Cronobacter infections are often very serious for babies; they can die. Cronobacter infection can also be very serious for older people and people whose bodies have trouble fighting germs, like people with HIV, organ transplants, or cancer. Foods and Germs Most people do not think about food safety until they or someone they know becomes infected with foodborne illness.
Skip directly to site content Skip directly to page options Skip directly to A-Z link. Two cases of hemorrhagic diarrhea caused by Cronobacter sakazakii in hospitalized nursing infants associated with the consumption of powdered infant formula. Franco, A. Characterization of putative virulence genes on the related RepFIB plasmids harbored by Cronobacter spp.
Microbiological quality of selected spices and herbs including the presence of Cronobacter spp. Gurtler, J. Performance of media for recovering stressed cells of Enterobacter sakazakii as determined using spiral plating and ecometric techniques. Hunter, C. Cronobacter : an emerging opportunistic pathogen associated with neonatal meningitis, sepsis and necrotizing enterocolitis. Iversen, C. Isolation of Enterobacter sakazakii and other Enterobacteriaceae from powdered infant formula milk and related products.
ICMSF Microorganisms in Foods 7. Microbiological Testing in Food Safety Management. Comparison of media for the isolation of Enterobacter sakazakii. The growth profile, thermotolerance and biofilm formation of Enterobacter sakazakii grown in infant formula milk. John, L. Herbal medicines use during pregnancy: a review from the Middle East. Oman Med. Kalyantanda, G.
Cronobacter species contamination of powdered infant formula and the implications for neonatal health. Kim, S. Microbial contamination of food products consumed by infants and babies in Korea. Lampel, K. Method for the isolation and detection of Enterobacter sakazakii Cronobacter from powdered infant formula. Lebre, P. Xerotolerant bacteria: surviving through a dry spell.
Lepuschitz, S. Multicenter study of Cronobacter sakazakii infections in humans, europe, Mayor, S. BMJ Muytjens, H. Quality of powdered substitutes for breast milk with regard to members of the family Enterobacteriaceae. Nazarowec-White, M. Thermal resistance of Enterobacter sakazakii in reconstituted dried-infant formula. Pan, Z. Isolation and molecular typing of Cronobacter spp. Foodborne Pathog. Parra-Flores, J. Cronobacter sakazakii and microbiological parameters in dairy formulas associated with a food alert in chile.
Patel, R. Antimicrobial evaluation of hibiscus rosa-sinensis plant extracts against some pathogenic bacteria. Patrick, M. Incidence of Cronobacter spp.
Sani, N. Occurrence and prevalence of Cronobacter spp. Springerplus Sharma, V. Antimicrobial activity of Trigonella foenum-graecum L. Singamsetty, V. Outer membrane protein a expression in Enterobacter sakazakii is required to induce microtubule condensation in human brain microvascular endothelial cells for invasion. Quantification of biofilm in microtiter plates: overview of testing conditions and practical recommendations for assessment of biofilm production by staphylococci.
APMIS , — Stoll, B. Enterobacter sakazakii is a rare cause of neonatal septicemia or meningitis in VLBW infants. Clinical signs that predict severe illness in children under age 2 months: a multicentre study. Lancet , — Tsai, H. Cronobacter infections not from infant formula, Taiwan.
Biochemical and molecular characterization of Cronobacter spp. Antonie van Leeuwenhoek 99, — Food and Drug Administration Food and Drug Administration. Voller, S. Neonatal sepsis. Wang, X. Characterization of the desiccation tolerance of Cronobacter sakazakii strains.
Geneva: WHO. Yusof, A. Cronobacter multi-species complex formerly Enterobacter sakazakii is a group of gram-negative bacteria that exists in the environment and which can survive in very dry conditions. The natural habitat for Cronobacter is not known. It has been found in a variety of dry foods, including powdered infant formula, skimmed milk powder, herbal teas, and starches. It has also been found in wastewater.
Cronobacter illnesses are rare, but they are frequently lethal for infants and can be serious among people with immunocompromising conditions and the elderly. Cronobacter can cause several different kinds of infections, and symptoms vary with both the site of infection and the age of the patient. Some infants may experience seizures. Those with meningitis may develop brain abscesses or infarcts, hydrocephalus, or other serious complications that can cause long-term neurological problems.
People of all ages: Cronobacter can cause wound infections or urinary tract infections. People with immunocompromising conditions and the elderly may also develop bloodstream infection due to Cronobacter. Cronobacter has also been isolated from the respiratory secretions of people undergoing mechanical ventilation; in this situation, however, Cronobacter is likely to be colonizing the respiratory tract rather than causing illness.
Similarly, Cronobacter has been isolated from the stool of asymptomatic individuals. Top of Page. Cronobacter infection is rare. A study conducted by Cho, et al. Salmonella enterica can contaminate powdered infant formula and grouped with Cronobacter sakazakii , under category "A" which causes illness in infants [ 37 ]. Cronobacter sakazakii is not the only problem for human beings but also other organisms such as chicks. As recent studies indicated Cronobacter sakazakii can also contaminate fertilized eggs which may result in weak chicks, poor chick growth increased mortality of embryos, lower hatch ability and increased early chick mortality [ 63 ].
Generally, even if this bacterium can contaminate various foodstuffs, it is an obscure danger in infant formulas and baby foods [ 56 ]. The effects of bacterial infections depend on health status, nutrition, hygiene, age, and bacterial related virulence factors such as toxins, structures, and enzymes [ 23 ]. Some pathogenic microbes possess structural, enzymatic, or toxic virulence factors that have a decisive role in their pathogenicity Figure 2.
That is why microbes possessing such kinds of virulence factors are deadly pathogens and infectious. Even if we have an array of "radar" like the immune system, these deadly pathogens have the power to dismantle our immune system using virulence factors.
