Hygienic quality and composition of raw sheep's bulk milk samples on selected Slovak farms during year 2018

At the control of raw ewe's milk (REM) quality is a major microbiological criterion to the total bacterial count (TBC). The aim of our work was to determine the incidence of technologically important species of microorganisms in REM in Slovak Republic. At the monitored 28 ewe´s farms, we took bulk milk samples from evening or morning milking in spring, summer and autumn during year 2018. We analyzed nutrients (fat, protein, lactose and urea) and somatic cell count (SCC). We established technologically important microorganisms (MO) of psychotrophic MO, coliform MO, thermoresistant MO, spore-forming anaerobic MO. We have found a gradual increase in milk components, except for lactose, which is apparently related to the increasing cont of somatic cells during the milking period. We found that the TBC in raw sheep's milk complied an average of 132 x 103 CFU.mL-1 per spring (min 34 x 103 CFU.mL-1, max 501 x 103 CFU.mL-1), 300 x 103 CFU.mL-1 in summer (min. 31 x 103 CFU.mL-1, max 640 x 103 CFU.mL-1) and in autumn with an average value of 147 x 103 CFU.mL-1 (min 52 x 103 CFU.mL-1, max 276 x 103 CFU.mL-1). The enormous occurrence of psychrotrophic bacteria was found in one farm in northern Slovakia during spring and summer, in the summer we increased our number to 3 farms, in the autumn of 2 farms. At the other farms we evaluated the average value of 12 x 103 CFU.mL-1 per spring and 28 x 103 CFU.mL-1 in summer, 130.5 x 103 CFU.mL-1 in the autumn. The count of thermoresistent MO achieved 57 CFU.mL-1 per spring, 15 CFU.mL-1 in summer and 33 CFU.mL-1 in the autumn. The presence of spore-forming anaerobic MO in raw ewe´s milk was found during spring at six farms out of 15, but in the summer at just one in 9, in the autumn two farms.

Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases

Background and aims. In the absence of classical features (fever, cardiac murmur, and peripheral vascular stigmata) the diagnosis of infective endocarditis (IE) may be difficult.Current clinical guidelines for the diagnosis and management of IE recommend the use of modified Duke criteria. Correct and prompt diagnosis of IE is crucial for the treatment and outcome of the patients.The aim of this study was to evaluate the presence and the individual value of each criterion of the modified Duke criteria in our patients with infective endocarditis.Methods. We performed a prospective observational study between January 2008 – June 2014, in which we enrolled consecutive adult patients admitted for suspicion of IE to the Hospital of Infectious Diseases and at the Heart Institute . We used and extensive database in order to collect demographic data, laboratory and echocardiography results, evolution and outcome of the patients. Using the modified Duke criteria we identified 3 categories of IE: definite, possible and rejected. In order to evaluate the importance of each criterion in the diagnosis of IE we tested two hypotheses. First, we excluded each criterion from the final diagnosis and we counted how many cases felt into a lower category. Second, after adding each major and minor criterion, we tested how many cases would have been classifiable as definite IE.Results. The study included 241 adult patients with a mean age 58.16 years and sex ratio male/female 1.94. According to the modified Duke criteria 137 patients had definite IE, 79 patients had possible IE and 25 cases had rejected IE We had blood cultures positive IE in 109 cases and blood culture negative IE (BCNE) in 132 (71.21%) cases. Antibiotic treatment prior to blood culture was recorded in 152 (63.07%) patients. In the absence of the echocardiography major criterion, 43% of cases would become possible. After extraction of major microbiological criterion, only one third of definite cases would become possible. Minor criteria such as fever and predisposition contributed to the diagnosis only in 10% of cases. In the presence of vascular or immunological phenomena, or in the presence of minor microbiological criterion, half of the possible IE cases could become possible.Conclusion. Twenty-years after their launch, the Duke criteria for the diagnosis of IE continue to be important tools. Low index of suspicion of IE and inappropriate use of antibiotics may have a great negative impact on the diagnosis of IE. Nowadays, the scarcity of classical Osler manifestations - bacteremia, fever and peripheral stigmata - makes the diagnosis of IE a challenge.

Frequency of Contamination with Listeria Monocytogenes of Raw Dried Cured Vacuum Packed Sausages

The aim of this study was to collect actual data concerning the frequency of contamination with Listeria monocytogenes of some raw dried cured vacuum packed sausages, which are very popular in Bulgaria produced from Oct. 2004 till May 2008. 148 vacuum-packed samples were taken from 9 different food business operators during all seasons of the year. The samples were analyzed according to the USDA method for meat foods. Ten specimens were positive for presence of Listeria monocytogenes, which is equal to 6,75% of all tested samples. In two other raw dried cured sausages L. welshimeri and L.innocua were found, but these species are not pathogenic for consumers. In the period before the official implementation of the HACCP system (01.01.2006) in Bulgaria, 52 samples were examined and 5 Listeria monocytogenes isolates were found (~10%). 2,5 years after the HACCP implementation, 96 specimens from the same meat factories were tested and 5 Listeria monocytogenes isolates (5,2%) were detected. Samples taken from lots, produced in winter time were contaminated with Listeria monocytogenes more often (7 of all 10) than specimens taken during other seasons. Data was discussed through the point of view of the effectiveness of hygienic practices and HACCP system application. Also, application of the ‘microbiological criterion’ set in the COMMISSION REGULATION (EC) No 2073/2005 for ready-to-eat foods unable to support the growth of L. monocytogenes was considered.

