Pathogens-Associated with Foodborne

Illnesses in Developing Countries

Khalifa Sifaw Ghenghesh

Dept. of Microbiology and Immunology,
Faculty of Medicine, Al-Fateh University,
Tripoli Libya
 Introduction
 National surveillance programs for
pathogens associated with foodborne
illnesses generally do not exist in most
developing countries despite the
substantial burden of disease.

 Most estimates of incidence in developing

countries are from laboratory-based
surveillance of pathogens responsible for
diarrhea.
 Pathogens-associated with
foodborne illnesses
 Bacterial:  Viral:
 Bacillus cereus  Hepatitis A
 Campylobacter sp.  Norovirus
 Clostridium botulinum  Rotavirus
 Clostridium perfringens
 Diarrheagenic  Parasitic:
Escherichia coli:  Entamoeba histolytica
 E. coli O157:H7  Giardia lamblia
 Listeria monocytogenes  Cryptosporidium sp.
 Salmonella sp.
 Shigella sp.
 Staphylococcus aureus
 Vibrio cholerae
 Yersinia sp.
 Salmonella
 S. typhi and S. paratyphi
 Typhoid fever
 Non-typhoid Salmonella
 Salmonellosis
 > 2,000 named serotypes (serovars).
 Based on iso-enzymes, rRNA sequences, and
DNA hybridization, it is generally accepted now
that there is only a single species of Salmonella
> S. enterica
 > S. enterica serotype Typhimurium
 Most common:
 S. Enteritidis > in developed countries
 S. Typhimurium
 S. Heidelberg?
 Shigella
 Shigellosis
 4 Major O Antigenic Groups:
Serogroup A = Sh. dysenteriae
Serogroup B = Sh. flexneri
Serogroup C = Sh. boydii
Serogroup D = Sh. sonnei :
 Campylobacter

 Campylobacteriosis:
 > 16 species
C. jejuni and C. coli
Salmonella, Shigella and Campylobacter
in Developing Countries
Isolation rates of Salmonella, Shigella and Campylobacter
from diarrhea specimens from children in selected
developing countries
Isolation rate (%)
Salmonella Shigella Campylobacter
 Argentina 2.4 8.5 3.2
 Bangladesh 1.8 9.2 17.4
 Brazil 2.2 6.2 5.4
 Egypt 7 5 7
 Guatemala NA 9.8 12.1
 Indonesia 2.5 4.2 0.4
 Jordan 3.9 8.3 5.6
 Kuwait 24 4 7
 Lao PDR 0.6 16.8 4.4
 Libya 11 5.7 6.3
 Pakistan 6.6 6.2 17.3
 Saudi Arabia 10.5 17.1 NA
 Thailand 12 13 13
 Tunis 2.4 4.1 4.7
 Zimbabwe 5.4 13.5 1.3
 Distribution of Salmonella serotypes:
 S. Typhimurium
 S. Enteritidis
 Other serotypes:
 Differs from one country to another
Salmonella Serotypes Isolated from Diarrheic Faeces
in Tripoli (1975-1980)
S. Wien
S. Muenchen
S. Typhimurium

Salmonella Serotypes Isolated from Children with

Diarrhea in Tripoli (1992-1993)
S. Saintpaul
S. Muenchen

Salmonella Serotypes Isolated from Children with

Diarrhea in Zliten (2000-2001)
S. Heidelberg
S. Enteritids
 Distribution of Shigella groups:
 Sh. flexneri

 Distribution of Campylobacter species:

 C. jejuni and C. coli are the two main species
isolated in developing countries.
 Similar to observations in developed countries, the
isolation rate of C. jejuni exceeds that of C. coli.
 Age of Infection:
 Most commonly isolated from <2-year-old children with
diarrhea.
 Shigella?

 Polymicrobial Infections:
 Campylobacter > common

 Isolation in Healthy Children:

 Campylobacter > common
 Shigella > rare
 Seasonal Variation:
 Contrary to developed countries, diarrhea due to
Salmonella, Shigella or Campylobacter, has no
seasonal preference in developing countries.

 Lack of seasonal preference may be due to:

 lack of extreme temperature variation
 lack of adequate surveillance for epidemics.

 Association with travelers' diarrhea:

 Travel to a developing country is a risk factor for
acquiring Salmonella-, Shigella- or Campylobacter-
associated diarrhea.
 The diarrhea is more severe, and strains are
associated with antibiotic resistance.
 Antibiotic resistance in Salmonella, Shigella
and Campylobacter isolates:
 Resistance is high in developing countries.
 Salmonella and Campylobacter enteritis are self-
limiting diseases, and antimicrobial therapy is not
generally recommended.

 Shigella
 Patients respond to antibiotics.
 disease duration diminished.
 Resistance of Salmonella species isolated from
children with diarrhoea in Zliten (2000- 2001)
to antibiotics
Antibiotic No. (%) resistant:
(n=23)
---------------------------------------------------------------------------------
Ampicillin 23 (100)
Amoxicillin+calvulanic acid 22 (95.7)
Cefoxitin 20 (87)
Gentamicin 18 (78.3)
Doxycycline 21 (91.3)
Chloramphenicol 22 (95.7)
Nalidixic acid 1 (4.3)
Norfloxacin 0 (0.0)
Trimethoprim-sulphamehtoxazole 1 (4.3)
_________________________________________________
 Sources of Salmonella, Shigella and
Campylobacter
 Shigella and S. Typhi:
Man is the only reservoir.

 Campylobacter and non-typhoid Salmonella:

 Animals products:
 Chicken
 eggs
 Meat
 Dairy products
Others:
 Total bacterial and coliform counts and pathogenic
bacteria isolated from ice cream sold in Tripoli—Libya

Ice cream
Bacteria Open Packed Total
(n = 111) (n = 49) (n = 160)
---------------------------------------------------------------------------------------------------
-
E. coli 7 (6)a 3 (6) 10 (6)
Salmonella sp. 7 (6) 1 (2) 8 (5)
Shigella sp. Absent Absent Absent
Aeromonas sp. 20 (18) 10 (20) 30 (19)
S. aureus 41 (37) 19 (39) 60 (38)
L. moncytogenes 7 (6) Absent 7 (4)
---------------------------------------------------------------------------------------------------
-
a No. (%) positive.
 Bacteria isolated from the houseflies collected
in Misurata - Libya
Collection site:
Bacteria Central Hospital City streets Abattoir All
(n=50)a (n=50) (n=50) (n=150)
-----------------------------------------------------------------------------------------------------------------
Escherichia coli 21 (42)b 21 (42) 16 (32) 58 (38.7)
Salmonella sp. 0 (0) 3 (6) 1 (2) 4 (2.7)
Shigella sonnei 0 (0) 0 (0) 1 (2) 1 (0.7)
Yersinia enterocolitica 0 (0) 2 (4) 1 (2) 3 (2.0)
Edwardsiella tarda 0 (0) 2 (4) 1 (2) 3 (2.0)
Aeromonas sp. 1 (2) 10 (20) 5 (10) 16 (10.7)
Pseudomonas sp. 48 (96) 18 (36) 17 (34) 78 (52)
Pasteurella sp. 0 (0) 1 (2) 2 (4) 3 (2.0)
Staphylococcus sp. 10 (20) 6 (12) 8 (16) 24 (16.0)
Streptococcus sp. 12 (24) 11 (22) 9 (18) 32 (21.3)
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aNo. of flies investigated

bNo (%) positive