一起食物中毒事件中产独特肠毒素表型的金黄色葡萄球菌病原学分析

目的对一起疑似为金黄色葡萄球菌所导致的食物中毒事件进行葡萄球菌肠毒素检测,结合金黄色葡萄球菌病原学分析,为明确食物中毒诊断提供依据。方法根据流行病学调查,采用ELISA方法对可疑食物进行葡萄球菌肠毒素检测,同时对可疑食物和患者呕吐物进行金黄色葡萄球菌分离,运用Vitek2 Compact全自动细菌鉴定仪和血浆凝固酶试验鉴定为金黄色葡萄球菌,采用脉冲场凝胶电泳(PFGE)对病原菌进行同源性分析,以ELISA方法对检出的金黄色葡萄球菌菌株进行肠毒素检测,用PCR方法对肠毒素基因进行分型。结果食物和患者样品中分别分离出2和11株金黄色葡萄球菌,PCR方法及ELISA方法对肠毒素分型结果显示,其中12株同时存在SEA、SEB、SED、SEE 4种肠毒素及相关基因,PFGE聚类分析显示,其中12株产肠毒素金黄色葡萄球菌具有高度同源性。结论本起食物中毒事件为具有独特肠毒素表型的金黄色葡萄球菌导致,在金黄色葡萄球菌中毒实验室调查过程中,肠毒素检测结合病原菌溯源分析可以为相关公共卫生事件提供科学依据。     

Coagulase-positive Staphylococci and Staphylococcus aureus in food products marketed in Italy

Staphylococcus aureus is a very common organism capable of producing several enterotoxins (SEs) that cause intoxication symptoms of varying intensity in humans when ingested through contaminated food. This paper reports the results of an investigation on the presence of Coagulase-Positive Staphylococci (CPS) and S. aureus in several food products marketed in Italy and on food contact surface swabs sampled from the food industry. A total of 11,384 samples were examined and 1971 of them (17.3%) were found to contain CPS. The assays performed on 541 CPS strains led to the identification of 537 S. aureus strains on which characterization of type A, B, C and D staphylococcal enterotoxins (SEA, SEB, SEC and SED) was performed. A total of 298 S. aureus strains (55.5%) produced one or more SEs: 33.9% of the strains produced SEC, 26.5% SEA, 20.5% SEA+SED, 13.4% SED, 2.7% SEB, 1.7% SEA+SEB, 0.7% SEC+SED and 0.3% produced SEA+SEC and SEB+SEC. The investigation highlighted that these organisms are very common and constitute a potential risk for consumers' health.     

食源性金黄色葡萄球菌肠毒素基因及其表达检测

金黄色葡萄球菌作为一种常见人类病原菌,可通过各种途径污染食品,引发食物中毒。其中,金黄色葡萄球菌肠毒素(SE)的分泌会大大增加其侵袭性和致病力。通过对比肠毒素基因的携带及其表达情况,有助于进一步分析肠毒素表达的环境条件,为产肠毒素金黄色葡萄球菌的防范和控制提供理论和数据支持。本研究采用PCR和3M^TMTecra^TM微孔板法分别检测33株食源性金黄色葡萄球菌中5种传统肠毒素SEA^SEE基因的携带及表达情况,结果显示,该批金黄色葡萄球菌中SE基因的检出率为100%,携带率最高和最低的分别为seb(48.48%,16/33)和see(9.09%,3/33)。而其中SE蛋白得到表达的菌株仅为63.64%(21/33),这表明不是有SE基因携带就一定可以有相应毒素蛋白的表达,可能还需相应的系统调控和适宜的环境因素。     

金黄色葡萄球菌肠毒素及移动基因元件研究进展

金黄色葡萄球菌肠毒素是一种热源性的超抗原。食用被肠毒素污染的食物能够引起食物中毒,导致恶心、呕吐、腹痛有时伴随腹泻。本文综述了肠毒素的分类命名、理化性质、以及编码不同肠毒素的基因在移动基因元件中的存在情况。这些移动基因元件在金黄色葡萄球菌毒力传播和进化过程中起着至关重要的作用,了解它们对于金黄色葡萄球菌流行病学溯源以及理解毒力机制具有一定的指导意义。     

Staphylococcal enterotoxins

Staphylococcus aureus is a major human pathogen that produces a wide array of toxins, thus causing various types of disease symptoms. Staphylococcal enterotoxins (SEs), a family of nine major serological types of heat stable enterotoxins, are a leading cause of gastroenteritis resulting from consumption of contaminated food. In addition, SEs are powerful superantigens that stimulate non-specific T-cell proliferation. SEs share close phylogenetic relationships, with similar structures and activities. Here we review the structure and function of each known enterotoxin.     

