Comparison between Salmonella enterica Serotype Enteritidis Genotyping Methods and Phage Type

A quantitative comparison between discriminatory indexes and concordance among multilocus variable-number tandem-repeat analysis (MLVA), pulsed-field gel electrophoresis (PFGE), automated ribotyping, and phage typing has been performed, testing 238 Salmonella enterica serotype Enteritidis isolates not epidemiologically correlated. The results show that MLVA is the best choice, but each typing method provides a piece of information for establishing clonal relationships between the isolates.     

Development of a New Molecular Subtyping Tool for Salmonella enterica Serovar Enteritidis Based on Single Nucleotide Polymorphism Genotyping Using PCR

The lack of a sufficiently discriminatory molecular subtyping tool for Salmonella enterica serovar Enteritidis has hindered source attribution efforts and impeded regulatory actions required to disrupt its food-borne transmission. The underlying biological reason for the ineffectiveness of current molecular subtyping tools such as pulsed-field gel electrophoresis (PFGE) and phage typing appears to be related to the high degree of clonality of S. Enteritidis. By interrogating the organism''s genome, we previously identified single nucleotide polymorphisms (SNP) distributed throughout the chromosome and have designed a highly discriminatory PCR-based SNP typing test based on 60 polymorphic loci. The application of the SNP-PCR method to DNA samples from S. Enteritidis strains (n = 55) obtained from a variety of sources has led to the differentiation and clustering of the S. Enteritidis isolates into 12 clades made up of 2 to 9 isolates per clade. Significantly, the SNP-PCR assay was able to further differentiate predominant PFGE types (e.g., XAI.0003) and phage types (e.g., phage type 8) into smaller subsets. The SNP-PCR subtyping test proved to be an accurate, precise, and quantitative tool for evaluating the relationships among the S. Enteritidis isolates tested in this study and should prove useful for clustering related S. Enteritidis isolates involved in outbreaks.     

Immune Responses against Salmonella enterica Serovar Enteritidis Infection in Virally Immunosuppressed Chickens

To understand the role of immune mechanisms in protecting chickens from Salmonella infections, we examined the immune responses of Salmonella enterica serovar Enteritidis-infected chickens and the effect of chicken anemia virus (CAV), a T-cell-targeted virus, on S. enterica serovar Enteritidis-induced immune responses. One-day-old chicks were orally inoculated with S. enterica serovar Enteritidis with or without intramuscular injection of CAV. The bacterial infection, pathology, and immune responses of chickens were evaluated at 14, 28, and 56 days postinoculation. The infection increased the levels of S. enterica serovar Enteritidis-specific mucosal immunoglobulin A (IgA), the number of gut-associated T cells, and the titer of serum IgG specific for S. enterica serovar Enteritidis surface antigens. CAV infection depressed these immune responses, especially the mucosal immune responses, but did not increase the number of S. enterica serovar Enteritidis-infected cells in the intestine. The severity of pathological lesions appeared to be reciprocal to the level of immune responses, but the S. enterica serovar Enteritidis infection persisted. These results suggest that oral infection of S. enterica serovar Enteritidis in chickens induces both mucosal and systemic immune responses, which have a limited effect on the S. enterica serovar Enteritidis infection under conditions designed to mimic the field situation.     

Fingerprinting of Salmonella enterica subsp. enterica serovar Enteritidis by ribotyping

Objective: To carry out an epidemiologic evaluation of Salmonella enterica subsp. enterica serovar Enteritidis outbreaks in households and small communities by means of rRNA gene restriction pattern analysis (ribotyping).
Method: One hundred Enteritidis isolates dating from 1989 to 1994 which could be allocated epidemiologically to different sources or to small community outbreaks were investigated with ribotyping, a fingerprinting method in which bacterial DNA is hybridized with the biotin-labeled plasmid pKK 3535 containing a ribosomal RNA operon of Escherichia coli to determine the ribosomal RNA gene restriction patterns.
Results: Four different ribotyping patterns were found with the restriction endonuclease Sma I and nine with Sph I. Ribotypes of isolates which could be allocated epidemiologically to a common source usually corresponded. Almost 60% of the Enteritidis infections had the ribotyping pattern Sph I-A. In contrast, this pattern was not found in any of the five Enteritidis strains isolated in 1989. The suspicion that Enteritidis phage type 4 infections are caused by consumption of insufficiently heated eggs is supported by the fact that the ribotyping pattern Sph 1-A was found in isolates from eggs and from human specimens.
Conclusions: As patterns Sph I-A and Sma I-J appeared in 58% and 75% of the isolates, respectively, ribotyping cannot be used for the differentiation between various outbreaks with these two patterns. In cases where the Enteritidis strains showed less frequent patterns, ribotyping seems to be a practical tool for the identification of infection chains. In addition newly appearing ribotyping patterns can give information about the epidemiologic development of Enteritidis infection.     

