Lisa Dettinger

Pennsylvania Department of Health, Harrisburg, Pennsylvania, United States

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Publications (6)13.07 Total impact

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    ABSTRACT: Background: Salmonellais a leading cause of foodborne illness in the United States. Although salmonellosis is often self-limiting, persons with drug-resistant infections are at risk for severe clinical outcomes. Pennsylvania has implemented an integrated system that compares enteric pathogens from ill persons with pathogens recovered from retail meat. Methods: During August 2009 through June 2013, Salmonellaisolates from meat (chicken breasts, ground turkey, ground beef, and pork chops, 470 of each) purchased from randomly selected retail outlets in southeastern Pennsylvania were analyzed by pulsed-field gel electrophoresis (PFGE). We compared the PFGE patterns with those of clinical isolates in the Pennsylvania surveillance database. All meat isolates and a subset of matched clinical isolates were tested for susceptibility to antimicrobial agents. Results: A total of 148 Salmonellaisolates were recovered from 1880 meat samples: 20% of chicken samples, 9.6% of turkey, 0.64% of beef, and 1.3% of pork were culture-positive. PFGE patterns of 66 (44.6%) retail meat isolates had PFGE matches among 1304 clinical isolates; 28 distinct PFGE patterns were represented. Sixteen (57.1%) of these patterns were associated with multi-drug resistance (resistance to ≥3 antimicrobial agents), and 11 (39.3%) were associated with drug-resistance profiles that were identical to profiles of PFGE-matched retail meat isolates. One Dublin PFGE pattern found in 10 clinical isolates and one beef isolate was associated with resistance to ≥6 antimicrobial agents. All eleven isolates demonstrated resistance to ampicillin and ceftriaxone. Six distinct patterns of clinical Typhimurium isolates shared resistance profiles that were identical to matched retail meat isolates. One isolate from pork was resistant to the same five antimicrobial agents (ACSSuT phenotype) as were 22 clinical Typhimurium isolates. Conclusion: In this comparison, Salmonella isolates known to have caused human illness had PFGE patterns indistinguishable from those found in retail meats. Of these, more than half were multidrug resistant. These data suggest that some antimicrobial resistant Salmonella infections in humans originate from contaminated retail meat.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Salmonella enterica subsp. enterica serovar Enteritidis (S. Enteritidis) is a major cause of foodborne salmonellosis. Rapid, efficient and accurate methods for identification are required to track specific strains of S. Enteritidis during outbreaks of human salmonellosis. By exploiting the hypervariable nature of virulence genes and Clustered Regularly Interspaced Short Palindromic Repeats (CRISPRs), we previously developed a powerful sequence-based subtyping approach, designated CRISPR-MVLST. To substantiate the applicability of CRISPR-MVLST, we analyzed a broad set of S. Enteritidis isolates collected over a six-year period. Among 141 isolates we defined 22 Enteritidis Sequence Types (ESTs), the majority of which were novel. Notably, strains exhibiting the common PFGE pattern, JEGX01.0004 (characteristic of ∼40% of S. Enteritidis isolates in the United States), were separated into twelve distinct sequence types. Conversely, isolates of EST4, the most predominant EST we observed, comprised eight different PFGE patterns. Importantly, we showed that some genotypes that were previously associated with the food supply chain at the farm level have now been identified in clinical samples. CRISPR sequence data shows subtle but distinct differences among different alleles of S. Enteritidis, suggesting that evolution of these loci occurs vertically, as opposed to previously reported evolution by spacer acquisition in other bacteria.
    Food Microbiology 05/2013; 34(1):164-73. DOI:10.1016/j.fm.2012.11.012 · 3.37 Impact Factor
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    ABSTRACT: In 2010, we surveyed 176 clinical laboratories in Pennsylvania regarding stool specimen testing practices for enteropathogens, including Campylobacter spp. Most (96.3%) routinely test for Campylobacter spp. In 17 (15.7%), a stool antigen test is the sole method for diagnosis. We recommend that laboratory practice guidelines for Campylobacter spp. testing be developed.
    Emerging Infectious Diseases 03/2012; 18(3):484-7. DOI:10.3201/eid1803.111266 · 7.33 Impact Factor
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    ABSTRACT: Staphylococcus aureus alpha toxin (AT) is an important virulence determinant and may be a valid target for immunoprophylaxis against staphylococcal disease. Here we report the identification of potent inhibitory anti-AT monoclonal antibodies (MAbs) derived using B-cell hybridoma technology from VelocImmune mice engineered to produce IgG with a human variable domain. A small panel of inhibitory MAbs blocked AT-mediated lysis of rabbit red blood cells, A549 human lung epithelial cells, and THP-1 human monocytic cells, in a dose-dependent manner. Binding studies indicated that these MAbs recognize a similar epitope on AT and exhibit dissociation constants (K(D)) ranging from 0.50 to 15 nM. In an S. aureus dermonecrosis model, mice passively immunized with anti-AT inhibitory MAbs exhibited significant reductions of lesion size relative to mice treated with an irrelevant IgG control. Interestingly, there was a correlation between MAb affinity for a single epitope, the 50% inhibitory concentration (IC(50)) in the AT hemolytic assay, and lesion size reduction in the dermonecrosis model. A representative high-affinity MAb, 2A3.1, was demonstrated to significantly reduce lesion size following infection with three different clinical isolates (USA300, CC30, and CC5). Taken together, these results indicate that in vitro potency of anti-AT MAbs predicts in vivo potency in this model, supporting their continued preclinical evaluation as molecules for immunoprophylaxis against staphylococcal skin and soft tissue infections caused by diverse clinical isolates.
