Salmonella dublin
Salmonella enterica subspecies enterica serotype Dublin (S. enterica Dublin) emerged for the first time in
New York, Pennsylvania, and Ohio in 1988.
Salmonella dublin (strain CT_02021853) is a bovine-adapted serovar that is genetically related to S. enteritidis that
lives in the bovine intestinal tract and can causes disease in humans. While rare in incidence, S. dublin infection
classically produces a syndrome of sustained bacteremia with fever, resulting in high morbidity and mortality.
S. dublin has a 15% mortality rate when septicemic in the elderly, and S. enteritidis is demonstrating approximately a
3.6% mortality rate in hospital/nursing home outbreaks, with the elderly being particularly affected.
Salmonella septicemia has been associated with subsequent infection of virtually every organ system.
Postenteritis reactive arthritis and Reiter's syndrome have also been reported to occur generally after 3 weeks.
Reactive arthritis may occur with a frequency of about 2% of culture-proven cases. Septic arthritis, subsequent or
coincident with septicemia, also occurs and can be difficult to treat.
8. Target Populations: All age groups are susceptible, but symptoms are most severe in the elderly, infants, and the
infirm. AIDS patients suffer salmonellosis frequently (estimated 20-fold more than general population) and suffer from
recurrent episodes.
Salmonella Typhimurium and Salmonella Dublin are two of the well-known serovars that are non-host adapted (able to
infect any vertebrate).
Salmonella enterica Serotype Dublin Infection: an Emerging Infectious Disease for the Northeastern United States
PATRICK L. MCDONOUGH,* DAVID FOGELMAN, SANG J. SHIN, MICHAEL A. BRUNNER,
AND DONALD H. LEIN
Diagnostic Laboratory, Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine,
Cornell University, Ithaca, New York 14853
Received 7 January 1999/Returned for modification 8 March 1999/Accepted 20 April 1999
Salmonella enterica subspecies enterica serotype Dublin (S. enterica Dublin) emerged for the first time in
New York, Pennsylvania, and Ohio in 1988. Since that time this host-adapted serotype has spread throughout the
veal- and dairy beef-raising operations in the region; very few dairy farms have experienced clinical S. enterica
Dublin infections. This study details the epidemiology of the outbreaks in cattle. During the period 1988
through 1995, nine New York and four Pennsylvania counties have been affected; 13 different locations were
involved in New York, and 10 were involved in Pennsylvania. The morbidity and mortality and seasonal
distribution of outbreaks, which totaled 35, is described. The antimicrobial susceptibility pattern of isolates
revealed that many of the strains were resistant to a number of commonly used drugs. Clinical case details and
pathology information are provided, with a caution to clinicians and microbiologists presented with suspect
animals, i.e., most cases occurred in older calves, which is atypical for salmonellosis for this region (calves were
8 or more weeks old) and presented as pneumonia and septicemia rather than the primarily diarrheal
syndrome that is more typically recognized for the region. The epidemiology of cases is analyzed through
cluster analysis of bacterial isolates and their fatty acid methyl ester profiles; at least six clones appeared in
the region during the study period. Results of the epidemiology analysis are used to support a hypothesis
regarding the source of S. enterica Dublin for the region and its manner of dissemination.
Br Med J. 1980 March 22; 280(6217): 815–818. PMCID: PMC1600964
Copyright notice
Veterinary surgeons as vectors of Salmonella dublin.
E Williams
Salmonella dublin is an important bovine pathogen, causing dysentery, abortion, and death from septicaemia. S dublin
dermatitis, a little-recognised occupational hazard for veterinary surgeons, does not cause serious disability or
inconvenience. During a survey of brucellosis in south-west Wales four cases of S dublin dermatitis were seen in
veterinary surgeons. One surgeon was reinfected three years later. On all five occasions the veterinary surgeons had
not worn or had discarded polyethylene gloves. An apparently healthy cow may serve as a latent carrier of S dublin.
Thus when disease starts in a closed, protected herd reactivation of infection within the herd is usually blamed and its
introduction by extraneous agents considered to be unlikely. Veterinary surgeons should be regarded as potential
vectors of S dublin.
J.Infect Dis. 1982 Sep ;146 (3):322-7 7108281 (P,S,G,E,B) Cited:9 [Cited?]Salmonella dublin infections in the United
States, 1979-1980.