Salmonella enterica Serotype Urbana Interference with Brucellosis Serology

Sheep were immunized with killed Salmonella enterica serotype Urbana cells and their sera were tested in various serological tests for antibody to Brucella sp., Yersinia enterocolitica O:9 and Escherichia coli O:157 H:7. Of the eight sheep, all gave a positive agglutination reaction in the brucellosis buffered antigen plate agglutination test (BPAT), seven gave positive brucellosis standard tube agglutination test (TAT) and complement fixation test (CFT) results and four gave slightly positive reactions in a competitive enzyme immunoassay (CELISA). Seven sera were negative in an indirect enzyme immunoassay (IELISA-SLPS) using B. abortus smooth lipopolysaccharide (SLPS) antigen and all were negative in a fluorescence polarization assay (FPA-OPS) using B. abortus O-polysaccharide antigen. Two sheep gave a slight positive reaction in an IELISA using Brucella rough lipopolysaccharide antigen (IELISA-RLPS) and four sheep were slightly positive in an FPA using Brucella LPS core antigen (FPA-CORE). All sheep had high antibody responses to S. enterica serotype Urbana, Y. and E. coli O:157 and 7 were positive for antibody to Y. enterocolitica O:9 when tested by IELISA. The sheep were negative when tested in the FPA using OPS from Y. enterocolitica O:9 but all were strongly positive in the FPA using OPS from E. coli O:157 while seven sheep had titers to S. enterica serotype Urbana. The impact on diagnostic serology for brucellosis is discussed.     

Breast abscess in a man due to Salmonella enterica serotype Enteritidis

Nontyphoidal salmonellae can cause breast infection only exceptionally. A case of breast abscess in a 70-year-old man due to Salmonella enterica serotype Enteritidis (Salmonella Enteritidis) is reported. The infection was successfully treated with a combination of surgical and antibiotic treatment.     

Antimicrobial Susceptibilities and Molecular Epidemiology of Salmonella enterica Serotype Enteritidis Strains Isolated in Hong Kong from 1986 to 1996

The incidence of salmonellosis has been increasing in Hong Kong since 1989. The most common Salmonella enterica serotype isolated in 1994 was S. enteritidis. The antimicrobial susceptibilities and molecular epidemiology of 275 S. enteritidis strains isolated in this locality between 1986 and 1996 were studied. Over 99% of the isolates were susceptible to 17 of the 19 antimicrobial agents tested. One isolate harbored an autotransferring plasmid that confers resistance to tetracycline and trimethoprim-sulfamethoxazole. Another isolate harbored a mobilizable plasmid that confers resistance to ampicillin and cephalothin. This isolate was found to produce a β-lactamase with a pI of 5.2. A total of 264 isolates (96%) were found to harbor one to five plasmids, and the majority (254) harbored a 60-kb plasmid. Of these isolates, 94% contained identical 60-kb plasmids. Based on plasmid profiles, plasmid and chromosomal fingerprints, ribotypes, and randomly amplified polymorphic DNA (RAPD) patterns, 170 (62%) isolates were allocated to group 1b. About 90% of isolates had identical or similar DNA fingerprints, ribotypes, and RAPD patterns, suggesting that a predominant clone of S. enteritidis was circulating in Hong Kong during the period being studied.     

