Cronobacter spp.: infections, occurrence and food regulations ‒ a review in Brazil

Abstract Cronobacter is an opportunistic bacterium associated with infections in newborns due to the consumption of powdered infant formulae. It is now known that Cronobacter can cause infections in individuals of any age with a higher prevalence in the elderly, urinary infections being the most common syndrome in this group. The identification of powdered infant formulae as the contamination vehicle in cases of meningitis caused by Cronobacter in neonates led the regulatory agencies to establish specific measures to control such pathogens in these products. Thus a literature review was carried out concerning the epidemiology of Cronobacter infections, the occurrence of the pathogen and food regulations in Brazil. It was found that cases of the infection were reported in Brazil from 1997-2013, with a higher occurrence in neonates. The precise number of cases could not be determined, and in some reports, identification of the microorganism was questionable. In most of the cases reported the contamination vehicle was not investigated or could not be determined. There have been reports of contamination by Cronobacter in samples of powdered infant formulae commercialized in Brazil, but their occurrence seems to have reduced after the adoption of stricter sanitary measures by the regulatory agencies. Cronobacter has also been isolated from spices and herbs, flours, cheese and from cereal mixes destined for children; and from these samples, four species were identified: C. sakazakii, C. malonaticus, C. dublinensis and C. muytjensii. The presence of the pathogen in different types of food is worrying because it may represent a risk if consumed by individuals belonging to one of the risk groups (neonates and elderly). It is important to encourage research about the epidemiology of the genus Cronobacter in order to identify the classes of food that can act as contamination vehicles and the real prevalence of infections in Brazil.