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Cronobacter Infection: What Is It?

Medically Reviewed by Melinda Ratini, DO, MS on August 02, 2022

Cronobacter sakazakii (formerly known as Enterobacter sakazakii) is a type of bacteria that can naturally live in very dry places. For example, rarely it may be found in dehydrated products like infant formula, protein shakes, and powdered milk as well as common pantry items like herbal teas, and starches like potatoes and rice. It can also be found in sewer water.

Cronobacter infection isn’t common. Around two to four cases are reported to the CDC each year. This germ can cause people of all ages to get sick. But it’s especially deadly in newborns, older people, and those who have a weakened immune system.

Who’s at Risk for Cronobacter Infection?

Cronobacter can affect anybody. But it can cause life-threatening infections in:

  • Babies under 2 months
  • Babies born prematurely
  • People who are 65 and over
  • Babies or adults with weakened immune systems caused by illnesses like HIV, an organ transplant, or cancer

What Are the Symptoms?

If babies under 12 months are infected, it can cause symptoms like:

  • Fever
  • Poor feeding
  • Crying a lot
  • Very low energy

In some cases, it can cause seizures. If you notice any of these symptoms, get medical help right away.

In adults, the symptoms of a cronobacter infection can vary from person to person. But it generally causes diarrhea (loose poop) and urinary tract infections (UTIs). It can also cause problems in places where you might have scraped your skin, have cuts, or in places where you’ve had surgery.

In people who are 65 or older, or if your body can’t fight off infections, the germ is more likely to cause an infection in the bloodstream. In some people, the bacteria may grow (or colonize) but not cause any symptoms. In such people, the germ is usually found in their poop.

Once the germ enters your body, the incubation period can be as little as 6-8 hours. The incubation period is the time it takes for the germ to enter your body to when the symptoms start to show.

What Kind of Illnesses Does Cronobacter Cause in Babies?

The bacteria can cause many types of infections. How serious it is will depend on your child’s age, health, and what part of the body it affects.

In babies less than 12 months of age, a cronobacter infection can cause:

Sepsis. It’s a serious infection in the bloodstream. It can cause symptoms like high fever, confusion, clammy or sweaty skin, or shortness of breath, among other things. Sepsis is a medical emergency. If you think your baby has sepsis, call 911 or go to the nearest hospital right away.

Meningitis. It’s a condition that causes the tissue around your brain and spine to swell. It’s most likely to happen to newborns who are 2 months old or younger. Cronobacter meningitis in young babies can lead to:

  • Seizures
  • Brain abscesses – pus-filled pockets
  • Brain infarctions. This tissue death is due to a lack of blood supply.
  • Hydrocephalus. It happens when fluid builds up in the deep cavities of the brain.

Meningitis is a deadly infection that may cause serious long-term brain problems in infants. In fact, around 4 in 10 babies who get cronobacter meningitis die.

How Does Cronobacter Spread?

Cronobacter is found naturally in the environment. But experts don’t know if it spreads from person to person. Though rare, it is most likely transmitted when someone does not thoroughly wash their hands or the items they are using.

In babies, the germ has been found in rare occasions in infant formula. In some cases, the powder might have been contaminated while it was being prepared in a factory, or the powder may have touched a bacteria-infested area. But it’s also possible for the bacteria to have gotten into the powder once you open it at home. For example, it might happen if you put the formula scoop or lid on the counter or sink, and it later touches the formula.

Babies have also gotten sick after they’ve had pumped breast milk because bacteria were found on the pump parts.

How Is It Diagnosed?

If you think you or your baby has a cronobacter infection, call your doctor right away. They’ll likely take a sample of blood, urine, and cerebrospinal fluid (CSF) and check for traces of the germ at a lab.

If your child has meningitis, they’ll also do brain imaging tests like an MRI to see if it caused brain abscesses or infarctions (death of tissue because of a blocked blood supply). If your doctor diagnoses your child with a cronobacter infection, in some states, they’ll have to alert the local or state health department.

In adults, cronobacter may be found around open wounds.

How Can You Treat a Cronobacter Infection?

If your child has cronobacter-related sepsis or meningitis, they’ll be hospitalized right away. Their doctor will give your child a course of antibiotics right away to help their body fight off the infection.

Adults with UTIs and cronobacter-related wound infections are also given antibiotics. But if the bacteria are present but don’t cause any symptoms, you might not need any treatment.

How Can You Prevent Cronobacter Infection in Babies?

To help prevent your child from getting cronobacter infection, you should:

  • Wash your hands with soap and water before you make formula.
  • Prepare your formula with water that is at least 158 F.
  • Clean kitchen counters, the sink, or any other surfaces that might touch baby formula with soap and water or a disinfectant wipe.
  • Clean and sanitize all baby feeding items such as bottles, nipples, caps, rings, and breast pump parts. You can also run them in the dishwasher if they are dishwasher-safe.
  • Allow all of the parts to thoroughly air-dry.
  • Keep the formula container, scoop, and lid dry. Don’t put it back if it’s wet. Wash it and allow it to air-dry.
  • Consider boiling your water and letting it cool for 5 minutes before you mix in the baby formula.
  • Carefully shake the formula inside the bottle, and don’t use a separate spoon to stir it.
  • Test the temperature of the formula before giving it to your baby by putting a few drops on the inside of your wrist. It should never feel hot, just warm.
  • Use the formula within 1 hour from the time your start to feed or within 2 hours after you prepare it.
  • Don’t save any leftover formula. Throw it away.
  • If you decide to not feed your baby after you make the formula, put it in the fridge right away. Use it within 24 hours or throw it away.
  • Don’t use expired baby formula.
  • Avoid buying imported baby formula through online sales as it could be fake and may have contaminated ingredients.
  • Don’t feed your baby homemade baby formula without checking with your doctor first.

Watch for any FDA recalls of formula products you use for your baby. If there has been a recall and you’re unsure if your product is contaminated, check the “lot number” listed on the packaging and search for it on the company’s website.

Show Sources

SOURCES:

CDC: “Cronobacter,” “Cronobacter: Frequently Asked Questions,” “People at Risk,” “Signs and Symptoms.”

FDA: “FDA Investigation of Cronobacter Infections: Powdered Infant Formula (February 2022).”

Alabama Department of Public Health: “Frequently Asked Questions: Cronobacter.”

Frontiers in Pediatrics: “The Roles of Epidemiologists, Laboratorians, and Public Health Agencies in Preventing Invasive Cronobacter Infection.”

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