1 Source attribution, prevalence and enumeration of Campylobacter spp. from 2 retail liver. 3 4 Strachan NJC1*, MacRae M2, Thomson A2, Rotariu O1, Ogden ID2 & Forbes KJ2. 5 6 7 1 8 University of Aberdeen, Cruickshank Building, St Machar Drive, Aberdeen, AB23 9 8GN Instutute of Biological and Environmental Sciences, School of Biological Sciences, 10 2 11 AB25 2ZD School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen 12 13 14 * Corresponding Author: 15 Norval Strachan, Institute of Biological and Environmental Sciences, School of 16 Biological Sciences, University of Aberdeen, Cruickshank Building, Aberdeen, AB24 17 3UU, UK. (email: n.strachan@abdn.ac.uk, Tel: +44 1224 272699, Fax: +44 1224 18 272703). 19 20 Running headline: Campylobacter in retail liver 21 22 Abstract 23 24 Campylobacter prevalence from retail liver (chicken, cattle, pig and sheep) was found 25 to be 81%, 69%, 79% and 78% respectively. Molecular source attribution 26 demonstrated that strains from chicken liver were most similar to those found 27 commonly in humans. This provides further evidence of liver being a probable source 28 of human infection. 29 30 Keywords: Campylobacter, outbreak, liver, source attribution, pâté 31 32 1 33 Campylobacter jejuni and C. coli are the major recognised cause of bacterial 34 gastroenteritis worldwide. There is a growing epidemic of human campylobacteriosis 35 in the UK (Strachan et al., 2010) with laboratory reports showing 69,281 cases in the 36 UK in 2010 a 35 % increase since 2005. These rates are likely to be substantial 37 underestimates of the actual disease burden because it is estimated that only 1 in 7 38 cases are reported in the United Kingdom (Wheeler et al., 1999). But, despite its 39 significance as a public health problem, the relative contributions of different sources 40 of infection remains complex with food (Adak et al., 2005), water (Said et al., 2003), 41 and environmental sources (Strachan et al., 2009) also being recognised contributing. 42 Source attribution methods employing multi-locus sequence typing (MLST) have 43 indicated that between 40 to 80% of cases are associated with chicken meat (Sheppard 44 et al., 2009) and it is known that 65% of broiler meat at retail is contaminated with 45 Campylobacter in the UK (Anonymous, 2011) (Gormley et al., 2008). 46 47 Although outbreaks of Campylobacter are apparently uncommon there have been a 48 growing number associated with chicken liver pâté (or parfait) particularly from food 49 service establishments (Little et al., 2010). Indeed, in England and Wales during 50 2010, out of the 16 recognised foodborne outbreaks of Campylobacter infection, 10 51 were linked to poultry liver pâté or parfait consumption and one other to pâté prepared 52 from duck liver. Further, in Scotland three recent events have been associated with the 53 consumption of chicken liver pâté (Oshin, 2005; Forbes et al., 2009; O'Leary et al., 54 2009). 55 56 Surveys of Campylobacter in raw liver from different animal species have revealed 57 diverse contamination rates. High prevalence (>90%) of Campylobacter in chicken 58 livers were reported in Chile (Fernandez and Pison, 1996) and in New Zealand 59 (Whyte et al., 2006) but in the USA (Cox et al., 2009), significantly lower values of 60 13% and 17% were observed in two separate flocks and in the UK prevalence ranged 61 widely between 8 and 54 % (Jennings et al., 2011). Two Japanese studies of cattle 62 livers showed a low prevalence of 1.4% (Matsumoto et al., 2008) and 5% (Enokimoto 63 et al., 2007). In N. Ireland (Moore and Madden, 2003) a prevalence of 6% was found 64 in pig livers whilst in New Zealand (Cornelius et al., 2005) 62% of sheep livers were 65 contaminated with Campylobacter. The aims of the current study were to provide 66 further evidence for the potential of liver from a number of host species to cause 2 67 infection in humans by determining (i) the prevalence and concentration of 68 Campylobacter and (ii) the MLST genotypes found and whether these were typical of 69 both the host species and those observed commonly in human clinical cases. 