    Clinical and vaccine Immunology: CVI 03/2012; 19(3):377-85. DOI:10.1128/CVI.05589-11 · 2.37 Impact Factor
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    ABSTRACT: Background: Tuberculosis Genotyping Information Management System (TB GIMS) is a new national centralized database of MTB genotypes (GT). Molecular analyses range from large sequence polymorphisms (lineage definition) to differences in single nucleotides and interspersed repeating units (spoligotyping & MIRU analyses). Some evidence suggests genotype may correlate with disease phenotype, especially extrapulmonary TB or strain virulence. Methods: Pennsylvania (PA) data for 3 highest-risk health districts from 2005 - mid 2010 were extracted from TB GIMS (GT cases) and linked to data from PA Notifiable Electronic Surveillance System. Descriptive analysis was performed on isolate and patient data for GT cases. Results: There were 1074 culture-confirmed cases. Genotyping was performed on 60% (n = 638) and linked to patient-level data; 46% are US born (USB), 52% are foreign born (FB). Lineages of FB cases are more diverse (Fig); EuroAmerican (EuroAmer) lineage accounts for 86% of USB and 41% of FB. FB account for the majority of IndoOceanic, East Asian, East African Indian, and Africanum lineages (85%, 80%, 96%, 100% resp). For GT cases there are 259 spoligotypes and 492 PCR types (spoligotyping + MIRU). Overall there are 114 unique PA clusters (≥2 with same PCR type). Six clusters have >5 cases each; of the largest cluster (n=30, East Asian lineage) 67% are FB. Two clusters have only USB. Of GT cases, pulmonary (pulm) account for 81% (n=498) and extrapulmonary (extrapulm) 19% (n=140). Of pulm cases, 52% are USB, 61% are FB. In USB extrapulm cases, only 15% are non-EuroAmer; however in FB extrapulm cases, no single lineage accounts for >31% of cases. The most common extrapulm sites are cervical lymph node (cerv LN, n=43, 81% FB) and bone (n=23, 52% FB). Of cerv LN cases, there is spoligotype grouping (27 unique) but no PCR type clustering despite 49% of cases from only 2 countries. Within pulm cases, there are 155 spoligotypes and 356 PCR types. Conclusion: FB cases have greater lineage diversity than USB for pulm and especially extrapulm cases. Future epidemiologic and molecular cluster analyses are needed to determine how genotyping could best serve to enhance TB control efforts and provide insight into linking disease phenotypes and genotypes.
    Infectious Diseases Society of America 2011 Annual Meeting; 10/2011
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    ABSTRACT: Background: Although Campylobacter is a leading cause of gastroenteritis, the epidemiology of cases reported to public health is inadequately described. Our aim was to characterize campylobacteriosis cases reported in Pennsylvania. Method: We reviewed electronic records of sporadic campylobacteriosis reported in Pennsylvania (excluding Philadelphia) during 2004-2008, and analyzed data on Campylobacter isolates studied at State Lab. A subset of isolates underwent pulsed-field gel electrophoresis (PFGE) and antimicrobial susceptibility testing using standards methods at the Centers for Disease Control and Prevention (CDC). Results: A total of 6537 campylobacteriosis cases (11.9 cases per 100,000 persons) were reported annually; 3043 (46.7%) were females, 830 (12.7%) were individuals aged ≤5 while 833 (12.7 %) were ≥65 years old. Annual incidence initially ranged from 10.8 cases per 100,000 persons in 2006 to 13.1 cases per 100,000 in 2008. Among cases with available information, 1239/4834 (25.6%) reported hospitalization. Although causality cannot be established, case patients reported consumption of raw meat (553 /4620, 10.7%) and drinking unpasteurized milk prior to onset of illness (377/4982, 7%). Only 46 Campylobacter isolates were confirmed at the State Lab; 37 were from patients and nine from raw milk; 54% of these were linked epidemiologically and by PFGE to a single outbreak associated with consumption of raw milk. Conclusion: In Pennsylvania, the incidence of campylobacteriosis is higher than the National health objectives (12.3 cases per 100,000 persons) and it is not declining, suggesting a need for additional or new control measures. Investigations of sporadic Campylobacter surveillance could be enhanced through increased submission of isolates to State Lab for molecular studies.
    Infectious Diseases Society of America 2009 Annual Meeting; 10/2009

Publication Stats

49 Citations
13.07 Total Impact Points

Institutions

  • 2009–2014
    • Pennsylvania Department of Health
      Harrisburg, Pennsylvania, United States
  • 2012
    • The Harvard Drug Group
      Ливония, Michigan, United States