Enterotoxin production and DNA fingerprinting in Staphylococcus aureus isolated from human and food samples. Relations between genetic types and enterotoxins

A total of 224 Staphylococcus aureus strains from human carriers (110 strains) and manually handled foods (114 strains) collected in the Principality of Asturias, Spain over 1995-1999 were analysed for the production of enterotoxins (SEs) A, B, C, and D by a reversed passive latex agglutination test and by amplification of ent genes (A, B, C, D, E, and J) using PCR. Sixty-two strains were enterotoxigenic and a good relation between detection of SEs and their ent genes was found. No strain carried entE and all strains producing SED carried entD and entJ genes. Among the enterotoxigenic strains the percentages registered were 29, 8, 35, 18, 2, 2, and 6 for SEA, SEB, SEC, SEDJ, SEAC, SEADJ and SECDJ, respectively. DNA fingerprinting of 77 strains (the SE prototypes, 62 enterotoxigenic and 10 non-enterotoxigenic [NE]) was carried out by randomly amplified polymorphic DNA using two selected primers independently. Combining results from both primers, 10 genetic types were defined, which showed a different degree of relationship (similarity coefficient: 0.9-0.36) and were clustered into three lineages. One lineage clustered five genetic types and a wide diversity of strains, mainly SEA, SEB, SEDJ, and NE. Another lineage clustered only SEC, SECDJ and NE strains. These two lineages showed a low genetic relationship and appeared as endemic in healthy humans living in the Principality of Asturias. The third lineage included only the prototype strains for SEA and SEE.     

Application of extended single-reaction multiplex polymerase chain reaction for toxin typing of Staphylococcus aureus isolates in South Korea

The extended single-reaction multiplex PCR (esr-mPCR) developed in this study to detect staphylococcal enterotoxins (SEs), including SEA, SEB, SEC, SED, SEE, SEH, SEI, and SEJ, requires fewer sets of primers than other conventional multiplex PCRs and can be used to detect newly identified staphylococcal enterotoxins SEs more readily. Esr-mPCR analysis of 141 isolates of Staphylococcus aureus obtained from abattoir and livestock product samples revealed that 27 of the S. aureus isolates were toxigenic, and two were 2 multitoxigenic isolates. The most prevalent SE type was SEI followed by SEA and SEH. In addition, we investigated the clonal relatedness of toxigenic S. aureus isolates by arbitrarily primed PCR (AP-PCR). AP-PCR analysis of toxigenic S. aureus isolates revealed that the discriminatory power of AP-PCR was 9 (D=0.81), 8 (D=0.77), and 10 types (D=0.83) with primers AP1, ERIC2, and AP7, respectively. The combination of three each AP-PCR result could rearrange toxigenic S. aureus isolates into 10 types and five subtypes, with the D-value of 0.92. Interestingly, our data showed that toxigenic S. aureus isolates from different sources had different fingerprinting patterns although some of them carried the same types of SE genes. These data suggest that combinations of esr-mPCR and AP-PCR can provide a powerful approach for epidemiological investigation of toxigenic S. aureus isolates.     

Development and use of PCR primers for the investigation of C1, C2 and C3 enterotoxin types of Staphylococcus aureus strains isolated from food-borne outbreaks.

Staphylococcus aureus is a major food-borne pathogen in many countries. Enterotoxins produced by S. aureus strains include staphylococcal enterotoxins (SEs) A, B, C, D, E and G, H, I, etc. For SEC, in addition to the three major SEC subtypes, i.e., SEC1, C2 and C3, other molecular variants may exist. Although the detection methods and the distribution of SEA, B, C, D, E types of S. aureus in staphylococcal infections or food-borne outbreaks have been well documented, the differentiation method and the distribution of SEC subtypes in staphylococcal infections are rarely reported. In this study, four polymerase chain reaction (PCR) primers used in pairs (ENTC1/ENTCR, ENTC2/ENTCR and ENTC3/ENTCR) for the specific detection of SEC1, C2 and C3 genes of S. aureus strains were developed. When 39 SEC S. aureus strains isolated from fecal samples of randomly selected diarrheal patients associated with food-borne outbreaks in central Taiwan in 6 years (1995-2000) were analyzed, it was found that the major SEC subtypes for these S. aureus strains were SEC2 and C3.     