70 71 Materials and Methods 72 73 Sampling and microbiology 74 Liver samples were purchased from retail supermarkets and butcher’s shops in 75 Aberdeen, NE Scotland between April 2006 and March 2008. Choice of liver types 76 was determined by availability in sentinel shops. Samples were chilled for transport 77 back to the laboratory for testing. Whole samples (median 382g) were rinsed in 300 78 mL Campylobacter enrichment broth (see below) and 0.1mL decimal dilutions plated 79 directly onto the modified Campylobacter Blood-Free Selective Agar Base (CCDA 80 base, CM0739; Oxoid, Basingstoke, UK) with CCDA selective supplement (SR 155; 81 Oxoid) for target enumeration (minimum detection limit of the plate count was 82 therefore 3 x103 cfu/ sample). The presence or absence of Campylobacter was 83 ascertained by incubating the remaining enrichment broth microaerobically in an 84 atmosphere of 10% CO2, 5% O2, balance N2, 100mL volumes of nutrient broth base 85 (Mast, Bootle, UK) with 5% horse blood, growth supplement (Mast Selectavial 86 SV61), amphotericin (2 mg/mL), cefoperazone (15 mg/mL), and trimethoprim (10 87 mg/mL); polymixin B (2500 IU/L) and rifampicin (5 mg/mL) were added, and the 88 broths incubated for 2 days at 37ºC (Bull et al., 2006). All antimicrobials were 89 purchased from Sigma-Aldrich (Gillingham, UK). Enrichment broths (0.1 mL) were 90 plated onto mCCDA agar incubated microaerobically for 2 days at 37ºC. Five 91 colonies were taken from each plate and presumptively identified as Campylobacter 92 by agglutination with Microscreen latex (Microgen, Camberley, UK). Individual 93 colonies were stored (-80ºC, nutrient broth, glycerol added to 15% [v/v]) for MLST. 94 Campylobacter presence was confirmed as C. jejuni or C. coli using isolate ST as 95 determined by MLST. 96 97 Genotyping 98 Presumptive positive isolates were genotyped by traditional 7 locus multilocus 99 sequence typing (MLST) as described previously (Sheppard et al., 2009) and allele 3 100 profiles and STs were assigned using the public Campylobacter MLST profile 101 database (http://www.pubmlst.org). 102 103 Attribution 104 Data (MLST) at the level of sequence type were used to identify the reservoir origin 105 (cattle, chicken, sheep, pigs or wild birds) based on source attribution scores 106 generated from the software programme STRUCTURE (Pritchard et al., 2000) 107 calibrated with data from the CaMPS study (Sheppard et al., 2009; Forbes, 2009). The 108 PopTools (available from http://www.cse.csiro.au/poptools) add-in to Microsoft Excel 109 was used to generate 95% confidence intervals. The percentage of strains (ST) from 110 each of the liver source species that were identical by MLST to the 10 most common 111 human clinical strains from the pan Scotland 2005/06 CaMPS study (Forbes, 2009) 112 was determined; these 10 strains accounted for nearly 50% of all clinical cases. 113 Binomial confidence intervals were calculated and significant differences were 114 calculated using @RISK software (Palisade, Ivybridge, UK) with the assumption that 115 the data were binomially distributed. 116 117 Results and Discussion 118 119 The prevalence of Campylobacter ranged from 81% to 69% (chicken and cattle livers 120 respectively) indicating significant contamination across all liver types tested and 121 confirming the putative role of this food as a source of infection for humans (Table 1). 122 The high prevalence in chicken is in line with a 2006 Campylobacter study in retail 123 chicken meat which showed 90.4% positive from 114 samples tested (Gormley et al., 124 2008). Further, it has been demonstrated (Whyte et al., 2006) that 90% of positive 125 Campylobacter chicken liver samples contained the pathogen in internal tissue and 126 that flash frying, as recommended in many recipes, to leave the centre of the liver 127 pink, may be ineffective at killing all Campylobacter present because there is a very 128 small margin of error between pink and undercooked. 129 130 Enumeration data showed the majority of samples were positive only after enrichment 131 (79%) indicating low numbers of Campylobacter on many retail livers. The higher 132 counts observed from direct plating were most frequently from associated with 133 chicken and cattle liver washes (>25%). This was not unexpected for chicken 4 134 (Gormley et al., 2008) which showed 65% retail chicken meat with Campylobacter 135 concentrations >100 cfu / sample). Only 3% of pig and 10% of sheep livers had 136 higher counts. 