Multiple-locus variable-number tandem repeat analysis for subtyping of Salmonella enterica subsp. enterica serovar Enteritidis

Salmonella enterica subsp. enterica serovar Enteritidis is a major food-borne pathogen that caused most of Salmonella infections worldwide. S. Enteritidis phage type 4 (PT4) especially presents a real challenge for the classical typing methods. We developed a simple multiple-locus variable-number tandem repeat analysis (MLVA) assay based on three hypervariable variable-number tandem repeat (VNTR) loci for subtyping of Salmonella Enteritidis. Testing an arbitrary chosen strain collection of 110 S. Enteritidis isolates, comprising PTs 4, 8, and 21, the MLVA assay yielded a higher discriminatory power, corresponding to a Simpson's index of diversity (ID) of 0.91, when compared to pulsed-field gel electrophoresis (PFGE) which had a Simpson's ID of 0.41. To simplify interpretation of results, we developed a VNTR allele code based on the repeat unit number. This code can easily be exchanged. In conclusion, MLVA is a promising new tool to investigate outbreaks of S. Enteritidis and constitutes a useful addition to the current phage typing scheme.     

Interpretations of Antibody Responses to Salmonella enterica Serotype Enteritidis gm Flagellin in Poultry Flocks Are Enhanced by a Kinetics-Based Enzyme-Linked Immunosorbent Assay

Many regulatory and diagnostic programs for the detection of Salmonella enterica serotype Enteritidis infection in commercial poultry flocks have relied on rapid Pullorum agglutination tests to screen birds because of the shared antigens of S. enterica Enteritidis and S. enterica Pullorum and Gallinarum; however, the use of the enzyme-linked immunosorbent assay (ELISA) format affords better analytical sensitivity than crude agglutination tests. In this study, we adapted our earlier conventional indirect ELISA, using gm flagellin as the antigen, to a kinetics-based, computer-controlled ELISA (KELA). The KELA was used to screen for flagellin antibody from three commercial flocks: (i) a large flock involved in a U.S. Department of Agriculture trace back from a human S. enterica Enteritidis foodborne outbreak (n = 3,209), (ii) a flock infected with the endemic S. enterica Enteritidis serotype but which also had multiple other salmonella serotypes (n = 65), and (iii) an S. enterica Pullorum-infected flock (n = 12). The first flock (S. enterica Enteritidis prevalence of 2.45% based on culture) provided a field test of the KELA and allowed the calculation of diagnostic sensitivity (D-Sn) and diagnostic specificity (D-Sp). With a cutoff of 10 (used for screening flocks [i.e., high sensitivity]), the KELA has a D-Sn of 95.2% and a D-Sp of 18.5%; with a cutoff of 140 (used in confirmatory flock testing [i.e., high specificity]), the KELA has a D-Sn of 28.0% and a D-Sp of 99.1%. We found that with a cutoff of 60 (D-Sn = 63.1%; D-Sp = 91.6%), we could eliminate reactions in the KELA caused by other non-S. enterica Enteritidis salmonellae. The KELA was also compared to two commercial rapid Pullorum tests, the Solvay (D-Sn = 94.9%; D-Sp = 55.5%) and the Vineland (D-Sn = 62.0%; D-Sp = 75.3%).     

Regional dissemination of Salmonella enterica serovar Enteritidis is season dependent

Objective  To carry out epidemiological typing of clinical isolates of Salmonella enterica serovar Enteritidis by pulsed-field gel electrophoresis (PFGE), random amplified polymorphic DNA (RAPD) and analysis of their antibiotic resistance.
Methods  Over a 12-month period, 44 Salmonella Enteritidis isolates, recovered from 40 patients admitted to the University Hospital Center of Amiens, France and from three outpatients, were characterized by the analysis of phenotypic and genotypic traits and clinical data from medical reports.
Results  Forty nontyphoidal salmonellosis episodes were diagnosed in hospitalized patients (34 episodes of gastroenteritis, two episodes of bacteremia not affecting other organs, one episodes of bacteremia plus urinary infection, one episodes of bacteremia plus gastroenteritis, one episodes of chronic colitis plus gastroenteritis and one episode of peritonitis), and three carriers were observed in outpatients. By means of PFGE, RAPD and antibiotic susceptibility patterns 44 isolates were subdivided into 16 clonally related groups. Two of them were predominantly implicated in the course of these infections, being responsible for two successive waves of infection, while the others were encountered sporadically.     