D N Taylor, J M Bied, J S Munro, R A Feldman
Human isolates of Salmonella dublin were reported to the Centers for Disease Control, Atlanta, 103 times in 1980, as
isolation rate nearly twice that reported in 1979. In 1979 and 1980 S. dublin was isolated predominantly in the western
United States, frequently from males (60% of the total), from adults older than 40 years of age (55%), and from blood
(37%). Detailed histories were obtained for 39 cases outside of California and Oregon, and 32 cases were matched
with 62 age-, sex-, and locality-matched control subjects. We found that persons infected with S. dublin were more
likely to have suffered from chronic noninfectious diseases (P less than 0.001) and were more likely to have ingested
antacids (P less than 0.01) than their controls. In the case-control study, 21 (66%) of the infected persons were
hospitalized and six (19%) died. When exposure to cattle, beef, or dairy products was examined, we found that cases
differed significantly from controls only by a more frequent consumption of raw milk (P less than 0.001).
CDC
MMWR
Weekly
http://www.cdc.gov/mmwr/preview/mmwrhtml/00000318.htm
April 13, 1984 / 33(14);196-8
Salmonella dublin and Raw Milk Consumption -- California
In 1981, 46 cases of human Salmonella dublin infection were reported in California, and in 1982, 70 cases were
reported. In both years, 24% of patients reported using certified raw milk (CRM). In 1983, 123 S. dublin cases were
identified--the most ever reported in a single year--and of the 99 persons providing information on raw milk use, 44%
reported using CRM.
The demographic characteristics and risk factors for S. dublin patients have consistently differed from those infected
with other Salmonella serotypes. S. dublin patients are much older, and many have underlying, debilitating disorders.
In 1983, 61% of S. dublin patients were 40 years of age or over, and 17% were less than 20 years of age. By contrast,
salmonellosis caused by other serotypes is generally a pediatric disease, with 60% of infections occurring among
individuals under age 20. At least 24 of the 1983 S. dublin patients had cancer, particularly lymphoma and leukemia;
five had acquired immunodeficiency syndrome (AIDS); and others had diabetes mellitus, were immunodeficient, or were
taking systemic corticosteroids and/or other immunosuppressants for a variety of disorders. Nearly 80% were
hospitalized, and 26% died.
S. dublin gave continued evidence of being a particularly invasive serotype, as 79% of the 1983 isolates were
recovered from extra-intestinal (nonfecal) sites, principally from blood, but also from cerebrospinal fluid, peritoneal
fluid, and lung. By contrast, only 10%-15% of Salmonella isolates from all other serotypes in any year are from extra-
intestinal sites. The invasiveness of S. dublin does not simply reflect the older age of the infected host: when controls
infected by other Salmonella serotypes were matched by age and sex to S. dublin patients, the percentage of controls
with positive extra-intestinal cultures remained below 15%.
To evaluate the possibility that (1) raw-to-rare beef or liver or (2) raw milk may be sources of S. dublin infection, the
1983 patients were asked about these food exposures: 16% reported consuming raw-to-rare beef or liver, whereas
44% reported using CRM. Raw milk use among persons with infections due to other Salmonella serotypes was 8% in a
previous study. Raw milk represents less than 1% of all market milk distributed in California.
Since 1977, nearly 200 Salmonella isolates have been made from CRM by 14 local, state, and federal laboratories.
Antibiogram tests of human S. dublin isolates have shown a statistically significant association between the patterns of
isolates recovered from CRM users and the antibiogram patterns of isolates recovered from CRM itself.
The risk of contracting S. dublin from CRM in California has been estimated: assuming that 12,000 gallons of CRM are
produced per day and that each user drinks 1 pint daily, the rate of S. dublin disease for CRM users in 1983 was
estimated at 458.3 per million population. This contrasts with a rate of 2.9 per million for S. dublin patients from the
California population that did not report drinking raw milk. The relative risk of illness from S. dublin for CRM users was,
therefore, 158.0 (458.3/2.9). The association between CRM ingestion and S. dublin disease in 1983 was about 15
times stronger than the well-accepted association between cigarette smoking and lung cancer. Just as the majority of
smokers do not develop lung cancer, the majority of raw milk users apparently do not develop S. dublin disease. The
number of S. dublin cases in California is not larger than it is because the population that drinks CRM is very small,
and the contamination of CRM appears intermittent. Salmonellosis from raw milk is a potential hazard that merits
greater appreciation by consumers, producers, and health-care providers. Adapted from California Morbidity (March
30, 1984) by SB Werner, MD, FR Morrison, DrPH, GL Humphrey, DVM, RA Murray, DrPH, J Chin, MD, State
Epidemiologist, California Dept of Health Svcs; Div of Bacterial Diseases, Center for Infectious Diseases, CDC.