Day 106 - 23 Mar 95 - Page 20

     
     1
     2   MS. STEEL:   Are there problems with salmonella strains becoming
     3        resistant to antibiotics which are wildly used in the
     4        poultry industry, which would then have implications for
     5        treating humans suffering from salmonella?
     6        A.  That problem is most associated with cattle, not with
     7        poultry.  That is a problem but it is not a poultry
     8        problem, not to my knowledge.
     9
    10   Q.   Can you explain what the problem is with cattle?
    11        A.  Over the last year we started to see a strain of
    12        salmonella typhimurium emerge, two strains actually, 104
    13        and 104C, strains traditionally associated with the cattle,
    14        and the 104C, particularly, was observed to be
    15        multi-resistant to various antibiotics used in human
    16        therapy.
    17
    18        In fact, there was quite an explosive growth, although from
    19        a small basis, something like a 300 per cent increase over
    20        the year.  It is a very, very significant rise and it is
         one of some concern -- some very great concern.
    22
    23   MR. JUSTICE BELL:  Where did the strains appear?
    24        A.  In a fairly, remarkably wide variety of foods in food
    25        poisoning outbreaks.  The work is not complete by any
    26        means.  But you have very long experience of being able to
    27        associate different strains of salmonellas with particular
    28        hosts.
    29
    30   MR. JUSTICE BELL:  Yes, I may not be following.  I am trying to
    31        distinguish between salmonella and salmonellosis as a
    32        result of ingestion of it.  What was actually resistant to
    33        the antibiotics?  Are you saying the salmonella strain was,
    34        or that people have suffered from salmonellosis as a result
    35        of infection by 104 and 104C and their illness has then
    36        proved resistant to antibiotics?  Are you saying that, or
    37        that a strain of salmonella in the animal has proved
    38        resistant to treatment?
    39        A.  The latter, my Lord.  The strain itself is resistant to
    40        antibiotics.  Now, just to clarify this, salmonella food
         poisoning in its normal event in man is not treated with
    42        antibiotics unless -- and this is quite important -- it
    43        becomes invasive.
    44
    45        If you like, the classic food poisoning is as I described
    46        to you earlier, with the classic gastroenteritis.  In
    47        salmonella, it will normally be diarrhoea, stomach pains,
    48        accompanied by fever, headache, nausea, sometimes vomiting,
    49        giddiness.  That is the primary stage.
    50 
    51        In a proportion of sufferers, the organism then gets 
    52        outside the gut system and invades the blood stream, hence 
    53        the term "invasive" and causes a more severe fever, almost
    54        akin to typhoid, and a very much more serious condition.
    55        At that stage, if it becomes invasive, it is normal
    56        practice to treat it with antibiotics.
    57
    58        Now, it is this invasive stage which can be life
    59        threatening, and also one finds of the typhimurium strain
    60        that a higher proportion of cases become invasive as