Prevalence of Salmonella enterica in Poultry and Eggs in Uruguay during an Epidemic Due to Salmonella enterica Serovar Enteritidis

Salmonella enterica serovar Enteritidis (S. Enteritidis) is frequently associated with food-borne disease worldwide. Poultry-derived products are a major source. An epidemic of human infection with S. Enteritidis occurred in Uruguay, and to evaluate the extent of poultry contamination, we conducted a nationwide survey over 2 years that included the analysis of sera from 5,751 birds and 12,400 eggs. Serological evidence of infection with Salmonella group O:9 was found in 24.4% of the birds. All positive sera were retested with a gm flagellum-based enzyme-linked immunosorbent assay, and based on these results, the national prevalence of S. Enteritidis infection was estimated to be 6.3%. Salmonellae were recovered from 58 of 620 pools made up of 20 eggs each, demonstrating a prevalence of at least 1 in every 214 eggs. Surprisingly, the majority of the isolates were not S. Enteritidis. Thirty-nine isolates were typed as S. Derby, 9 as S. Gallinarum, 8 as S. Enteritidis, and 2 as S. Panama. Despite the highest prevalence in eggs, S. Derby was not isolated from humans in the period of analysis, suggesting a low capacity to infect humans. Microarray-based comparative genomic hybridization analysis of S. Derby and S. Enteritidis revealed more than 350 genetic differences. S. Derby lacked pathogenicity islands 13 and 14, the fimbrial lpf operon, and other regions encoding metabolic functions. Several of these regions are present not only in serovar Enteritidis but also in all sequenced strains of S. Typhimurium, suggesting that these regions might be related to the capacity of Salmonella to cause food-borne disease.Salmonella enterica is a major cause of food-borne disease worldwide (14, 18, 46). Poultry-derived products, particularly chicken eggs, are considered a major source of human infection with Salmonella (2, 20, 38). Chickens can be infected with many different serovars of Salmonella. Of these, S. enterica serovars Pullorum and Gallinarum (S. Pullorum and S. Gallinarum, respectively) are host specific and represent a major concern for the poultry industry but have no impact on public health. Other S. enterica serovars frequently isolated from chickens, such as Typhimurium, Enteritidis, and Heidelberg, can infect a wider range of hosts and frequently reach the human food chain, causing food-borne disease.A peculiar epidemiological feature of human salmonellosis is that epidemics are commonly associated with a particular prevalent serovar of S. enterica that shows temporal and geographical variation. Until the 1980s, S. enterica serovar Typhimurium (S. Typhimurium) was the serovar most commonly isolated from humans worldwide, but by the late 1980s, S. enterica serovar Enteritidis (S. Enteritidis) emerged as the most common cause of salmonellosis in Europe, and during the 1990s, it became the most prevalent serovar in many countries worldwide (9, 22, 33, 40, 43). The reasons for this worldwide serovar shift are still not understood, and several hypotheses have been proposed, including the existence of a rodent reservoir for S. Enteritidis or the epidemiological change induced by vaccination of poultry against the closely related bacterium S. Gallinarum (47).In Uruguay, S. Typhimurium was the most frequently isolated serovar until 1994, and S. Enteritidis was only sporadically isolated (3, 24, 37). In 1995, a first outbreak of S. Enteritidis occurred, starting an epidemic that lasted almost 10 years. This outbreak was traced back to sandwiches prepared with contaminated mayonnaise that were distributed nationwide by a local catering service. According to data provided by the national public health authorities, the outbreak affected an estimated 600 individuals countrywide. From then on, several other outbreaks of various sizes occurred and S. Enteritidis was identified as the cause in 89% of Salmonella food poisoning episodes. In most of these cases (80%, according to official records), eggs or chicken meat was identified as the source of infection. From 1997 to 2004, S. Enteritidis was the most frequently identified serovar in Uruguay, accounting for more than 50% of the strains received each year at the National Salmonella Center and for more than 85% of the strains isolated from humans (3). After 2005, there was a dramatic reduction in the number of S. Enteritidis outbreaks, and this year was considered the end of the epidemic. Over the last 3 years, S. Typhimurium has become the serovar most frequently associated with isolated cases of food poisoning, and S. Derby and S. Panama have been sporadically isolated. Nevertheless, S. Enteritidis is still the serovar most frequently associated with outbreaks in the country.S. Enteritidis frequently colonizes the alimentary tracts of chickens without causing disease. However, it can produce a systemic infection in young chicks that may further lead to the infection of egg contents (13, 51). With the aim of knowing the prevalence of S. Enteritidis infection in poultry, we designed and conducted a countrywide serological and microbiological survey of chicken flocks and commercially available eggs from 2000 to 2002, and the results are presented here. An unexpected result of the survey was a higher prevalence of S. Derby than S. Enteritidis in eggs, particularly because while the latter was identified as the etiological agent of the epidemic there were no reports of human infections with S. Derby in the same period of time. This suggested a low capacity of S. Derby isolates to infect humans; thus, we performed a genomic comparison of the two serovars to search for genetic differences that could be the basis of such marked differences in epidemiological behavior. We found that S. Derby lacks several genomic regions related to virulence, suggesting that these regions could be involved in the capacity of Salmonella to cause food-borne disease.     