Although Cronobacter sakazakii is an opportunistic foodborne pathogen that can cause life-threatening meningitis and necrotizing enterocolitis in premature infants, much was not known about its virulence determinants [ 65 ]. Cronobacter sakazakii possesses virulence factors that aid in tissue adhesion, invasion and host cell injury [ 9 , 17 ].
The specific virulence factors associated with the pathogenesis are outer membrane proteins, enterotoxin, outer membrane protease, sialic acid utilization, iron acquisition system, efflux system, proteolytic enzymes, lipopolysaccharides, and type III hemolysin [ 17 ] Figure 2. As reports revealed Cronobacter sakazakii strains were able to adhere to cell lines, HT, and N1E cells and the majority of them demonstrated diversified virulence factors [ 9 ].
As reported by Almajed and Forsythe [ 6 ], Cronobacter sakazakii was able to persist and multiply in phagocytic macrophage and microglial cells. A study conducted by Parra-Flores, et al. New and novel virulence factors known as labp have been discovered in Cronobacter sakazakii that promote the production of lipid A by using a binding partner called LpxA [ 65 ].
Virulence genes that encode various proteins involved for motility, synthesis of iron-chelating such as Enterobactin, metabolism of sugars like galactose, and mannose are critical for virulence [ 64 ]. Biophysical growth factors such as the formation of biofilms are critical for Cronobacter sakazakii that makes this bacterium to be a potential pathogen [ 17 ].
Microbes either causing infection or spoilage can be attached to biotic or abiotic surfaces which have a detrimental impact on the medical and food sectors. When they are attached on these surfaces they come together within a group of microbial communities known as biofilms. These surface-attached microbial communities can be a source of continual contamination of foods that has food safety and economic implications [ 67 ].
As it has been reported this bacterium can tolerate desiccation which might be the attributes of biofilm formation. The other critical issue that is accompanied by biofilm formation is antibiotic resistance of microbes that worsen the problem.
Cronobacter sakazakii showed multidrug resistance to some antibiotics [ 68 ]. Biofilm formation and multiple antibiotic resistance were highly interconnected irrespective of the source, type, and environment of the isolates [ 19 ]. There was also a correlation between putative virulence factors and antibiotic resistance among the tested Cronobacter species [ 69 ]. From a food preservation point of view, hyperosmolarity and desiccation are paramount to hinder food spoilers and foodborne pathogens.
However, this food preservation technique is not applicable for all groups of microbes because some groups of microbes encode mechanisms to survive and withstand these stresses [ 70 ].
The prolonged persistence of pathogens in the desiccated state is important especially in contaminating dried foods that have low water activity [ 47 , 71 ]. Cronobacter sakazakii can survive in such kinds of dried habitats and other hostile environments for long periods [ 7 , 17 , 72 - 74 ]. The ability of this bacterium to tolerate desiccation is a tremendous advantage to persist in dry environments, such as in milk powder factories, on food processing surfaces and food preparation utensils and so that it can be source of post-contamination for the final food product [ 75 - 77 ].
The ability of this bacterium to produce biofilm is paramount in resisting dry and other hostile environmental conditions. This is because biofilm by its nature has a "spongy" like structure that can absorb water and prevent bacteria from desiccation. Therefore, biofilm is resistant to adverse conditions such as antibiotics, desiccation, and immune defenses and are key contributors to many chronic infections [ 78 ].
As a general Cronobacter sakazakii is more resistant than other Enterobacteriaceae to various environmental cues and stresses, such as low water activity, pH, temperature and dryness [ 77 ]. Biofilm formation, possession of virulence factors, high resistance to elevated osmotic, low pH, heat, oxidation, and desiccation are critical features of Cronobacter sakazakii that help this bacterium to survive in hostile dried foods such as powdered infant formula and cause disease in infants and other susceptible age groups [ 79 ].
Accessory genes, existing as sessile and planktonic life form, resistant genes, virulence and niche-specific genes enables Cronobacter sakazakii to adapt in diverse and hostile environments [ 64 ]. Generally, Cronobacter sakazakii can survive in extremely arid environments such as powdered infant formula and becomes a critical problem for all age groups, especially infants and neonates are highly susceptible age groups [ 73 ].
Biofilm is a microbial community that is attached to biotic or abiotic surfaces or interface onto each other and embedded in a self-produced matrix of extracellular polymeric substances [ 80 ]. Bacterial biofilm formation requires a series of stepwise processes accompanied by physiological and structural changes.
This dynamical process comprises 1 Initial attachment; 2 Irreversible attachment; 3 Microcolony formation; 4 Maturation; 5 Dispersion [ 81 ] Figure 1.
Biofilm formation is cyclical, therefore, bacteria have the means to disrupt their biofilms and return to their free-form or planktonic lifestyle. For these cyclical events enzymes played a tremendous role in cleaving basic components of the biofilm matrix and thus weakening the biofilm architecture which allowed dispersion [ 82 ] Figure 1.
Biofilms formation on food and food processing surfaces depends on the interactions of different cues such as physical, chemical, and biological processes, nutrient availability and types, temperature, molecular cross-talks, production of extracellular polymeric substance EPS , maturation of biofilm, and dispersal steps [ 83 ].
A plethora of bacteria including food spoilage bacteria and pathogens can have the ability to form biofilms on different surfaces such as food processing surfaces which could be a source of food contamination or spoilage [ 84 ].
This is because surface-attached microbial community harbor pathogens and food spoilers [ 67 , 85 , 86 ]. Cronobacter sakazakii is foodborne pathogen that can affect food safety by forming biofilms on a number of different food processing surfaces [ 86 ].
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