Villar R G, Macek M D, Simons S, Hayes P S, Goldoft M J, Lewis J H, Rowan L L, Hursh D, Patnode M, Mead P S
Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
JAMA. 1999 May 19;281(19):1811-6. doi: 10.1001/jama.281.19.1811.
Multidrug-resistant Salmonella Typhimurium DT104 has recently emerged as a cause of human and animal illness in Europe and North America. In early 1997, health officials in Yakima County, Washington, noted a 5-fold increase in salmonellosis among the county's Hispanic population.
To characterize bacterial strains and identify risk factors for infection with Salmonella Typhimurium in Yakima County.
Laboratory, case-control, and environmental investigations.
Patients with culture-confirmed Salmonella Typhimurium infection living in Yakima County and age- and neighborhood-matched control subjects.
Food vehicle implication based on case-control study and outbreak control.
Between January 1 and May 5, 1997, 54 culture-confirmed cases of Salmonella Typhimurium were reported. The median age of patients was 4 years and 91% were Hispanic. Patients reported diarrhea (100%), abdominal cramps (93%), fever (93%), bloody stools (72%), and vomiting (53%); 5 patients (9%) were hospitalized. Twenty-two patients and 61 control subjects were enrolled in the case-control study. Seventeen case patients (77%) reported eating unpasteurized Mexican-style soft cheese in the 7 days before onset of illness compared with 17 control subjects (28%) (matched odds ratio, 32.3; 95% confidence interval, 3.0-874.6). All case-patient isolates were phage definitive type 104 (DT104) (n = 10) or DT104b (n = 12), and 20 (91%) were resistant to ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline. The cheese produced and eaten by 2 unrelated patients was made with raw milk traced to the same local farm. Milk samples from nearby dairies yielded Salmonella Typhimurium DT104. The incidence of Salmonella Typhimurium infections in Yakima County returned to pre-1992 levels following interventions based on these findings.
Multidrug-resistant Salmonella Typhimurium DT104 emerged as a cause of salmonellosis in Yakima County, and Mexican-style soft cheese made with unpasteurized milk is an important vehicle for Salmonella Typhimurium DT104 transmission. We postulate that recent increases in human salmonellosis reflect the emergence of Salmonella Typhimurium DT104 among dairy cows in the region. Continued efforts are needed to discourage consumption of raw milk products, promote healthier alternatives, and study the ecology of multidrug-resistant Salmonella Typhimurium.
多重耐药性鼠伤寒沙门氏菌DT104最近在欧洲和北美成为人类和动物疾病的病因。1997年初，华盛顿州亚基马县的卫生官员注意到该县西班牙裔人群中沙门氏菌病增加了5倍。
对亚基马县的细菌菌株进行特征分析，并确定感染鼠伤寒沙门氏菌的危险因素。
实验室、病例对照和环境调查。
居住在亚基马县且经培养确诊为鼠伤寒沙门氏菌感染的患者以及年龄和邻里匹配的对照对象。
基于病例对照研究和疫情控制确定食物载体。
1997年1月1日至5月5日期间，报告了54例经培养确诊的鼠伤寒沙门氏菌病例。患者的中位年龄为4岁，91%为西班牙裔。患者报告有腹泻（100%）、腹部绞痛（93%）、发热（93%）、血便（72%）和呕吐（53%）；5名患者（9%）住院治疗。22例患者和61名对照对象纳入了病例对照研究。17例病例患者（77%）报告在发病前7天食用了未经巴氏消毒的墨西哥式软奶酪，而对照对象中有17名（28%）（匹配比值比为32.3；95%置信区间为3.0 - 874.6）。所有病例患者的分离株均为噬菌体定型104（DT104）（n = 10）或DT104b（n = 12），20株（91%）对氨苄青霉素、氯霉素、链霉素、磺胺甲恶唑和四环素耐药。2名不相关患者生产并食用的奶酪是用追溯到同一当地农场的生牛奶制作的。附近奶牛场的牛奶样本检测出鼠伤寒沙门氏菌DT104。基于这些发现采取干预措施后，亚基马县鼠伤寒沙门氏菌感染的发病率恢复到了1992年以前的水平。
多重耐药性鼠伤寒沙门氏菌DT104在亚基马县成为沙门氏菌病的病因，用未经巴氏消毒牛奶制作的墨西哥式软奶酪是鼠伤寒沙门氏菌DT104传播中的重要载体。我们推测，近期人类沙门氏菌病的增加反映了该地区奶牛中鼠伤寒沙门氏菌DT104的出现。需要持续努力劝阻食用生奶制品，推广更健康的替代品，并研究多重耐药性鼠伤寒沙门氏菌的生态学。