Assessment of Whole-Genome Mapping in a Well-Defined Outbreak of Salmonella enterica Serotype Saintpaul

We investigated the use of whole-genome mapping and pulsed-field gel electrophoresis (PFGE) with isolates from an outbreak of Salmonella enterica serotype Saintpaul. PFGE and whole-genome mapping were concordant with 22 of 23 isolates. Whole-genome mapping is a viable alternative tool for the epidemiological analysis of Salmonella food-borne disease investigations.     

Subtyping of Salmonella enterica serotype enteritidis strains by manual and automated PstI-SphI ribotyping

Salmonella enterica subsp. enterica serotype Enteritidis is not readily subtyped beyond the level of phage type (PT). A recently developed method for ribotyping of this organism, which uses a mixture of PstI and SphI (PS) for restriction of DNA (PS ribotyping), has proved useful for further subtyping of a number of PTs of this organism, including PT 4. However, it has not been extensively tested with PT 8. In the present study the PS ribotyping method was used to investigate outbreaks of both S. enterica serotype Enteritidis PT 4 and PT 8 and provided subtyping data that were consistent with information obtained from epidemiologic investigations. The method proved to be more discriminatory than phage typing and pulsed-field gel electrophoresis (PFGE) combined and was useful for investigating a pseudo-outbreak involving isolates that had identical PTs and PFGE types but that could not be linked epidemiologically. Several PS ribotypes were found within the cluster of isolates indistinguishable by other subtyping methods, confirming the epidemiologic findings. Although the PS ribotyping method proved to have a superior discriminatory ability in resolving clusters, it did not have high enough throughput for use in outbreak investigations. This method has therefore been adapted for use in automated ribotyping with a RiboPrinter, and the results were compared with those obtained by manual ribotyping. Both methods produce equivalent results and are useful for obtaining epidemiologically relevant subtyping data for S. enterica serotype Enteritidis, including PT 8 strains not extensively tested previously.     

Kinetics of the human antibody response against Salmonella enterica Serovars Enteritidis and Typhimurium determined by lipopolysaccharide enzyme-linked immunosorbent assay

Two indirect enzyme-linked immunosorbent assays (ELISAs) were employed to measure levels of immunoglobulin G (IgG), IgM, and IgA antibodies against Salmonella in sera from 303 Danish patients diagnosed by fecal culture with either Salmonella enterica serovar Enteritidis or Salmonella enterica serovar Typhimurium infections. The ELISAs were based on serovar Enteritidis lipopolysaccharide (LPS) and serovar Typhimurium LPS. The antibody levels were assessed approximately 1, 3, 6, and 12 months after the onset of salmonellosis. Sera from 164 healthy blood donors were analyzed to establish cutoff values for each analysis. One month after the onset of symptoms, the sensitivities of the assays were 95% for patients recovering from a serovar Enteritidis infection and 89% for patients recovering from a serovar Typhimurium infection. Three months after the onset of symptoms, these values had decreased to 85% and 55%. At 6 months they were 62% and 40%, and at 12 months they were 40% and 16%, respectively. The specificities of the assays were 97% for the serovar Enteritidis LPS ELISA and 94% for the serovar Typhimurium LPS ELISA. The high values for both sensitivity and specificity make these two ELISAs useful for serodiagnoses of Salmonella infection shortly after the acute phase of the infection and of Salmonella-associated reactive arthritis, as well as for seroepidemiological studies. A mixed ELISA consisting of both antigens, i.e., serovar Enteritidis and serovar Typhimurium LPS, was developed as a diagnostic tool with very high values for both specificity and sensitivity.     

