Managing of the outbreak of staphylococcal food poisoning in primary school

Open access

Izvleček

Izhodišče: Oktobra 2010 smo imeli na Gorenjskem v eni izmed osnovnih šol z vrtcem izbruh stafilokokne zastrupitve s hrano.

Metode: Izvedli smo retrospektivno kohortno epidemiološko raziskavo in izračunali stopnjo obolevnosti v izbruhu ter relativno tveganje (RT) za vsako živilo. Pri obolelih smo kultivirali blato in izbruhanino. Opravili smo terenski ogled z odvzemom vzorca hrane, brisov delovnih površin na snažnost in brisa rok zaposlenih v kuhinji. V okviru usmerjenega pregleda smo trem zaposlenim v kuhinji odvzeli kužnine za mikrobiološke preiskave. Izolatom bakterije Staphylococcus aureus smo določili enterotoksine s testom aglutinacije SET RPLA (Oxoid). Za primerjavo sorodnosti bakterije S. aureus iz živila in humanih vzorcev smo opravili tipizacijo izolatov s pulzno elektroforezo (PFGE).

Rezultati: Obolelo je 73 oseb od 374 izpostavljenih. Stopnja obolevnosti je bila 19,5-odstotna. Najpogostejši bolezenski znaki so bili: bruhanje (87,7 %), bolečine v trebuhu (75,3 %), driska (64,2 %) in slabost (59,3 %). Največje relativno tveganje (RT) za zastrupitev je bilo povezano z uživanjem mesnega sira (RT= 24,2 (95 % CI 12,1-48,5; p<0,001) in krompirjeve solate (RT= 19,4 (95 % CI 10,7-35,2; p<0,001). S kože rok osebe, zaposlene v kuhinji, iz vzorca hrane in kužnin obolelih otrok smo izolirali bakterijo S. aureus, ki je izločala enterotoksina A; po občutljivosti za antibiotike se ni razlikovala od drugih; z metodo PFGE se je pokazala 96,3-odstotna sorodnost med sevi.

Zaključki: Opisana raziskava je vzorčen primer dela in ukrepanja področnega epidemiologa in mikrobiologa ob pojavu izbruha. V izbruhu smo dokazali epidemiološko povezane izolate in opredelili pomen posameznih preiskav.

1. Tauxe RV, Swerdlow DL, Hughes JM. Foodborne disease. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practise of infectious diseases. 5th ed. Philadelphia: Churchill Livingstone, 2000: 1150-60.

2. Grmek-Košnik I, Mueller-Premru M, Seljak M, Pavlica T, Peternelj B, Pohar M et al. Analiza epidemije stafilokokne zastrupitve s hrano. Zdrav Vestn 2000; 69: 439-43.

3. Kloos WE, Bannerman TL. Staphylococcus and micrococcus. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH. Manual of clinical microbiology. 6th ed. Washington: ASM Press, 1995: 282-98.

4. Kraigher A, Sočan M, Klavs I, Frelih T, Grilc E, Grgič Vitek M. Epidemiološko spremljanje nalezljivih bolezni v Sloveniji v letu 2010. Inštitut za varovanje zdravja, 2010. Pridobljeno 23. 10. 2013 s spletne strani: http://www.ivz.si/Mp.aspx?ni=105&pi=5&_5_id=788&_5_PageIndex=0&_5_groupId=219&_5_newsCategory=&_5_action=ShowNewsFull&pl=105-5.0.

5. Grmek-Košnik I, Virnik B, Pavlica T. Izolati proti meticilinu odpornega S. aureus (MRSA) iz blata bolnikov z akutnim gastroenterokolitisom pogosto izločajo enterotoksin (SE). Med Razgl 2000; 39: 144-5.

6. Brizzio AA, Tadeschi FA, Zalazar FE. Multiplex PCR strategy for the simultaneous identification of Staphylococcus aureus and detection of staphylococcal enterotoxins in isolates from food poisoning outbreaks. Biomedica 2013; 33: 122-7.

7. Hennekinne JA, De Buyser ML, Dragacci S. Staphylococcus aureus and its food poisoning toxins: characterization and outbreak investigation. FEMS Microbiol Rev 2012; 36: 815-36.

8. Johler S, Tichaczek- Dischinger PS, Rau J, Sihto HM, Lehner A, Adam M et al. Outbreak of staphylococal food poisoning due to SEA-producing Staphylococcus aureus. Foodborne Pathog Dis 2013; 10: 777-81.

9. Boost MV, Wong A, Ho J, ODonoghue M. Isolation of methicillinresistant Staphylococcus aureus (MRSA) from retail meats in Hong Kong. Foodborne Pathog Dis 2013; 10: 705-10.

10. Hyeon JY, Gyung TC, Sun HB, Kyung SK, Hyeon HL, Soo JK et al. A foodborne outbreak of Staphylococcus aureus associated with fried chicken in Republic of Korea. J Microbiol Biotechnol 2013; 23: 85-7.

11. Soares MJS, Tokumaru-Miyazaki NH, Noleto ALS, Figueiredo AMS. Enterotoxin production by Staphylococcus aureus clones and detection of Brazilian epidemic MRSA clone (III::B:A) among isolates from food handlers. J Med Microbiol 1997; 46: 214-21.

12. Villavicencio RT, Wall M. The pathogenesis of Staphylococcus aureus in the trauma patient and potential future therapies. Am J Surg 1996; 172: 291-6.

13. Jorda GB, Marucci RS, Guida AM, Pires PS, Manfredi EA. Carriage and characterization of Staphylococcus aureus in food handlers. Rev Argent Microbiol 2012; 44: 101-4.

14. Xiaomel Y, Bing W, Xiaoxia T, Qinghua H, Zhigang C, Jianzhong Z et al. Characterization of Staphylococcus aureus strains associated with food poisoning in Shenzhen, China. Appl Environ Microbiol 2012; 78: 6637-42.

15. Maina EK, Hu DL, Tsuji T, Omoe K, Nakane A. Staphylococcal enterotoxin A has potent superantigenic and emetic activities but not diarrheagenic activity. Int J Med Microbiol 2012; 302: 88-95.

16. CLSI. Performance standards for antimicrobial susceptibility testing. CLSI document M100-S20. Wayne: Clinical and Laboratory Standards Institute, 2010.

17. Tenover FC, Arbeit RD, Goering RV et al. Interpreting chromosomal DNA restriction patterns produced by pulsedfield electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995; 33: 2233-9.

18. Bergdoll MS. Detection of the staphylococcal toxins. Adv Exper Med Biol 1996; 391: 465-79.

19. Mendel F, Reuven R. Rewiew of the inhibition of biological activities of food-related selected toxins by natural compounds. Toxins 2013; 5: 743-75.

20. Doyle ME, Hartmann FA, Lee Wong AC. Methicillin-resistant staphylococci: implications for our food supply? Anim Health Res Rev 2012; 13: 157-80.

Slovenian Journal of Public Health

The Journal of National Institute of Public Health

Journal Information

IMPACT FACTOR 2017: 0.620
5-year IMPACT FACTOR: 0.488



CiteScore 2017: 0.33

SCImago Journal Rank (SJR) 2017: 0.147
Source Normalized Impact per Paper (SNIP) 2017: 0.429

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 204 204 14
PDF Downloads 80 80 4