Danger lurking in infant formula…

Cronobacter

Sakazakii

A Case History The , sakazakii is ubiquitous in A female infant born in New nature, but can cause severe Mexico was delivered vaginally illness or death in newborn at full term. She had been fed babies if it is ingested. The powdered infant formula since most likely cause for an birth. At four weeks old a family infection is through By Jay Hardy, CLS, SM (NRCM) member noted that she had a contaminated powdered infant

fever of 100.9 deg. F., and formula or if the bacteria are consequently was taken to the present in the water used to mix Jay Hardy is the founder and emergency room. powdered infant formula. president of Hardy Diagnostics. He began his career in She was observed then Because Cronobacter sakazakii microbiology as a Medical Technologist in Santa Barbara, discharged without treatment, is found frequently in nature, it California. but returned to the ER again is important to sterilize both

In 1980, he began manufacturing after becoming fussier, bottles and the water used to culture media for the local vomiting, and exhibiting make the formula. hospitals. Today, Hardy seizure-like activity. Diagnostics is the third largest culture media manufacturer in the Before 2007, this Gram United States. This time she was found to have negative rod was known as a bulging fontanel, severe neck sakazakii. While To ensure rapid and reliable turn around time, Hardy Diagnostics stiffness, and dehydration. the organism has been found in

maintains eight US distribution Cerebrospinal fluid and blood other foods, only Powdered

centers, and produces over 3,500 cultures were taken. After 11 Infant Formula (PIF) has been products used in clinical and industrial microbiology weeks of hospitalization and linked to disease outbreaks, laboratories throughout the world. receiving extensive antibiotic since PIF is not a sterile therapy, the infant was product. The organism is discharged with severe brain unusually resistant to

injury. Although the blood desiccation and can be viable cultures were negative, the for years in a dried state. spinal fluid cultures showed growth of Cronobacter Premature, low weight and sakazakii. immune compromised infants are at a higher risk of infection.

The way powdered infant formula becomes contaminated with these bacteria is not well understood. Contamination can occur from the raw ingredients used in the formula, during the manufacturing process or during the preparation and reconstitution process.

Contamination may also occur through blenders, feeding bottles and utensils used to cleanse feeding bottles. Contamination may be more likely when reconstituted formula is kept at improper temperatures prior to use or for The photo above shows November 2011 - Several a longer duration than suggested colonies of C. sakazakii shipments of Kotex tampons by manufacturers. growing on Hardy Diagnostics were recalled due to a C. HardyCHROM sakazakii. sakazakii contamination. The organism has been found in other foods, but only powdered April 2008 – A male baby that infant formula has been linked Recent incidents of C. sakazakii was breastfed for six months to disease outbreaks. Adults can contamination include: was transitioned to PIF. At also become infected, but the seven months old he died disease is far less severe than March 2012 – An entire unexpectedly while taking his with infants. shipment of baby food powder usual nap. The blood cultures from Russia (manufactured in taken at autopsy revealed a Israel) was impounded due to septicemia due to C. sakazakii. positive samples for C. sakazakii. April 2001 – A prematurely born infant in a Tennessee December 2011 - Four infants NICU died due to C. sakazakii. in the US became sick and two It was found that the PIF used died from C. sakazakii bacteria in the NICU, called Portagen, believed to come from was contaminated with C. Cronobacter sakazakii is powdered infant formula or the sakazakii. dangerous because once it water used during preparation. enters the digestive system, it Two of the infants had The CDC states that typically quickly causes death to portions consumed Mead Johnson’s four to six cases of infant of the intestines, often leading Enfamil PIF, however, no infections with C. sakazakii to septicemia and . pathogens could be recovered occur each year, however in from other units within the same 2011, there were twelve. It is While digestive issues are lot. estimated that 40 to 80% of the common in newborn babies, a cases will be fatal. Cronobacter sakazakii infections have symptoms that Hardy Diagnostics produces a rapidly worsen. chromogenic culture medium specifically for C. sakazakii, in which the colonies will turn a turquoise color, that facilitates the easy recognition of these bacteria.

More information can be found on the CDC website.

Jay Hardy Santa Maria, California

C. sakazakii is a gram negative rod closely related to the Enterobacter and genera.

At the onset of infection, C. sakazakii would lead to digestive symptoms in The information contained in this article is for newborns. These may include educational purposes only and is not intended nor recommended as a substitute for medical irritability caused by abdominal advice, diagnosis, or treatment. pain, fever, food intolerance, vomiting, and a complete lack of appetite. This may progress very quickly to more severe symptoms as the bacteria cause tissue necrosis in the intestines. More severe symptoms may include abdominal distention (swelling) and blood in the feces. As time passes, skin over the abdomen will turn a dark reddish color.

Due to the many problems associated with PIF, sterile liquid formula (though more expensive) would be a better choice for these infants than non-sterile PIF. Even better still, would be to continue breast feeding for as long as possible.