Listeria in Italy: An on-going outbreak

In the first seven weeks of 2016, six cases of invasive listeriosis were recorded in Ancona province, Italy. Five strains of Listeria monocytogenes serotype 1/2a were isolated and typed by enterobacterial repetitive intergenic consensus (ERIC)-PCR and PFGE, indicating clonality. In addition, seven serotype 1/2a L. monocytogenes strains from cases of invasive listeriosis recorded in the same area in 2015 were also typed and showed relatedness. Here we provide details of the ongoing outbreak.

listeria4From 4 January to 15 February 2016, six L. monocytogenes strains (3 from blood, 3 from cerebrospinal fluid (CSF)) were isolated from six patients diagnosed with invasive listeriosis at the Clinical Microbiology Laboratory of Ancona Regional Hospital (eastern Italy) of Area Vasta 2 (AV2) which encompasses Ancona, Fabriano, Senigallia, and Jesi.

Patients had been admitted to four different departments: emergency room (ER) (n=2), oncology (n=2), infectious diseases (n=1), and intensive care unit (ICU) (n=1). Four of the six patients were women and the most common risk factors/underlying conditions were: age (n=5; >71 years), cancer (n=2), and diabetes (n=1). Clinical manifestations included septicaemia (n=3), meningitis (n=2) and meningoencephalitis (n=1).

In addition to the cases detected in 2016, eight L. monocytogenes strains (5 from blood and 3 from CSF) had been isolated in AV2 (from 7 cases) and nearby Ascoli Piceno (from 1 case) in 2015 (Figure 1); clinical samples came from six hospital departments: ER (n=1), general medicine (n=3), nephrology (n=1), vascular surgery (n=1), infectious diseases (n=1), and ICU (n=1). Five patients were men and the mean patient age was 73.6 years (range: 55–84; median: 75); a 77 year-old man died.

The 2015 and 2016 isolates were identified as L. monocytogenes by Gram staining and the Vitek MS system (bioMérieux Italia SpA, Firenze, Italy). Susceptibility to ampicillin, meropenem, erythromycin, and sulphamethoxazole-trimethoprim was tested by the E-Test (Liofilchem, Teramo, Italy) according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines [1]. All strains were susceptible to all the antibiotics tested.

The incidence of listeriosis has been rising since the early 2000s in several European countries, mainly in immunocompromised patients older than 65 years [7-9]. In particular, a statistically significant increase was reported in Austria, Denmark, Hungary, Italy, France, Spain, and Sweden from 2005 to 2009 [10]. In the past 30 years, outbreaks of listeriosis have been mostly linked to serotype 1/2a and 4b clones [8]. A shift to serotype 1/2a has been observed in Europe and North America in the last decade [8]. In Italy, surveillance of invasive listeriosis has found an increase in serotype 1/2a isolates over the same period, mainly in the central and northern regions (about 80% of cases) [10-14].

Listeriosis is an infection of great concern to public health due its clinical severity and high case fatality rate, despite its low incidence compared with other foodborne diseases such as salmonellosis or campylobacteriosis. The present data suggest an ongoing outbreak of listeriosis due to serotype 1/2a L. monocytogenes in AV2 that most probably started in 2015, since the strain was already present in the area in 2015. As in other European countries, most cases were associated with an underlying condition and involved elderly people [8,9].

Local authorities are working with the Italian national public health institute (the Istituto Superiore di Sanità, Rome) and the regional Istituto Zooprofilattico Umbria and Marche to identify the sources of food contamination. A recent press release [15] points out that there are findings which suggest contamination of a pork product as a possible vehicle of infection for at least one human case. At present, however, no clear link can be established between the contaminated pork product and the infections. Investigation into the source of infection in AV2 is still in progress.


Ongoing outbreak of invasive listeriosis due to serotype 1/2a Listeria monocytogenes, Ancona Province, Italy, January 2015 To February 2016

28 April 2016

Eurosurveillance, Volume 21, Issue 17

E Marini, G Magi, C Vincenzi, E Manso, B Facinelli

678 sick with gastro linked to bottled water in Spain

The health authority of the northeastern Spanish region of Catalonia says more than 670 people have been affected by an outbreak of gastroenteritis linked to bottled water.

05_eden LOGOThe authority said on its official Twitter account that, as of Saturday, 678 people had been treated for symptoms including nausea, vomiting, abdominal pain, diarrhea and high fever.