DETECTION OF STAPHYLOCOCCAL ENTEROTOXIN A FROM RICOTTA CHEESE BY CELL CULTURE

Staphylococcal food poisoning (SFP) is a very common foodborne disease. Milk and dairy products are frequently contaminated with enterotoxigenic Staphylococcus aureus, which are often involved in SFP. These foods may become contaminated owing to subclinical staphylococcal mastitis or during handling, storage and trade. For sanitary purposes, an effective approach is to detect the staphylococcal enterotoxins directly in foods, rather than detect, count and type the isolated S. aureus strains, because the toxin is the causative agent of foodborne illness. This paper illustrates a cell‐based bioassay that uses the PEB (bovine embryo lung cells) cell line to detect staphylococcal enterotoxin type A (SEA) directly from artificially contaminated ricotta cheese. The test was able to detect SEA in the contaminated samples after 24 and 48 h of incubation at 37C, while results were uncertain when the samples were incubated for 72 h. The test proved to be easy to use and rapidly provided results.     

SUITABILITY OF CYNOMOLOGUS MONKEYS (MACACA FASCICULARIS) FOR STAPHYLOCOCCAL ENTEROTOXIN BIOASSAY

Cynomologus monkeys (Macaca fascicularis) were tested for their sensitivity and specificity to staphylococcal enterotoxin A (SEA). Thirty-two of 38 monkeys vomited within 5 h in response to intragastric feeding of 4.8–18 μg of crude SEA. Twenty-four of these 32 responding monkeys were subjected to specificity study by feeding crude SEA which was neutralized with specific Antiserum A. Twenty-two (92%) of the 24 demonstrated specificity by not vomiting when fed neutralized crude SEA. The remaining two (8%) monkeys showed specificity only with purified SEA neutralized with the Antiserum. The emetic dose -50 for crude SEA was 6.5 μg per monkey. These suggest that cynomologus monkeys are suitable for SE bioassay and for identification of new enterotoxins.     

PCR detection of Staphylococcal enterotoxins (SEs) N, O, P, Q, R, U, and survey of SE types in Staphylococcus aureus isolates from food-poisoning cases in Taiwan

Staphylococcal enterotoxins (SEs) are superantigenic toxins. They are five major classical types, i.e., SEA, SEB, SEC, SED, SEE, and new SEs or SE-like superantigens, such as SEG to SEU. Only the staphylococcal superantigens (SAgs) that induce emesis following oral administration in a monkey model are designated as SEs while other related toxins are called SE-like (SEl) superantigens. To survey the enterotoxin genotypes for S. aureus strains isolated from food-poisoning cases in Taiwan, we developed PCR primers specific for SEN, SEO, SEP, SEQ, SER, and SEU genes. The complete SE sequences and their expression potential for strains positive to sen, seo, sep, seq, ser, and seu specific primers were also determined. These strains were used as reference strains. With the PCR primers specific for all SEs or SAgs, including toxic shock syndrome toxin I (TSST-1), we assayed the genotypes of 147 S. aureus strains isolated from patients associated with staphylococcal food-poisoning outbreaks occurred during 2001-2003. For these 147 strains, 135 (91.8%) were found positive for one or more SE or SAg genes. For classical enterotoxin and TSST-1 types, the major one was tsst-1 (59.1%) following by sea (29.2%), seb (19.7%), sec (6.8%), and sed (2.0%). For new SE and SAg types, the major one was sei (29.9%) and sep (27.9%) followed by, sek (16.3%), seo (14.3%), seu (14.2%), sem (11.6%), sen (10.9%), seq (10.9%), seh (8.2%), sel (6.8%), and ser (5.4%) etc. This report reveals the whole SE and SAg genotypes for S. aureus strains isolated from staphylococcal food-poisoning cases in Taiwan.     

The detection of enterotoxins and toxic shock syndrome toxin genes in Staphylococcus aureus by polymerase chain reaction

