Intermittent and persistent shedding of Escherichia coli O157 in cohorts of naturally infected calves

AIMS

We conducted two short-term studies of cohorts of naturally infected calves to determine the prevalence and concentrations of Escherichia coli O157 shed in faeces.

METHODS AND RESULTS

Two cohorts of calves were sampled; in the first study 14 calves were sampled up to five times a day for 5 days; in the second study a group of 16 separate calves were sampled once or twice a day for 15 days. All cattle within the two cohorts shed E. coli O157 at some point during the respective studies. In 18% of samples, E. coli O157 could only be isolated using immunomagnetic separation after an enrichment period, suggesting concentrations <250 CFU g(-1). The highest concentrations recorded were 6.7 x 10(5) and 1.6 x 10(6) CFU g(-1) for studies 1 and 2 respectively.

CONCLUSIONS

Persistent, high shedders (shedding >10(3) CFU g(-1)) were evident in both studies but, in the majority of calves, the pathogen was isolated intermittently.

SIGNIFICANCE AND IMPACT OF THE STUDY

The variable patterns of shedding have important implications for the design of appropriate sampling protocols and for gaining meaningful estimates of parameters used in mathematical models of transmission.

Pathogen-induced actin filament rearrangement in infectious diseases

Host defence mechanisms involve the establishment and maintenance of numerous barriers to infectious microbes, including skin and mucosal surfaces, connective tissues, and a sophisticated immune system to detect and destroy invaders. Defeating these defence mechanisms and breaching the cell membrane barrier is the ultimate challenge for most pathogens. By invading the host and, moreover, by penetrating into individual host cells, pathogens gain access to a protective niche, not only to avoid immune clearance, but also to replicate and to disseminate from cell to cell within the infected host. Many pathogens are accomplishing these challenges by exploiting the actin cytoskeleton in a highly sophisticated manner as a result of having evolved common as well as unique strategies.

Evaluation of the German cockroach (Blattella germanica) as a vector for verotoxigenic Escherichia coli F18 in confined swine production

German cockroaches are common pests of confined swine production in North Carolina and other southeastern states. Vector competence of German cockroaches for one of the most important porcine bacterial pathogens, verotoxigenic Escherichia coli F18, was evaluated in laboratory bioassays using a culturing approach followed by multiplex PCR. In addition, the populations of fecal coliforms from the feces of piglets and cockroaches collected from a swine nursery were assessed. Viable and virulent cells of E. coli F18 were detected in cockroach feces for up to 8 days after the initial exposure. The population of fecal coliforms in cockroach feces was high (4.4 x 10(5) CFU g(-1)) and comparable to that of piglet feces (1.9 x 10(6) CFU g(-1)). This study demonstrates that cockroaches may serve as important mechanical vectors of pathogenic E. coli. Integrated management of cockroach populations should be incorporated into the disease prevention and control programs in the swine industry.

Quantitative contamination and transfer of Escherichia coli from foods by houseflies, Musca domestica L. (Diptera: Muscidae)

The housefly, Musca domestica L. (Diptera: Muscidae), is recognized as an important factor in the dissemination of various infectious diseases such as cholera, shigellosis, and salmonellosis. They can also serve as a cross-contamination vector for other foodborne pathogens. However, the potential for bacterial transfer by houseflies has been demonstrated in a qualitative rather than quantitative manner. In this study, the numbers of bacteria a housefly can carry on its body and transfer to a clean surface after exposure to a sugar-milk aqueous solution, steak, and potato salad contaminated with a fluorescent gene Escherichia coli (8 log10 CFU/ml) were determined. In the first series of experiments to quantify bacterial numbers on the flies, about 40-60 flies were transferred into a sterile cage, exposed to the food for 30 min, the flies immobilized and the attached E. coli on each fly enumerated. Detectable E. coli (>1.7 log10 CFU/fly) were found on 43% (29/67), 53% (23/43), and 62% (32/52) of the flies in the cages with sugar/milk, steak, and potato salad, respectively. For the positive flies, the geometric mean carriage (log10 CFU/fly) was 2.93+/-1.24 for sugar-milk, 3.77+/-1.28 for steak, and 2.25+/-0.64 for the potato salad. In the second series of experiments, the transfer of bacteria by individual flies from contaminated food to the inner surface of a sterile jar per each landing was determined. E. coli transferred from the sugar-milk was 3.5+/-0.7 log10 CFU/fly-landing, 3.9+/-0.7 for steak and 2.61+/-1.16 for the potato salad. From the initial contamination levels of bacteria and the number of transferred bacteria, it can be calculated that flies contaminate clean surfaces with approximately 0.1 mg of food per landing.