Catalonia’s regional health agency said in a statement that bottles of water have been withdrawn from retail outlets and scientific samples are being taken from bottling plants and distributors to determine the source of the outbreak. It did not name the company.

The bottled water company Grupo Eden Springs, however, said in a statement it had withdrawn pallets of bottled water that came from its source in Font d’Arinsal, near Barcelona.

Was it the irrigation water? 206 sickened with Salmonella in central Italy

Monophasic variant of Salmonella enterica subspecies enterica serovar Typhimurium (monophasic S. Typhimurium), with antigenic structure 1,4,[5],12:i:-, appears to be of increasing importance in Europe.

salm.pig.italyIn Italy, monophasic S. Typhimurium represented the third most frequent Salmonella serovar isolated from human cases between 2004 and 2008. From June 2013 to October 2014, a total of 206 human cases of salmonellosis were identified in Abruzzo region (Central Italy).

Obtained clinical isolates characterised showed S. Typhimurium 1,4,[5],12:i:- with sole resistance to nalidixic acid, which had never been observed in Italy in monophasic S. Typhimurium, neither in humans nor in animals or foods.

Epidemiological, microbiological and environmental investigations were conducted to try to identify the outbreak source. Cases were interviewed using a standardised questionnaire and microbiological tests were performed on human as well as environmental samples, including samples from fruit and vegetables, pigs, and surface water. Investigation results did not identify the final vehicle of human infection, although a link between the human cases and the contamination of irrigation water channels was suggested.

Outbreak Of Unusual Salmonella Enterica Serovar Typhimurium Monophasic Variant 1,4 [5],12:I:-, Italy, June 2013 To September 2014

Eurosurveillance, Volume 21, Issue 15, 14 April 2016

F Cito, F Baldinelli, P Calistri, E Di Giannatale, G Scavia, M Orsini, S Iannetti, L Sacchini, I Mangone, L Candeloro, A Conte, C Ippoliti, D Morelli, G Migliorati, NB Barile, C Marfoglia, S Salucci, C Cammà, M Marcacci, M Ancora, AM Dionisi, S Owczartek, I Luzzi

Italy blew 12 sanitary alerts due to excess coliforms in Galician mussel

FIS reports that up to 12 alerts has set off Italy on account of the Galician mussel since the start of 2016. Yesterday, E. coli was detected above the allowable level in several consignments of bivalve molluscs sent from Spain.

Galician musselAccording to the reports from Italian health authorities to the rapid alert system for food and feed (RASFF), some of the intercepted mussels doubled, tripled and even showed a seven-fold increase of the legal limit allowed of fecal coliform because there were alarms that detected levels amounting to 490, 700 and even 1,700 E. coli per hundred grams of meat, when the legally allowed limit is 230. There is no evidence that the product has reached the market and caused poisoning among consumers and in most cases the problem was solved with the purification of the product, or with the retention of the bivalve mollusc before reaching the market.

In Galicia, the Department of Marine Affairs is investigating the incident, while downplaying the role if these alarms. From the department, Rosa Quintana explained that the European Commission notifies thousands of food health alerts through the RASFF, “a system of health control authorities to exchange information on measures as carried out to settle the risks.” So, after one of these warnings, a check protocol is activated. And that is what Galicia has done, trying to ascertain whether, as Italy claims, the intercepted mussel did not meet the parameters of zone A (areas in which due to the level of coliform it is not necessary for the mollusks to go through depuration process) and had levels belonging to zone B (which do require this process before marketing the products as fresh). The reports from the department cast doubt on that view and alert Italy as to the polygons macrobiologically classified as areas A and also the Intecmar analysed the samples from these production to check whether they meet the requirements of this classification.

Listeriosis in Italy

In relation to cases of human listeriosis occurred in the Marche and Umbria regions, caused by the same strain of Listeria monocytogenes found on a subsequent sample of suspect food, consumers are advised that the product called “Coppa di Testa” Lot. 51209 with maturity 01.09.2016, Company Salumificio Monsano srl located in Via Toscana 27, Monsano (AN) (CE IT 1523 L) is tainted.

coppa.di.testaThe authorities of the Marche Region, after its visit at the company Salumificio Monsano Ltd., have suspended the production activities of the plant and the sale of all types of foods, as Listeria monocytogenes is a germ contaminates the environment and, therefore, the other products of the same plant could be at risk.