A simple polymerase chain reaction (PCR)-based procedure was developed for the detection of fragments of staphylococcal enterotoxins (SEs) SEA, SEB, SEC, SED, SEE, SEG, SEH, and SEI together with the toxic shock syndrome toxin (TSST-1) genes of Staphylococcus aureus. One hundred and twenty-nine cultures of S. aureus were selected, 39 of which were recovered from 38 suspected staphylococcal food-poisoning incidents. The method was reproducible, and 32 different toxin genotypes were recognized. The presence of SE genes was associated with S. aureus strains reacting with phages in group III, and the TSST-1 gene with phages in group I. There was a 96% agreement between the PCR results for detection of SEA-D and TSST-1 as compared with a commercial reverse passive latex agglutination assay for the detection of SEs from cultures grown in vitro. Enterotoxin gene fragments were detected in S. aureus cultures recovered from 32 of the 38 suspected staphylococcal food poisoning incidents, and of these, 17 were associated with SEE, SEG, SEH, and SEI in the absence of SEA-D. Simple PCR procedures were also developed for the detection of SE directly in spiked food samples, and this was most successfully achieved in mushroom soup and ham. Detection was less successful in three types of cheese and in cream. SEA or SEB were detected by enzyme-linked immunosorbent assay in three food samples (two of which were associated with food poisoning incidents) naturally heavily contaminated with S. aureus: the appropriate SEA or SEB gene fragments were detected directly in these three foods by PCR.     

Comparison of virulence and antibiotic resistance genes of food poisoning outbreak isolates of Staphylococcus aureus with isolates obtained from bovine mastitis milk and pig carcasses

Staphylococcus aureus is the etiological agent in a variety of infections in humans and livestock and produces enterotoxins leading to staphylococcal food poisoning (SFP), one of the most prevalent foodborne intoxication diseases worldwide. Pork and bovine milk are considered possible sources of SFP because pig skin is often colonized by S. aureus and bovine mastitis caused by S. aureus is common, but conclusive data are limited. The objective of the present study was to compare S. aureus isolates associated with cases of SFP with isolates obtained from bovine mastitis milk and pig carcasses. DNA microarray analysis and spa gene typing were performed with 100 S. aureus isolates: 20 isolates related to outbreaks of SFP in humans, 39 isolates obtained from pig carcasses, and 41 isolates collected from bovine mastitis milk. No overlap in spa types was observed for SFP isolates (t008, t015, t018, t024, t056, t084, t279, t377, t383, t648, t733, t912, t1239, t1270, t4802, and t6969) and isolates gathered from milk or pork. The porcine isolates were assigned to t034, t208, t337, t524, t899, t1939, t2922, t2971, t4475, and t7006, and the bovine isolates belonged to t267, t524, t529, t1403, t2953, t7007, t7008, and t7013. Comparison of microarray profiles revealed similar virulence gene patterns for isolates collected from the same host (pigs or cattle) but few similarities between SFP isolate profiles and the profiles of isolates obtained from bovine mastitis milk and pig carcasses. Although only some bovine and porcine isolates possessed the β-lactamase gene blaZ (milk, 24%; pork, 28%), significantly higher numbers of SFP isolates contained blaZ (90%). Investigations of these isolates provided no evidence that pork or bovine mastitis milk represent common sources of SFP.     

Characterization of Staphylococcus aureus strains associated with food poisoning outbreaks in France

Enterotoxins produced by Staphylococcus aureus are responsible for staphylococcal food-poisoning outbreaks (SFPO). In France, SFPO are the second cause of food-borne diseases after Salmonella. However, very little is known about the strains involved. The objective of this study was to characterize the staphylococcal strains related to these SFPO through phenotypic and genotypic analyses. A total of 178 coagulase-positive staphylococcal isolates recovered from 31 SFPO (1981-2002) were screened through biotyping. Thirty-three strains representative of the different biotypes in each SFPO were further examined for SmaI macrorestriction-type, phage-type, resistance to various antimicrobial drugs, presence of staphylococcal enterotoxin (se) genes sea to sei, and production of enterotoxins SEA to SED. All these 33 strains were identified as S. aureus species: 27 were of human biotypes and six ovine or non-host-specific biotypes. Most (74.1%) strains reacted with group III phages. Eleven strains were resistant to at least two classes of antibiotics and among them, two were resistant to methicillin. Twenty-nine strains carried one or several of the eight se genes tested; the gene sea was most common (n=23), and often linked to sed (n=12) or seh (n=5). The novel se genes seg-i were in all cases associated with se genes sea to sed except for one strain which carried only seg and sei. Pulsed-Field Gel Electrophoresis (PFGE) of SmaI macrorestriction digests of the 33 strains discriminated 32 PFGE patterns grouped into nine biotype-specific clusters. All five strains carrying sea and seh were grouped together into the same sub-cluster. Three of the four se-gene-negative strains were in one PFGE cluster: all four should be tested for se genes not included in this study and, if negative, be further investigated for the presence of unidentified SEs.     

