsylvania, 2016

Cited by 50 publications

References 5 publications

The Secretion of Toxins and Other Exoproteins of Cronobacter: Role in Virulence, Adaption, and Persistence

The Secretion of Toxins and Other Exoproteins of Cronobacter: Role in Virulence, Adaption, and Persistence

Virulence and Antibiotic Resistance Profiles of Cronobacter sakazakii and Enterobacter spp. Involved in the Diarrheic Hemorrhagic Outbreak in Mexico

Reconstituting the History of Cronobacter Evolution Driven by Differentiated CRISPR Activity

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