As a precautionary measure, consumers are advised not to consume all types of products of Salumificio srl company Monsano Monsano (AN) (CE IT 1523 L), Via Toscana n. 27 may be in their possession.  


Campylobacter in turkeys – Italian edition

In this retrospective study, typing ability, discriminatory power, and concordance between typing results obtained on 123 Campylobacter jejuni turkey isolates, collected in 1998, within 14 different farms, applying multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE), antibiotic resistance profile, and virulence gene pattern, were assessed and compared.

therm.turkey.oct.13Overall, 33 sequence types, 28 pulsotypes, 10 resistotypes, and 5 pathotypes were identified. MLST and PFGE showed the better discriminatory ability (i.e., Simpson’s diversity index >0.90) as well as unidirectional (i.e., Wallace and adjusted Wallace coefficients >0.86) and bidirectional (i.e., adjusted Rand coefficient >0.60) concordance.

Moreover, both methods showed a good unidirectional and bidirectional concordance with the resistotype. On the contrary, the congruence of both genotyping methods and resistotype with the pathotype seemed due to chance alone. A clonal relationship was identified among 66.7% of the isolates. Furthermore, 59.7% of the investigated isolates were resistant to two or more antimicrobials and 92% to tetracycline.

All the isolates harbored cadF and pldA genes, whereas a flaA gene product and a cdtB gene product were amplified from 85.4% and 79.7% of the isolates, respectively, using the primers designed by Bang et al. (2003).

mr-bean-turkeyThe results of this study clarify the level of genetic diversity among the C. jejuni originating from turkeys. MLST level of correlation with PFGE, resistotype, and pathotype is assessed. This result supports the selection of type and number of typing methods to use in epidemiological studies. Finally, the identification of clonal complexes (i.e., groups of profiles differing by no more than one gene from at least one other profile of the group using the entire Campylobacter MLST database) shared between turkey and human isolates suggests that turkeys could be a possible source of Campylobacter infection.

Typing of Campylobacter jejuni isolated from turkey by genotypic methods, antimicrobial susceptibility, and virulence gene patterns: a retrospective study

Gerardo Manfreda, Antonio Parisi, Alessandra De Cesare, Domenico Mion, Silvia Piva, and Renato G. Zanoni

Foodborne Pathogens and Disease


Are they really ‘dynamic, interactive and arousing adolescents’ interest’ Food safety risk communication in games

Raising consumers’ awareness about food safety issues is one of the primary objectives of Italian public health organizations.

SophiaLorenNew dynamic and interactive tools, based on web applications, are already playing a leading role in health promotion campaigns targeted at adolescents. Among the web-based tools specifically designed for young people, educational videogames have proved especially effective in furthering learning and disseminating information, as they arouse adolescents’ interest and curiosity.

When a number of cases of hemolytic-uraemic syndrome (HUS) were reported in 2010, particularly among children, the Italian Ministry of Health stressed the need to implement communication initiatives aimed at raising consumers’ awareness of the potential risks associated with raw milk consumption at home.

The pilot study described in the article is a relevant example of educational projects implemented in Italy, oriented to transmit knowledge about food risks to young consumers (aged 16–18). To provide correct information on safe milk handling practices and to reduce health issues, including serious ones, the videogame “A mysterious poisoning” was developed. This tool was administered online to 359 upper secondary school students from four different provinces in Italy. The videogame covered all stages of the milk supply chain, from stable to table, and enabled players to identify the crucial moments when milk can be contaminated and to discover safe milk handling practices. By completing a series of tasks, students helped a detective discover the cause of a food poisoning outbreak. This videogame provided an opportunity for students to test their knowledge of the product and to receive more detailed and accurate information. Data collected through two structured questionnaires that were administered before and after the controlled use of the videogame showed that this serious game was capable of changing players’ perception of risk exposure and their cognitive associations, particularly increasing their levels of knowledge about the risks associated with raw milk consumption.

Food safety and young consumers: Testing a serious game as a risk communication tool

Crovato, A. Pinto, P. Giardullo, G. Mascarello, F. Neresini, L. Ravarotto

Salmonella and listeria and raw milk

Two quantitative risk assessment (RA) models were developed to describe the risk of salmonellosis and listeriosis linked to consumption of raw milk sold in vending machines in Italy.

colbert.raw.milkExposure assessment considered the official microbiological records monitoring raw milk samples from vending machines performed by the regional veterinary authorities from 2008 to 2011, microbial growth during storage, destruction experiments, consumption frequency of raw milk, serving size, and consumption preference.