137 138 In comparison to published studies, prevalence and counts here agreed with the sheep 139 data from New Zealand (Cornelius et al., 2005) but differed from the two Japanese 140 cattle studies (Matsumoto et al., 2008; Enokimoto et al., 2007) and the N. Ireland pig 141 data (Moore and Madden, 2003) (all with lower prevalence values). The chicken data 142 reported here is in line with the high prevalence and enumeration data in the reports 143 from Chile (Fernandez and Pison, 1996) and New Zealand (Whyte et al., 2006) but 144 USA studies (Cox et al., 2009) (2009) showed significantly lower values of 13% and 145 17% in two separate flocks. Meanwhile, the large variation in flock prevalence in the 146 UK (Jennings et al., 2011) does encompass the findings of the current study but it 147 must be remembered that there may be opportunity for cross contamination of livers 148 post abattoir. Finally, the difference in reported data may reflect microbiological 149 methodology, animal husbandry in the country of origin and source (animal species) 150 of the liver samples tested. 151 152 Source attribution showed that the MLST types found in chicken livers were more 153 similar to those found in retail broiler meat compared to other sources (Table 1). 154 There was relatively poor attribution of cattle isolates (29%) which was not 155 significantly better than random (25%). However, most of the misclassifications of 156 liver isolates from cattle were as sheep (and vice-versa) and when the analysis was 157 repeated treating sheep and cattle as one “ruminant” species then the attribution was 158 much improved (81%). This commonality of MLST genotypes from cattle and sheep 159 has already been reported elsewhere (McCarthy et al., 2007). 160 161 Comparison of the MLST genotypes from liver with those commonly found in 162 humans showed that those of chicken origin had the greatest overlap (56%, P<0.05). 163 This provides further evidence, beyond outbreak case questionnaires, that chicken 164 livers are a risk to humans. It is unclear why the degree of overlap was less for the 165 other species but this could be due to a number of reasons that include: less 166 consumption of livers from species other than chicken; the strains found in these other 5 167 hosts are less infectious to humans and livers/liver products from hosts other than 168 chicken may be more likely to be cooked correctly. 169 170 The growing number of chicken liver outbreaks may not explain the whole reason for 171 the recent rise of human campylobacteriosis in the UK, since these outbreaks only 172 encompass a small of fraction of cases. However, here we have shown that the 173 prevalence of Campylobacter in chicken livers is high and that a number of these 174 strains are identical to those found commonly in humans. Further, we have also 175 shown that there is a high prevalence in all the species of livers tested and although 176 the most common human strains are not so frequently found in these other livers, they 177 presumably do pose a risk to human health. Therefore it is important that food 178 caterers treat raw liver as a foodstuff likely to be contaminated with Campylobacter 179 and that it should be handled in a manner to minimise cross contamination with other 180 foodstuffs and surfaces as well as requiring adequate cooking to ensure successful 181 killing of this pathogen. Only once this has been achieved will the number of reported 182 outbreaks decline. 183 184 185 186 187 188 189 190 Acknowledgements We thank Food Standards Agency, Scotland for funding this work. References 191 192 Adak, G.K., Meakins, S.M., Yip, H., Lopman, B.A., O'Brien, S.J.,2005. Disease risks 193 from foods, England and Wales, 1996-2000. Emerging infectious diseases (Print) 11, 194 365-372. 195 Anonymous. (2011). Campylobacter infections by year in england and wales, 1989- 196 2010. 