Incidence of enterotoxigenic staphylococci and their toxins in foods

Of 504 food samples collected from cafeterias, 19 (3.8%) yielded strains of enterotoxigenic staphylococci, and 10 (52.6%), 4 (21.1%), 3 (15.8%), and 2 (10.5%) of these strains produced enterotoxins C (SEC), D (SED), B (SEB), and A (SEA), respectively. Moreover, SEA, SEB, and SEC were isolated from three hamburger samples. Of 181 food samples collected from four restaurants before the implementation of the hazard analysis and critical control point (HACCP) system, 7 (3.9%) were found to contain enterotoxigenic strains, and SED, SEC, and SEA were produced by 4 (57.1%), 2 (28.6%), and 1 (14.3%) of these strains, respectively. One meatball sample with SEC was detected in a restaurant. After the implementation of the HACCP system in four restaurants, neither enterotoxigenic staphylococci nor enterotoxins were detected in 196 studied samples.     

食源性金黄色葡萄球菌肠毒素及其检测方法

金黄色葡萄球菌是一种重要的食源性致病菌,在自然界中广泛分布,其引起的食物中毒是世界性的公共卫生问题。金黄色葡萄球菌肠毒素是引起金黄色葡萄球菌食物中毒的主要致病因子。目前共发现22种金黄色葡萄球菌肠毒素或类肠毒素(SEA-SEE、SEG-SET、SElU、SElU_2和SElV),其中具有催吐活性的被定义为肠毒素,没有催吐活性或者尚待验证的被定义为类肠毒素(SEl)。传统肠毒素SEA~SEE被报道是引起金黄色葡萄球菌食物中毒的主要肠毒素类型,但是大多数新型肠毒素或类肠毒素与食物中毒的关系还没有被真正认识。本文对近几年关于金黄色葡萄球菌肠毒素与食物中毒的关系、肠毒素的表达调控以及肠毒素检测方法的研究进展进行了总结,以期更好地了解金黄色葡萄球菌新型肠毒素致病性,为今后金黄色葡萄球菌食物中毒的预防和控制提供依据。     

A superantigen bioassay to detect staphylococcal enterotoxin A

Current detection methods for enterotoxins of Staphylococcus aureus are labor intensive and limited in sensitivity. Furthermore, these immunochemical protocols fail to adequately detect heat-treated enterotoxins. Staphylococcal enterotoxins cause severe gastrointestinal illness at relatively low concentrations and retain toxigenicity even after heat treatment. Presented here is a novel method to detect staphylococcal enterotoxin A (SEA). This method is a bioassay that exploits SEA's activity as a superantigen in that it induces in cytotoxic T lymphocytes a cytotoxic response against SEA-bound Raji cells. Target cell death is assayed colorimetrically with the CytoTox 96 cell lysis detection kit. In the experiments presented here, this bioassay was also able to detect heat-treated SEA, albeit with a slight compromise in sensitivity. This system detected SEA at picomolar concentrations. Because of the sensitivity of this assay, it is conceivable that it could be incorporated into current detection methods as a confirmatory test.     

食品基质中不同金黄色葡萄球菌肠毒素基因型表达差异研究

目的 比较研究食品基质中不同金黄色葡萄球菌肠毒素(Staphylococcal enterotoxins ,SEs)基因型的蛋白表达差异,为预防金黄色葡萄球菌食物中毒提供参考依据。方法 采用特异聚合酶链反应方法(polymerase chain reaction,PCR)对食品中分离的金黄色葡萄球菌菌株进行肠毒素基因型检测;选择sea、seb、sec、sed等基因型阳性菌株,分别接种于胰酪大豆胨液体培养基(trypticase soy broth,TSB)、牛奶、鸡肉中,按照国家标准GB 4789.10—2016酶联免疫吸附试验法(enzyme linked immunosorbent assay,ELISA)定量检测TSB培养基、牛奶和鲜鸡肉中不同金黄色葡萄球菌肠毒素基因型的蛋白表达量。结果 30株金黄色葡萄球菌中检测到14株肠毒素基因型阳性菌株,所占比例为46.67%,其中sea基因携带率最高(16.67%),而seb、sec、sed、seh则各占6.67%。SEA 在TSB、牛奶、鸡肉3种基质中的平均表达量为7.37 ng/mL,高于SEB、SEC、SED;不同基质环境对肠毒素的表达具有一定影响,如SEA、SEB、SEC、SED在TSB中的表达水平最高,平均表达量为9.04 ng/mL,牛奶次之,鸡肉最低。结论 肠毒素基因型的表达与菌株自身的调控及环境作用密切相关,本研究对肠毒素的产生机制进行初步了解,有助于进一步降低食物中毒风险。