Elimination of Listeria monocytogenes from Vacuum-Packed Dry-Cured Ham by E-Beam Radiation

The inactivation kinetics for Listeria monocytogenes Scott A (CIP 103575, serotype 4b) and Listeria innocua (NTC 11288) after E-beam radiation were studied in vacuum-packed ready-to-eat dry-cured ham to optimize the sanitation treatment of this product. A treatment of 1.12 kGy was calculated to reach the food safety objective according to the U.S. Department of Agriculture criterion. No irradiation treatment is necessary to meet the European Union microbiological criterion for this bacterium. No changes (at doses ≤4 kGy) in the 2-thiobarbituric acid reactive substances values and texture were observed. Dry-cured hams treated with 1 and 2 kGy had negligible sensory modifications (appearance, odor, and flavor). However, the application of 3 and 4 kGy resulted in an increase in the intensity of off-odors and off-flavors. Despite these effects, all irradiated vacuum-packed dry-cured hams treated at ≤4 kGy were deemed acceptable for trading.

Performance of IFIGC/MSG/EORTC Criteria for the Diagnosis of Invasive Pulmonary Aspergillosis in the Clinical Management of Unselected Patients with Acute Leukemia.

Invasive pulmonary aspergillosis (IPA) is a severe complication in patients (pts) treated for acute leukemia. Since its diagnosis is still difficult, sets of non-invasive diagnostic criteria were recently proposed by IFIGC/MSG/EORTC for study purposes. The performance of those criteria in the clinical management of unselected leukemic pts is still unknown. We have therefore applied IFIGC/MSG/EORTC criteria to the diagnosis of pulmonary infiltrates occurred in 83 consecutive pts, aged <65, with newly diagnosed acute leukemia (19 APL, 38 AML, 26 ALL) treated at a single Institution between 1/2000 and 12/2003. The frequency of the different categories of IPA as diagnosis of pulmonary infiltrates and the relative contribution of the specific sets of diagnostic criteria were analysed. Forty-one pulmonary infiltrates developed in 30/83 pts (36.1%), during 364 chemotherapy cycles. IPA was diagnosed in 22 pts (26.5%). “Proven” IPA occurred in 1 (1.2%), “probable” IPA in 7 (8.4%) and “possible” IPA in 14 pts (16.8%). IPA was significantly more frequent in AML (36,8%), than in APL (15,7%) or ALL (15,3%) (P=0.041), and during the first induction (21/83; 25.3%) than during subsequent cycles (20/281; 7.1%) (P< 0.001). Considering the episodes of pulmonary infiltrate, IPA criteria were met in 27/41 (65,8%) [1 “proven”, 7 “probable” (17%) and 19 “possible” (46,3%)]. Specifically, “host criteria” were met in 41/41 (100%), “microbiological criteria” in 8/41 (17%), and “clinical criteria” in 27/41 (65,8%). The presence of one “major clinical” criterion, i.e. a typical radiological image on chest Xray or CT, was significantly associated with the positivity of a “microbiological” criterion, hence with a diagnosis of “probable” IPA (P=0,012). On the other hand, since “host” criteria were not discriminant, being positive in 100% of cases, the presence of two aspecific “minor clinical” criteria (dyspnea, cough, pleural rub, chest pain, hemophtysis) was the sole responsible for the classification of any non-typical pulmonary infiltrate either as “possible” IPA (17/19 cases; 84.2 %) or as “no IPA”. The bacterial origin of the pulmonary infiltrate was documented on follow-up in 5/19 “possible” IPA, which responded to specific antibacterial treatment. All patients had received antifungal prophylaxis, in 88% with oral itraconazole. A clinical response to ampho/voriconazole was obtained in 6/8 (71,4%) “proven/probable” and 17/19 (89,4%) “possible” IPA. Four of 22 pts with IPA (2 “probable” and 2 “possible”) died early during aplasia (multiorgan failure (MOF) 3, cerebral hemorrhage 1) compared to 2/8 pts without IPA (MOF 1, leukemia 1). In conclusion, according to IFIGC/MSG/EORTC criteria, IPA was diagnosed in 26.5% of pts with acute leukemia and in 65,8% of pulmonary infiltrates. AML and the first induction cycle were significant risk factors. “Proven” IPA was rare. “Probable” IPA was more frequent (8,4% of pts), its diagnosis being strongly supported by the association of a “major” clinical criterion with one microbiological criterion. “Possible IPA” likely represents an overestimation (43,9% of pulmonary infiltrates) since its diagnosis derived in most cases from the combined presence of a “host” criterion with two “minor” aspecific clinical criteria. These data allow a critical analysis of IFIGC/MSG/EORTC criteria in the setting of acute leukemia.