Some time ago we shocked by the news of the discovery of harmful bacteria in powdered infant milk products. The infecting organism was Enterobacter sakazakii, an unusual but often fatal, invasive pathogen. In the fatal Tennessee case, the infection was traced to contaminated powdered infant formula. Other infants in the same nursery were screened for E sakazakii. Of 49 screened infants, 10 events were discovered (1 proven infection, 2 assumed infections, and 7 colonizations). E sakazakii has been reported to cause or be associated with bacteremia,2,3 necrotizing enterocolitis,4 meningitis,5,6 and colonization.7 There are also reports of E sakazakii contaminating infant formula8–10; however, this report detailed for the first time a direct link to an unopened product.

Powdered formula is made from pasteurized (ie, sterile) liquid that is then freeze-spray dried into a powder. It is possible for organisms to be introduced in the final stages of production.

“Enterobacter sakazakii”

E. sakazakii was first discovered in 1958 in 78 cases of infants with meningitis infection. There is also reported several similar cases in several countries. Although these bacteria can infect at any age, the greatest risk of exposure is the age of the baby. A large increase in cases reported in the Neonatal Intensive Care Units (NICUs) of hospitals in England, Holland, America, and Canada.

In the United States the incidence of infection of E. sakazakii have ever been reported is 1 per 100,000 infants. An increase in the incidence to 9.4 per 100,000 in infants with very low birth weight (

In a 2007 study, some researchers to clarify the criteria taxonomy using more sophisticated way, namely by f-AFLP, automated ribotyping, full-length 16S rRNA gene sequencing and DNA-DNA hybridization. The result is an alternative classification with the findings of a new genus, namely Cronobacter consisting of 5 species.

Until now not much is known about the virulence and pathogenic power of this dangerous bacteria. Materials enterotoxins produced by some types of bacteria strains. By using tissue culture, known enterotoxin effects and some of these strains. Obtained two types of strains of bacteria that have the potential to cause death, while several other strains of non-pathogenic or harmless. This also might explain why so many have been found contaminated milk, but not many casualties were reported infected with the bacteria.

Enterobacter Sakazakii Infection

Although very rare, infections because these bacteria can cause a very dangerous disease to be life-threatening, include neonatal meningitis (infection of the lining of the brain in infants), hydrocephalus (big head because of excess brain fluid), sepsis (severe infection), and necrotizing enterocolitis (severe damage to the gastrointestinal tract). While in some cases have been reported urinary tract infection.

In general, the case fatality rate (case-fatality rate) or can be life-threatening risk to range between 40-80 percent in newborns who received a diagnosis of severe infections due to this disease. Brain infection caused by E. sakazakii may lead to myocardial or brain abscess (brain damage) with the formation of cysts, severe neurological disorders and sequelae of developmental disorders.

Enterobacter Sakazakii Symptoms

Symptoms that may occur in infants or children include:

• diarrhea
• bloating
• vomiting
• high fever
• the baby looks yellow
• decreased consciousness (lazy drink, do not cry)
• suddenly blue
• shortness of up to seizures
• Premature babies
• low birth weight (less than 2,500 grams) and patients with immune disorders are those individuals most at risk for this infection

Although rarely pathogenic bacteria also can lead to bacterimeia and osteomyelitis (bone infection) in adult patients. In a recent study found the ability of 12 species of strains of E. sakazakii to survive at a temperature of 58 degrees Celsius in the heating rehydration formula.

Enterobacter Sakazakii Detection

• The occurrence of bacterial contamination can be initiated when dairy cows are milked from the nipple. The nipple hole has a small diameter that allows bacteria to grow around it. The bacteria is carried on with the milk when milked. Nevertheless, the application of technology can reduce pollution levels at this stage with the use of milking machine (milking machine) so that the milk coming out of the nipple is not in contact with air.
• Milk contamination by microorganisms may further occur during milking (milking), handling (handling), storage (storage), and pre-processing activities (pre-processing) more. Chain of milk production requires a sterile process from upstream to downstream so that bacteria do not get a chance to grow and develop in milk.
• Milking equipment is not sterile and unclean storage areas can cause contamination of milk by bacteria. Milk require storage in a low temperature to avoid bacterial contamination. The air contained in the neighborhood around where the processing is a medium that can carry the bacteria to contaminate the milk. Processing milk is highly recommended to be done behind closed doors.
• Humans who are in the process of milking and milk processing can be a cause of bacteria in milk. Hands and other limbs must be sterile when milking and milk processing. In fact, the breath of humans when the milking and milk processing can be the source of the bacteria. Dairy cows and ranchers who are in a farm must be in good health and clean so as not to contaminate the milk. The process of milk production at farm level requires application of good farming practice as it has been applied in developed countries.

Solution

The recommendation to use boiling water (recommended by the FDA but not the CDC) is controversial. First, adding boiling water may not accomplish the job of killing E sakazakii13 or other organisms. Second, boiling water certainly alters the ingredients of the formula, destroying an unknown amount of vitamins, and possibly also altering other substances such as proteins. It is not clear to what extent boiling water will alter the formulas or if formula mixed in boiling water will meet the requirements of the Infant Formula Act. Third, boiling water changes the dissolution characteristics of the formula causing it to clump. Fourth, these recommendations cannot be applied to Human Milk Fortifier, because it is generally added as a powder directly to mother’s milk. Finally, adding boiling water directly to powdered formula may endanger those preparing the formula. Most formula labs are not equipped to perform this maneuver, risking spills and burns. The risks of using boiling water to reconstitute powered formula outweigh the benefits. This recommendation is not supported.