Abstract
Mucoralean invasive fungal infections, while unusual among the general population, have a high mortality rate among immunocompromised individuals who become infected. They are also common spoilage organisms in cultured dairy products, some fresh produce, and baked goods. Additionally, Mucor and Rhizopus spp. are utilized in the production of traditional fermented foods including mold ripened cheeses and fermented soy products. The risk that consumption of these foods poses to immunocompromised consumers has been previously identified. However, actionable guidance on implementation of appropriate dietary restrictions and microbial specification targets for food manufacturers serving these populations is scarce and is limited by insufficient data regarding traceback analysis in cases of invasive fungal infections where food is the suspected transmission vector. Culture-dependent and molecular subtyping methods, including whole genome sequencing, will improve identification of the point source. In turn, the empirically determined information on root-cause can best direct the development of appropriate food safety policies and programs.
Highlights
In the fall of 2013, a Class II recall of Greek yogurt was issued due to contamination and spoilage from the dimorphic fungus, Mucor circinelloides, after consumers reported visible quality defects and symptoms of temporary gastroenteritis [1]
This issue has been raised by Paterson and Lima (2017) and Benedict et al (2016) [4,5]. These reports largely summarize (1) the prevalence of opportunistic fungal pathogens in food, beverages, and supplements and (2) case reports of invasive fungal infections that are potentially linked to food which, while providing a framework to justify additional studies, requires further evaluation of causation through traceback assessments in order to come to actionable conclusions
The risk of invasive fungal infection through consumption of contaminated, spoiled, or mold fermented foods is likely based on a variety of factors, in addition to health status of the host
Summary
In the fall of 2013, a Class II recall of Greek yogurt was issued due to contamination and spoilage from the dimorphic fungus, Mucor circinelloides, after consumers reported visible quality defects and symptoms of temporary gastroenteritis [1]. The link between the case report and the spoiled product was not definitively confirmed with molecular subtyping methods, the risk of invasive filamentous fungal infections in immunocompromised individuals who consume foodborne fungi is an area of growing concern, as the global incidence of immune suppression continues to rise [3] This issue has been raised by Paterson and Lima (2017) and Benedict et al (2016) [4,5]. The authors instead concluded that it was more likely that patients were infected from a pool of diverse strains from the environment rather than from a shared source, which indicates the complexity of determining the source of mucoralean fungi implicated in invasive infections among immunocompromised individuals [18] This lack of available root-cause evidence inherently limits the development of policies and best practices for food safety recommendations for immunocompromised consumers, the manufacturers of their food, and their health-care providers
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