Milk and Dairy Products

Milk and Dairy Products

Raw Milk

Pathogens associated:
• E. coli O157:H7

• Salmonella typhimurium
• Campylobacter jejuni

• Listeria monocytogenes
• Staphylococcus aureus (mastitis)

Why is raw milk consumed? Easy access to raw but less access to pasteurized

• Drinking raw milk has been practiced over time

• A notion that raw milk is better than pasteurized

Spoilage bacteria Bacteria that limits the shelf life:  Total Psychrotrophic counts in raw milk Needs to be <100,000 cfu/ml single farm or 300,000 cfu/ml combined farms  Psychrotrophic spore formers Bacilus cereus
 Lipolytic

and proteolytic psychrotrophs:

Pseudomonas fluorescens Release heat resistant enzymes

Post-Pasteurization Contamination
• Pseudomonas


• Bacillus cereus • Lactic acid bacteria

Standards for Pasteurized Milk and Milk Products cooled to 10oC or less

• Temperature

• Bacterial counts < 20, 000 cfu/ml • Coliform counts < 10 cfu/ml •Antibiotic presence: negative • Phosphatase < 1Цg

Dried Milk
• Low

water activity prevents growth of pathogens and spoilage bacteria • Largest foodborne illness outbreak associated with Staphylococcus aureus was in Japan 2000, 13,000 cases

• The incident was the result of post-pasteurization contamination with Staph aureus toxin that is not destroyed by drying

Fermented milk products: produced by bacterial or fungal transformation for carbohydrate (lactoselactate)

• Fermented

products are preserved by acids and alcohol produced by the beneficial bacteria that inhibits spoilage bacteria and pathogens

• Product

made from the curd of the milk of cows or other animals

• Casein

coagulated by rennin and acid

• Subsequent heating, salting, pressing, aging

 Salmonella : two distinct species : Salmonella enterica

and Salmonella bongori .
 S. enterica subspecies I contains 1367 serotypes, is mainly

isolated from warm-blooded animals (mammals and birds), and accounts for _99% of all clinical isolates.
 The remaining subspecies (II, IIIa, IIIb, IV, VI, and VII) are

mainly isolated from coldblooded animals and account for _1% of clinical isolates.

 Salmonella continues to be a major

cause of food poisoning throughout the world. Salmonellosis sickens as many as 3.84 million Americans and costs billions of dollars in lost productivity and medical costs per year

 the most prevalent recognized communicable diseases

caused by bacteria in the United States today.  transmitted from animals to humans through food and occasionally from person to person through the fecaloral route  Salmonellosis in the human occurs in a variety of forms, presenting a broad clinical spectrum.

A. Gastroenteritis
 The incubation period 6–72 hours. There is

abdominal pain and loose, watery diarrhea, occasionally with mucous or blood. Nausea and vomiting are frequent  Fever of 38–39°C is common, and there may be an initial chill. Abdominal pain is frequent and may cause mild to severe discomfort. In uncomplicated cases, the acute stage usually resolves within 48 hours.  However, illness is occasionally more protracted, with persistent diarrhea and low-grade fever for 10–14 days. In severe cases, dehydration may lead to hypotension, cramps, oliguria, and uremia. Symptoms are likely to be more severe in infants and older adults (>60 years

Bacteremia  Salmonella enterica serotypes : prolonged fever and a positive blood culture, Gastroenteritis + / - , sweats, anorexia, and weight loss.  The characteristic symptoms of typhoid fever, which include rose spots, leukopenia, and sustained fever, are absent.

Enteric or Paratyphoid Fever
 S. cholerae-suis and S. enterica serotypes

paratyphi A and paratyphi B. have symprom like typhoid Fever : prolonged fever, rose spots, splenomegaly, leukopenia, gastrointestinal symptoms, and positive blood and stool culture  Milder than S. typhi infections, but differentiation on clinical grounds is not possible in the individual case.

Local Infections
 Meningeal localization of infections is common in

newborns and infants  Polyarthritis

Escherichia coli
 In 1945, Bray and other researchers

demonstrated that E.coli involvement in gastroenteritis. E. coli involve in gastroenteritis categorized into five major groups according to their virulence mechanisms:  enteropathogenic (EPEC), enterotoxigenic (ETEC), enteroinvasive (EIEC), enterohemorrhagic (EHEC), and enteroaggregative (EAEC). Other strains, namely diffusely adherent E. Coli (DAEC), are less well established as pathogens

Enterotoxigenic E. coli
 ETEC produces a watery diarrhea, cramps and a

low-grade or no fever,  has a lot in common with cholera; both result from ingestion of large inocula of bacteria, which then colonize the small intestine and produce toxins that cause net secretion into intestinal lumen.

Enteroinvasive E. coli
 EIEC infection produces a disease similar to that

caused by Shigella.  The diarrhea is initially acute and watery, accompanied by fever and abdominal cramps, and then may progress to a colonic phase with bloody and mucoid stools.  EIEC infection has been traced to contaminated foods and water also spread from person to person.

Enterohemorrhagic E. coli
 The EHEC group causes severe bloody diarrhea

(hemorrhagic colitis), hemolytic uremic syndrome (HUS), and thrombotic thrombocytopenic purpura  sometimes the infection causes only diarrhea or no symptoms.  In the United States, hemolytic uremic syndrome is the principal cause of acute kidney failure in children.

Enteroaggregative E. coli
 Acute, persistent, and bloody diarrhea disease in

children and nosocomial and community outbreaks worldwide  EAEC as the causative agent of diarrheal disease in HIV-infected adults in the developed world

Enterobacter sakazakii
 Fam. Enterobacteriaceae, genus Enterobacter.