197 http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Campylobacter/Epide 198 miologicalData/campyDataEw/ 199 Bull, S.A., Allen, V.M., Domingue, G., Jorgensen, F., Frost, J.A., Ure, R., Whyte, R., 200 Tinker, D., Corry, J.E., Gillard-King, J., Humphrey, T.J.,2006. Sources of Retrieved 10/6, 2011, from 6 201 Campylobacter spp. colonizing housed broiler flocks during rearing. Applied and 202 Environmental Microbiology 72, 645-652. 203 Cornelius, A., Nicol, C., Hudson, J.,2005. Campylobacter spp. in New Zealand raw 204 sheep liver and human campylobacteriosis cases. International journal of food 205 microbiology 99, 99-105. 206 Cox, N., Richardson, L., Buhr, R., Fedorka Cray, P.,2009. Campylobacter species 207 occurrence within internal organs and tissues of commercial caged Leghorn laying 208 hens. Poultry science 88, 2449-2456. 209 Enokimoto, M., Kubo, M., Bozono, Y., Mieno, Y., Misawa, N.,2007. Enumeration 210 and identification of Campylobacter species in the liver and bile of slaughtered cattle. 211 International journal of food microbiology 118, 259-263. 212 Fernandez, H., Pison, V.,1996. Isolation of thermotolerant species of Campylobacter 213 from commercial chicken livers. International journal of food microbiology 29, 75-80. 214 Forbes, K.J.,2009. The Molecular Epidemiology of Scottish Campylobacter Isolates 215 from Human Cases of Infection using Multilocus Sequence Typing.S14006, 1-150. 216 Forbes, K.J., Gormley, F.J., Dallas, J.F., Labovitiadi, O., MacRae, M., Owen, R.J., 217 Richardson, J., Strachan, N.J., Cowden, J.M., Ogden, I.D., McGuigan, C.C.,2009. 218 Campylobacter immunity and coinfection following a large outbreak in a farming 219 community. Journal of clinical microbiology 47, 111-116. 220 Gormley, F.J., Macrae, M., Forbes, K.J., Ogden, I.D., Dallas, J.F., Strachan, 221 N.J.,2008. 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Letters in applied microbiology 43, 591-595. 266 9 267 Table 1 Campylobacter spp. from retail livera: prevalence, counts, attribution of 268 genotypes to source species and similarity to common human genotypes. 269 Animal Prevalence species Campylobacter of High countsb Liver isolates’ Percentage of all (%) (%) genotype liver isolates correctly belonging to the attributed to top 10 human source species genotypes (%) (%) Chicken 21/26 (81) 7/26 (27) 64 56 Cattle 22/32 (69) 8/32 (25) 30 20 Pig 23/29 (79) 1/29 (3) 41 18 Sheep 31/40 (78) 4/40 (10) 43 13 Total 97/127 (76) 20/127 (16) 45 26 270 a 271 information. 272 b 273 x103 cfu/ sample). Full details on samples and types of individual isolates are in the supplementary High counts are designated as those samples that gave direct plate counts (i.e.> 3 274 275 276 277 10 278 279 280 281 282 283 284 Isolate R014 7496B R071 7494A 7498B R022 R066 R067 R068 7499A 10011 8920 R029 R001 R080 R027 R050 7499B R081 7439 R019 7553B 7591B R010 R079 R006 R039 R052 R082 7486 7506 7771 7843 8094 8289 8945 8962 R035 R062 R044 Supplementary information The following table contains details on each of the samples: Table S1 Sample details, enumeration and STs of C. jejuni/coli in retail liver Date collected 13/11/2007 12/04/2006 26/02/2008 12/04/2006 12/04/2006 04/12/2007 19/02/2008 19/02/2008 19/02/2008 12/04/2006 10/10/2006 22/06/2006 11/12/2007 06/11/2007 04/03/2008 04/12/2007 22/01/2008 12/04/2006 11/03/2008 31/03/2006 27/11/2007 24/04/2006 26/04/2006 13/11/2007 04/03/2008 06/11/2007 14/01/2008 24/01/2008 11/03/2008 07/04/2006 12/04/2006 23/05/2006 31/05/2006 05/07/2006 19/07/2005 27/09/2006 04/10/2006 08/01/2008 12/02/2008 14/01/2008 Animal species sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep sheep Counts Counts Sample Counts MLST Campylobacter per per ml weight (g) per g Sequence present / absent sample wash typea present <900 <3 420 <2 42 present <900 <3 416 <2 50 present <900 <3 400 <2 50 present 99000 330 332 298 52 present <900 <3 310 <3 53 present <900 <3 315 <3 61 present <900 <3 205 <4 61 present <900 <3 200 <5 61 present <900 <3 600 <2 190 present 15000 50 226 66 206 present <900 <3 273 present <900 <3 526 <2 422 present <900 <3 368 <2 422 present <900 <3 418 <2 520 present <900 <3 426 <2 618 present <900 <3 500 <2 822 present <900 <3 372 <2 822 present <900 <3 226 <4 827b present <900 <3 236 <4 827 b present <900 <3 210 <4 962 b present <900 <3 356 <3 2340 present <900 <3 342 <3 2666 present <900 <3 356 <3 2670 present 12000 40 252 48 UA present <900 <3 398 <2 UA present <900 <3 512 <2 Camp. spp. present <900 <3 315 <3 Camp. spp. present <900 <3 604 <1 UA present 3000 10 264 11 UA present <900 <3 300 <3 Camp. spp. present <900 <3 300 <3 Camp. spp. absent 425 absent absent 384 absent 556 absent 392 absent absent 424 absent 234 absent 294 11 7593 R036 R090 R091 7732 R056 R047 R032 7592 R016 R075 R076 R013 R058 8095 100551 R072 R005 R028 R070 R085 R042 R055 7495 7497 7554 7672 8946 R002 8776 R008 7941 R031 R063 R087 7362 7474B R078 R088 R025 R043 R077 R034 R020 R073 R059 8425B R048 R049 R060 26/04/2006 08/01/2008 18/03/2008 18/03/2008 17/05/2006 24/01/2008 22/01/2008 12/12/2007 26/04/2006 27/11/2007 04/03/2008 04/03/2008 13/11/2007 12/02/2008 05/07/2006 24/10/2006 26/02/2008 06/11/2007 04/12/2007 26/02/2008 11/03/2008 14/01/2008 24/01/2008 12/04/2006 12/04/2006 24/04/2006 10/05/2006 27/09/2006 06/11/2007 05/09/2006 13/11/2007 07/06/2006 11/12/2007 19/02/2008 18/03/2008 14/03/2006 07/04/2006 04/03/2008 18/03/2008 04/12/2007 14/01/2008 04/03/2008 08/01/2008 27/11/2007 26/02/2008 12/02/2008 02/08/2006 22/01/2008 22/01/2008 12/02/2008 pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig pig chicken chicken chicken chicken chicken chicken chicken chicken chicken chicken chicken chicken chicken chicken chicken chicken chicken chicken chicken chicken chicken present present present present present present present present present present present present present present present present present present present present present present present absent absent absent absent absent absent present present present present present present present present present present present present present present present present present present present present present <900 <900 <900 <900 <900 <900 <900 <900 <900 <900 <900 <900 <900 <900 <900 <900 <900 3000 <900 <900 <900 <900 <900 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 10 <3 <3 <3 <3 <3 <900 <900 <900 1200 <900 <900 <900 <900 <900 <900 33000 <900 <900 12000 <900 <900 291000 <900 27000 12000 3000 <3 <3 <3 40 <3 <3 <3 <3 <3 <3 110 <3 <3 40 <3 <3 970 <3 90 40 10 209 458 382 459 502 336 471 340 382 424 434 300 249 340 367 393 242 488 360 439 414 516 340 340 394 340 380 400 400 227 400 238 400 10 250 400 400 400 400 400 400 400 400 400 400 400 400 <4 <2 <2 <2 <2 <3 <2 <3 <2 <2 <2 <3 <4 <3 <2 8 <4 <2 <3 <2 <2 19 21 21 21 58 206 270 1058 b 1096 b 1096 b 1096 b 1096 b 1143 b 2219 2508 b 2697 3609 UA UA UA UA Camp. spp. UA <2 <2 <4 30 <4 <2 90 <4 <2 <2 83 <2 <2 30 <2 <2 728 68 30 8 19 22 45 45 45 50 257 257 257 257 574 574 574 586 699 828 b 872 b 2687 UA UA UA 12 7297 7324 7325 7326 R089 7473B 8426 7555 R011 R004 R069 R084 R024 10057 R057 8098 8065 R054 8919 7493B R053 R033 7590B 7939A 7939B R017 R086 7733 7772 7940 8288 8293 10012 R009 R023 R064 R065 285 286 287 27/02/2006 07/03/2006 07/03/2006 07/03/2006 18/03/2008 07/04/2006 02/08/2006 24/04/2006 13/11/2007 06/11/2007 26/02/2008 11/03/2008 04/12/2007 24/10/2006 12/02/2008 05/07/2006 28/06/2006 24/01/2008 22/09/2006 12/04/2006 24/01/2008 11/12/2007 26/04/2006 07/06/2006 07/06/2006 27/11/2007 11/03/2008 17/05/2006 23/05/2006 07/06/2006 19/07/2005 19/07/2005 10/10/2006 13/11/2007 04/12/2007 19/02/2008 19/02/2008 a b chicken chicken chicken chicken chicken cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle cattle absent absent absent absent absent present present present present present present present present present present present present present present present present present present present present present present absent absent absent absent absent absent absent absent absent absent <900 <900 <900 15000 6000 <900 21000 <900 <900 <900 <900 <900 <900 <900 <900 30000 15000 <900 9000 <900 15000 12000 <3 <3 <3 50 20 <3 70 <3 <3 <3 <3 <3 <3 <3 <3 100 50 <3 30 <3 50 40 19 400 250 241 211 373 379 442 385 492 550 255 253 498 418 362 440 413 414 386 470 470 386 449 360 250 412 626 484 205 219 <4 <4 <4 40 16 <2 55 <2 <2 <4 <4 <2 <2 <2 <2 73 36 <2 19 <2 39 27 19 21 50 61 206 206 206 262 266 273 505 574 575 806 827 b 827 b 854 b 2669 2676 2677 Camp. spp. UA Unassigned to sequence type (UA) C. coli 13