Salmonellosis is the second most reported gastrointestinal disorder in the EU resulting from the consumption of Salmonella-contaminated foods. Symptoms include gastroenteritis, abdominal cramps, bloody diarrhoea, fever, myalgia, headache, nausea and vomiting. In 2018, Salmonella accounted for more than half of the numbers of foodborne outbreak illnesses reported in the EU. Salmonella contamination is mostly associated with produce such as poultry, cattle and their feeds but other products such as dried foods, infant formula, fruit and vegetable products and pets have become important. Efforts aimed at controlling Salmonella are being made. For example, legislation and measures put in place reduced the number of hospitalizations between 2014 and 2015. However, the number of hospitalizations started to increase in 2016. This calls for more stringent controls at the level of government and the private sector. Food handlers of “meat processing” and “Ready to Eat” foods play a crucial role in the spread of Salmonella. This review presents an updated overview of the global epidemiology, the relevance of official control, the disease associated with food handlers and the importance of food safety concerning salmonellosis.

Salmonella, Food Safety and Food Handling Practices.

Actinomycosis, is a slowly progressive infection that may mimic malignancy due to the invasive- ness of tissues and the ability to form sinus tracts. Infective Endocarditis (IE) is a rare disease with significant morbidity and mortality. Interestingly, even though there are scarce data of IE by Actinomyces spp. in the literature, a review adequately summarizing all available evidence on the topic in a systematic way is lacking. The aim of this study was to systematically review all cases of IE by Actinomyces spp. in the literature and describe the epidemiology, microbiology, clinical characteristics, treatment and outcomes of this infection. A systematic review of PubMed, Scopus and Cochrane library (through 19 August 2021) for studies providing epidemio- logical, clinical, microbiological as well as treatment data and outcomes of IE by Actinomyces spp. was performed. A total of 31 studies providing data for 31 patients were included. A prosthetic valve was present in 12.9%, while the most common microorganism was A. meyeri . Aortic valve was the most commonly infected intracardiac site, followed by the mitral valve. Diagnosis was most commonly performed with transesophageal echocardiography, while the diagnosis was made at autopsy in 16.1%. Penicillin, cephalosporins and aminopenicillins were the most commonly used antimicrobials. Clinical cure was noted in 80.6%, while mortality was 19.4%. Development of heart failure was associated with mortality by IE. This systematic review thor- oughly describes IE by Actinomyces and provides information on epidemiology, clinical presentation, treatment and outcomes.

antimicrobial

The role of food-producing environments in the emergence and spread of antimicrobial resistance (AMR) in EU plant-based food production, terrestrial animals (poultry, cattle and pigs) and aquaculture was assessed. Among the various sources and transmission routes identified, fertilisers of faecal origin, irrigation and surface water for plant-based food and water for aquaculture were considered of major importance. For terrestrial animal production, potential sources consist of feed, humans, water, air/dust, soil, wildlife, rodents, arthropods and equipment. Among those, evidence was found for introduction with feed and humans, for the other sources, the importance could not be assessed. Several ARB of highest priority for public health, such as carbapenem or extended-spectrum cephalosporin and/or fluoroquinolone-resistant Enterobacterales (including Salmonella enterica), fluoroquinolone-resistant Campylobacter spp., methicillin-resistant Staphylococcus aureus and glycopeptide-resistant Enterococcus faecium and E. faecalis were identified. Among highest priority ARGs bla CTX -M, bla VIM, bla NDM, bla OXA -48-like, bla OXA -23, mcr, armA, vanA, cfr and optrA were reported. These highest priority bacteria and genes were identified in different sources, at primary and post-harvest level, particularly faeces/manure, soil and water. For all sectors, reducing the occurrence of faecal microbial contamination of fertilisers, water, feed and the production environment and minimising persistence/recycling of ARB within animal production facilities is a priority. Proper implementation of good hygiene practices, biosecurity and food safety management systems is very important. Potential AMR-specific interventions are in the early stages of development. Many data gaps relating to sources and relevance of transmission routes, diversity of ARB and ARGs, effectiveness of mitigation measures were identified. Representative epidemiological and attribution studies on AMR and its effective control in food production environments at EU level, linked to One Health and environmental initiatives, are urgently required.

Role played by the environment in the emergence and spread of antimicrobial resistance (AMR) through the food chain