Two separate RA models were developed: one for the consumption of boiled milk and the other for the consumption of raw milk. The RA models predicted no human listeriosis cases per year either in the best or worst storage conditions and with or without boiling raw milk, whereas the annual estimated cases of salmonellosis depend on the dose-response relationships used in the model, the milk storage conditions, and consumer behavior in relation to boiling raw milk or not.

For example, the estimated salmonellosis cases ranged from no expected cases, assuming that the entire population boiled milk before consumption, to a maximum of 980,128 cases, assuming that the entire population drank raw milk without boiling, in the worst milk storage conditions, and with the lowest dose-response model.

The findings of this study clearly show how consumer behavior could affect the probability and number of salmonellosis cases and in general, the risk of illness. Hence, the proposed RA models emphasize yet again that boiling milk before drinking is a simple yet effective tool to protect consumers against the risk of illness inherent in the consumption of raw milk.

The models may also offer risk managers a useful tool to identify or implement appropriate measures to control the risk of acquiring foodborne pathogens. Quantification of the risks associated with raw milk consumption is necessary from a public health perspective.


Quantitative risk assessment of human salmonellosis and listeriosis related to the consumption of raw milk in Italy

Journal of Food Protection®, Number 1, January 2015, pp. 4-234, pp. 13-21(9)

Giacometti, Federica; Bonilauri, Paolo; Albonetti, Sabrina; Amatiste, Simonetta; Arrigoni, Norma; Bianchi, Manila; Bertasi, Barbara; Bilei, Stefano; Bolzoni, Giuseppe; Cascone, Giuseppe; Comin, Damiano; Daminelli, Paolo; Decastelli, Lucia; Merialdi, Giuseppe; Mioni, Renzo; Peli, Angelo; Petruzzelli, Annalisa; Tonucci, Franco; Bonerba, Elisabetta; Serraino, Andrea

The safety of donkey milk in Italy

There is a growing interest in donkey’s milk as food for sensitive consumers, such as infants with cow’s milk protein allergy and elderly people. The aim of this study was to carry out a survey on the dairy donkeys farming in Piedmont, Italy.

donkey-shrekThe research was conducted in order to analyze the farm characteristics as well as the chemical and microbiological quality of milk. All the farms were small-sized, family-run, and, in most cases, animals were farmed semi-extensively. The donkey milk from Piedmont farms was characterized by a protein content around 1.5 g/100 mL and a fat content lower than 0.1 g/100 mL. Lysozyme activity was considerably higher than that reported in raw cow milk.

The milk microbiological profile greatly differed among the farms. Milk sampled in the farm that performed hand milking showed total viable counts significantly lower than milk collected in the farms equipped with automatic milking. Samples were tested for several pathogens and negative results were observed, except for the detection of Bacillus cereus in one sample. The survey provided useful data for the laying down of recent regional regulation for the production and commercialization of donkey’s milk. The results of the survey indicate that further research is needed in order to define the best management and nutritional strategies for the improvement of the quali-quantitative production of dairy donkeys.

A survey on the milk chemical and microbiological quality in dairy donkey farms located in NorthWestern Italy

Food Control, Volume 50, Pages 230-235

Laura Cavallarin, Marzia Giribaldi, Maria de los Dolores Soto-Del Rio, Emanuela Valle, Gandolfo Barbarino, Maria Silvia Gennero, and Tiziana Civera

Just cook it doesn’t cut it, Italian tragic version

After an 18-month child died of hemolytic uremic syndrome (HUS) in Italy, an Italian doctor blamed the eating habits of his family.

e.coli.spain.aug.14“You do not understand” – write the family – as such a finding may have relevance in search of responsibility borne by those who, by profession and vocation, would have to give little David the care he needed. Evidently, Dr. Colasanto is not well clear what are institutional functions.

That responsibility will be investigated and ascertained by prosecutors in Bari who received the complaint of the parents and has already entered in the register of suspects four people, including two doctors Giovanni XXIII Hospital of Bari, where the baby died, a doctor of ‘Ospedale della Murgia and a nurse.