In the past as a “yellow-pigmented” Enterobacter cloacae.  In 1980 E. sakazakii was designated as a unique species, based on differences from E. cloacae in DNA relatedness, pigment production, and biochemical reactions.  A mortality rate of 40–80%, in many cases neonates die within days of birth. In surviving patients severe neurological sequelae such as hydrocephalus, quadraplegia,  Contaminated dry infant formulas as the source of E. sakazakii

 E. sakazakii has been isolated from insects collected

at a dairy farm. Could not isolate from surface water, soil, mud, rotting wood, grain, bird faeces, rodents, domestic animals, cattle, or raw cow’s milk.  E. sakazakii strains have been isolated from clinical sources, blood, or cerebrospinal fluid.

 Enterobacter spp. (E. Sakazakii) are frequently

the cause of nosocomial diseases, E. sakazakii is usually a rare opportunistic pathogen causing severe meningitis in neonates and premature babies, the most common gastrointestinal emergency in newborns.  In a few cases the symptoms were limited to septicemia only.

 E. sakazakii overcomes the gastrointestinal barrier,

gaining access to the blood stream and finally to the cerebrospinal fluid. Severe symptoms of the disease such as ventriculitis, brain abscess, infarction, and cyst formation  The mortality rate is usually high, E. sakazakii seems to be more susceptible to commonly used antibacterial agents than other Enterobacteriaceae, and treatment with ampicillin/gentamicin is effective in most cases

 In manufacturing process, preparation, handling,

and use of the bottles with the reconstituted liquid formulas.  The use of boiled water, sterilized bottles and teats .  Formulas containing probiotic bacteria, should not be prepared with hot water

 Risk comes from the list of pathogens possible

in the raw milk:
         

Enterotoxigenic Staphylococcus aureus Campylobacter jejuni Salmonella species E. coli (EHEC) (ETEC) Listeria monocytogenes Mycobacterium tuberculosis Mycobacterium bovis Brucella species (abortus –cattle) (melitensis- goats) Coxiella burnetii Yersinia enterocolitica

(Sheehan, 2005)

 Several forms  Symptoms include:
 Diarrhea, fever, abdominal cramps

 May cause hospitalization
 Death can occur if not treated

(CDC, 2008)

E. Coli 0157:H7
 Symptoms include:  Bloody diarrhea, severe abdominal cramps, vomiting  Potentially fatal  Can cause hemolytic uremic syndrome

 Sensitive to heat  Killed by cooking and proper pasteurization
(Vasavada, 1988) , (Karns et al., 2007)

Campylobacter jejuni
 Gram-negative, nonsporeforming bacterium

 Symptoms include:
 Mild enteritis or severe enterocolitis, nausea,

abdominal cramps, bloody diarrhea
 Sensitive to heat, oxygen, drying, and acidic pH  Killed with normal pasteurization

(Vasavada, 1988)

Listeria monocytogenes
 Gram-positive, nonsporeforming

 Found in:
 Soil, manure, unpasteurized raw milk

 Symptoms include:
 Meningitis, infectious abortion, perinatal

septicemia, encephalitis  Can cause stillbirths or deaths of infants
 Sensitive to heat / pasteurization

(Vasavada, 1988)

 Prevalence of Foodborne Pathogens in Bulk

Tank Milk
 Of dairy producers consuming raw milk:  21 of 79 (26.6%) had 1 or more pathogenic bacteria in milk
 35 of 131 (26.7%) bulk tank samples

 Found:  Campylobacter jejuni (9.2%)  Shiga-toxin producing E. coli (3.8%)  Listeria monocytogenes (4.6%)  Salmonella spp. (6.1%)  Yersinia enterocolitica (6.1%)

(Jayarao et al., 2001)

 Prevalance of Salmonellae, Listeria

monocytogenes, and Fecal Coliforms in Bulk Tank Milk on US Dairies
 861 samples collected, 21 states

 Coliforms detected in 95% of samples
 Found:  Salmonella (2.6%)  Listeria monocytogenes (6.5%)

(Kessel et al., 2003)

Bulk Tank Sample
 Tests used:
 TSA – tests for bacterial growth
 Blood agar – tests for bacterial growth  Violet Red Bile Glucose (VRBG) agar – used for

numerating coliform organisms in dairy products  MacConkey (MAC) agar – used for isolating and differentiating coliforms based on fermentation  Xylose Lysine Deoxycoagulate (XLD) agar – used for isolating and differentiating gram-negative and enteric bacteria from the gut

Who are affected the most?
 Children
 Rely on us for guidance and protection  Educate children about the bad bugs

 Immunocompromised  Elderly

 Pregnant Women

(Bren, 2004)

 According to the USFDA:
 Outbreaks differ depending on type of pathogen,

geographic location, and species of milk
 Not all outbreaks are recognized  Not all get reported to the Centers for Disease

Control (CDC)

(Sheehan, 2005)

 E. coli O157:H7  September 28, 2006  Washington dairy causes illness in 2 unrelated

 8 year-old boy  5 year-old girl

 Hospitalized

(Sheehan, 2005)

 Salmonella typhimurium

 2002-2003

 62 people infected  40 - IL, IN, OH, TN
 After investigation:  Raw milk only product associated with illnesses

(Sheehan, 2005)

 Salmonella dublin

 1971 – 1975  CA – infections increased 5 times
 44 of 113 from raw milk exposure  35 from 1 single dairy  89 of 113 hospitalized  22 died
(Sheehan, 2005)

 Listeria monocytogenes  Cause of 2500 illnesses each year  ~500 die  Only 0.02% of foodborne illnesses, but 27.6%

of deaths from foodborne infection

(Sheehan, 2005)

Disease Outbreaks From Milk Products

(Courtesy of Cornell University)

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