Non-typhoidal salmonella can cause serious, life-threatening invasive infections involving the bloodstream and other normally sterile sites. We aimed to systematically review the prevalence of complications and case-fatality ratio (CFR) of non-typhoidal salmonella invasive disease to provide contemporary global estimates and inform the development of vaccine and non-vaccine interventions.We did a global systematic review and meta-analysis of studies investigating the complications and mortality associated with non-typhoidal salmonella invasive disease. We searched Embase, MEDLINE, Web of Science, and PubMed for peer-reviewed, primary research articles published from database inception up to June 4, 2021, with no restrictions on language, country, date, or participant demographics. Only studies reporting the proportion of complications or deaths associated with non-typhoidal salmonella invasive disease, confirmed by culture of samples taken from a normally sterile site (eg, blood or bone marrow) were included. We excluded case reports, case series, policy reports, commentaries, editorials, and conference abstracts. Data on the prevalence of complications and CFR were abstracted. The primary outcomes were to estimate the prevalence of complications and CFR of non-typhoidal salmonella invasive disease. We calculated an overall pooled CFR estimate and pooled CFR stratified by UN region, subregion, age group, and by serovar when available with a random-effects meta-analysis. A risk-of-bias assessment was done, and heterogeneity was assessed with Cochran's Q Test, I2, and τ2. This study was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and is registered with PROSPERO, CRD42020202293.The systematic review returned a total of 8770 records. After duplicates were removed, 5837 titles and abstracts were screened, yielding 84 studies from 35 countries after exclusions. Of these included studies, 77 (91·7%) were hospital-based and 66 (78·6%) were located in Africa or Asia. Among 55 studies reporting non-typhoidal salmonella disease-associated complications, a total of 45 different complications were reported and 1824 complication events were identified among 6974 study participants. The most prevalent complication was septicaemia, occurring in 171 (57·2%) of 299 participants, followed by anaemia in 580 (47·3%) of 1225 participants. From 81 studies reporting the CFR of non-typhoidal salmonella invasive disease, the overall pooled CFR estimate was 14·7% (95% CI 12·2-17·3). When stratified by UN region, the pooled CFR was 17·1% (13·6-21·0) in Africa, 14·0% (9·4-19·4) in Asia, 9·9% (6·4-14·0) in Europe, and 9·6% (0·0-25·1) in the Americas. Of all 84 studies, 66 (78·6%) had an overall high risk of bias, 18 (21·4%) had a moderate risk, and none had a low risk. Substantial heterogeneity (I2>80%) was observed in most (15 [65·2%] of 23) CFR estimates.Complications were frequent among individuals with non-typhoidal salmonella invasive disease and approximately 15% of patients died. Clinicians, especially in African countries, should be aware of non-typhoidal salmonella invasive disease as a cause of severe febrile illness. Prompt diagnoses and management decisions, including empiric antimicrobial therapy, would improve patient outcomes. Additionally, investments in improving clinical microbiology facilities to identify non-typhoidal salmonella and research efforts towards vaccine development and non-vaccine prevention measures would prevent non-typhoidal salmonella invasive disease-associated illness and death.EU Horizon 2020 research and innovation programme. 

Complications and mortality of non-typhoidal salmonella invasive disease: a global systematic review and meta-analysis

Salmonella genus represents the most common foodborne pathogens causing morbidity, mortality, and burden of disease in all regions of the world. The introduction of antimicrobial agents and Salmonella-specific phages has been considered as an effective intervention strategy to reduce Salmonella contamination. However, data from the United States, European countries, and low- and middle-income countries indicate that Salmonella cases are still a commonly encountered cause of bacterial foodborne diseases globally. The control programs have not been successful and even led to the emergence of some multidrug-resistant Salmonella strains. It is known that the host immune system is able to effectively prevent microbial invasion and eliminate microorganisms. However, Salmonella has evolved mechanisms of resisting host physical barriers and inhibiting subsequent activation of immune response through their virulence factors. There has been a high interest in understanding how Salmonella interacts with the host. Therefore, in the present review, we characterize the functions of Salmonella virulence genes and particularly focus on the mechanisms of immune escape in light of evidence from the emerging mainstream literature.

Salmonella Virulence and Immune Escape

Summary Background Non-typhoidal salmonella invasive disease is a major cause of global morbidity and mortality. Malnourished children, those with recent malaria or sickle-cell anaemia, and adults with HIV infection are at particularly high risk of disease. We sought to estimate the burden of disease attributable to non-typhoidal salmonella invasive disease for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. Methods We did a systematic review of scientific databases and grey literature, and estimated non-typhoidal salmonella invasive disease incidence and mortality for the years 1990 to 2017, by age, sex, and geographical location using DisMod-MR, a Bayesian meta-regression tool. We estimated case fatality by age, HIV status, and sociodemographic development. We also calculated the HIV-attributable fraction and estimated health gap metrics, including disability-adjusted life-years (DALYs). Findings We estimated that 535 000 (95% uncertainty interval 409 000–705 000) cases of non-typhoidal salmonella invasive disease occurred in 2017, with the highest incidence in sub-Saharan Africa (34·5 [26·6–45·0] cases per 100 000 person-years) and in children younger than 5 years (34·3 [23·2–54·7] cases per 100 000 person-years). 77 500 (46 400–123 000) deaths were estimated in 2017, of which 18 400 (12 000–27 700) were attributable to HIV. The remaining 59 100 (33 300–98 100) deaths not attributable to HIV accounted for 4·26 million (2·38–7·38) DALYs in 2017. Mean all-age case fatality was 14·5% (9·2–21·1), with higher estimates among children younger than 5 years (13·5% [8·4–19·8]) and elderly people (51·2% [30·2–72·9] among those aged ≥70 years), people with HIV infection (41·8% [30·0–54·0]), and in areas of low sociodemographic development (eg, 15·8% [10·0–22·9] in sub-Saharan Africa). Interpretation We present the first global estimates of non-typhoidal salmonella invasive disease that have been produced as part of GBD 2017. Given the high disease burden, particularly in children, elderly people, and people with HIV infection, investigating the sources and transmission pathways of non-typhoidal salmonella invasive disease is crucial to implement effective preventive and control measures. Funding Bill & Melinda Gates Foundation.

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The global burden of non-typhoidal salmonella invasive disease: a systematic analysis for the Global Burden of Disease Study 2017

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The global burden of non-typhoidal salmonella invasive disease: a systematic analysis for the Global Burden of Disease Study 2017