Gas-forming splenic abscess due to Salmonella enterica serotype Enteritidis in a chronically hemodialyzed patient.

We describe a diabetic patient who was chronically hemodialyzed due to end-stage renal disease and developed a gas-forming splenic abscess and bacteremia caused by Salmonella enterica serotype Enteritidis. Fever persisted despite urgent splenectomy and intravenous ceftriaxone and metronidazole for 14 days. He recovered completely after intravenous ciprofloxacin/metronidazole treatment for a further 14 days. The isolate was susceptible to ciprofloxacin and ceftriaxone and did not exhibit extended-spectrum beta-lactamase phenotype.     

Erythema Nodosum and Bilateral Breast Abscesses Due to Salmonella enterica Serotype Poona

A woman presented with erythema nodosum followed by bilateral breast abscesses without a gastrointestinal manifestation, due to a rare serotype of Salmonella, namely, Salmonella enterica serotype Poona. This is the first reported case of erythema nodosum presumably associated with Salmonella infection without a gastrointestinal manifestation.     

Subtyping of Salmonella enterica serovar typhimurium outbreak strains isolated from humans and animals in Iceland

A total of 75 Salmonella enterica serovar Typhimurium strains of various (mainly human and animal) origins were typed by pulsed-field gel electrophoresis (PFGE) and phage typing. These strains were collected during an outbreak in Iceland in 1999 and 2000. The typing revealed that 84% of the strains belonged to the same PFGE and phage type (PT), namely, PFGE type 1Aa and PT 1.     

Evaluation of a modified single-enzyme amplified fragment length polymorphism (SE-AFLP) technique for subtyping Salmonella enterica serotype Enteritidis

Salmonella enterica subsp. enterica serotype Enteritidis is not readily subtyped beyond the level of phage type (PT). Pulsed field gel electrophoresis (PFGE) is generally acknowledged to be the most discriminating typing method for Salmonella, but only a restricted variety of PFGE types has been described for S. enterica serotype Enteritidis. In the present study, a modification of the SE-AFLP typing method was used to investigate both outbreak and apparently sporadic isolates of S. enterica serotype Enteritidis belonging to different PTs and/or PFGE types. The method proved to be as discriminatory as PFGE when combined with phage typing, and provided subtyping data consistent with epidemiological information. Although the modified SE-AFLP typing method did not prove to achieve a superior discriminatory ability in resolving clusters, it has a high enough throughput for use in outbreak investigations. This method can be used in combination with other typing methods to obtain epidemiologically relevant subtyping data on S. enterica serotype Enteritidis.     

Genetic Diversity and Evolution of Salmonella enterica Serovar Enteritidis Strains with Different Phage Types

Phage typing has been used for the epidemiological surveillance of Salmonella enterica serovar Enteritidis for over 2 decades. However, knowledge of the genetic and evolutionary relationships between phage types is very limited, making differences difficult to interpret. Here, single nucleotide polymorphisms (SNPs) identified from whole-genome comparisons were used to determine the relationships between some S. Enteritidis phage types (PTs) commonly associated with food-borne outbreaks in the United States. Emphasis was placed on the predominant phage types PT8, PT13a, and PT13 in North America. With >89,400 bp surveyed across 98 S. Enteritidis isolates representing 14 distinct phage types, 55 informative SNPs were discovered within 23 chromosomally anchored loci. To maximize the discriminatory and evolutionary partitioning of these highly homogeneous strains, sequences comprising informative SNPs were concatenated into a single combined data matrix and subjected to phylogenetic analysis. The resultant phylogeny allocated most S. Enteritidis isolates into two distinct clades (clades I and II) and four subclades. Synapomorphic (shared and derived) sets of SNPs capable of distinguishing individual clades/subclades were identified. However, individual phage types appeared to be evolutionarily disjunct when mapped to this phylogeny, suggesting that phage typing may not be valid for making phylogenetic inferences. Furthermore, the set of SNPs identified here represents useful genetic markers for strain differentiation of more clonal S. Enteritidis strains and provides core genotypic markers for future development of a SNP typing scheme with S. Enteritidis.