Antimicrobial resistance of Escherichia coli strains isolated from urine of women with cystitis or pyelonephritis and feces of dogs and healthy humans

OBJECTIVE

To assess the prevalence and patterns of antimicrobial resistance among Escherichia coli strains isolated from the urine of women with cystitis or pyelonephritis and from fecal samples from dogs and healthy humans.

DESIGN

Cross-sectional survey.

SAMPLE POPULATION

Escherichia coli isolates from 82 women with cystitis, 170 women with pyelonephritis, 45 dogs, and 76 healthy human volunteers.

PROCEDURE

Susceptibility to 12 antimicrobial agents was determined by means of disk diffusion testing as specified by the NCCLS.

RESULTS

Overall, the 4 most common antimicrobial resistance patterns were resistance to ampicillin, sulfisoxazole, trimethoprim, and trimethoprim-sulfamethoxazole (n = 45 [12% of all isolates]); ampicillin alone (33 [9%]); ampicillin and sulfisoxazole (29 [8%]); and sulfisoxazole alone (14 [4%]). None of the isolates were resistant to ceftazidime, ciprofloxacin, nitrofurantoin, or piperacillin-tazobactam. Resistance was significantly more common and extensive among isolates from women with cystitis or pyelonephritis than among isolates from healthy humans or dogs. Resistance was least common among isolates from dogs. The only resistance phenotype that was more common among canine isolates than human isolates was resistance to sulfisoxazole alone.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that dogs are unlikely to be an important external reservoir of antimicrobial-resistant E. coli strains causing infections in humans. On the contrary the data suggest that dogs conceivably could acquire resistant E. coli strains from humans.

Ten-year study on the effect of intrapartum antibiotic prophylaxis on early onset group B streptococcal and Escherichia coli neonatal sepsis in Australasia

BACKGROUND

Intrapartum antibiotics have reduced the incidence of neonatal early onset (EO) group B streptococcal (GBS) disease. Some surveillance data suggest that this success may be at the cost of increasing rates of non-GBS infection, especially in premature neonates.

OBJECTIVE

To examine rates of EOGBS infection and EO Escherichia coli neonatal sepsis in Australasia.

METHODOLOGY

Analysis of trends in EO (<48 h age) GBS and E. coli sepsis from longitudinal prospective surveillance data collected from representative tertiary obstetric hospitals in each state of Australia and selected centers in New Zealand during a 10-year period from 1992 through 2001. Statistical analysis used Poisson regression.

RESULTS

206 GBS and 96 E. coli cases occurred in 298,319 live births during the study period. The EOGBS sepsis rate fell from a peak of 1.43/1000 live births in 1993 to 0.25/1000 in 2001 (P < 0.001). The overall EO E. coli sepsis rate was 0.32/1000. In babies with birth weight <1500 g, it was 6.20/1000. There was an overall trend to decreasing EO E. coli sepsis (P = 0.07), and there was no significant change in E. coli sepsis in babies <1500 g (P = 0.60). Sixty-nine percent of E. coli cases occurred in the <1500 g cohort; the case fatality rate in this group was 50%. The overall case fatality rate from E. coli sepsis was 36%, and this rate remained stable during the study period (P = 0.47).

CONCLUSIONS

The increasing use of intrapartum antibiotics produced a steady decline in EOGBS disease in Australasia. There was also a trend to decreasing EO E. coli sepsis in all babies, and the rate in very low birth weight infants remained stable.

Neonatal early onset Escherichia coli sepsis: trends in incidence and antimicrobial resistance in the era of intrapartum antimicrobial prophylaxis

BACKGROUND

Although intrapartum antimicrobial prophylaxis has lowered the incidence of early onset group B Streptococcus (GBS) sepsis, there are concerns that the increased use of antibiotics may raise the incidence of non-GBS antimicrobial-resistant infections. The objective of this study was to determine trends in the incidence and antimicrobial resistance of early onset sepsis caused by Escherichia coli in the era of antimicrobial prophylaxis.

METHODS

All neonates with early onset E. coli infection who were born at La Paz Hospital, Madrid, from January 1, 1992, through December 31, 2002, were identified from a microbiologic register of all neonatal infections. To evaluate the effect of the guidelines for GBS prevention, data were pooled and compared for: 1992 through 1995 (Period 1); 1996 through 1998 (Period 2); and 1999 through 2002 (Period 3).

RESULTS

Early onset E. coli infection was diagnosed in 41 of 84 612 live births. The infection rate did not change significantly during the 3 time periods (0.56, 0.24 and 0.55 per 1000 during Periods 1, 2 and 3, respectively; P = 0.936, linear-by-linear association). The proportion of E. coli infections that were resistant to ampicillin increased significantly among preterm infants, from 25% (1 of 4) in Period 1, to 100% (2 of 2) in Period 2 and to 91% (10 of 11) in Period 3 (P = 0.017, linear-by-linear association), but not among term infants, with 67% (8 of 12) in Period 1, 50% (1 of 2) in Period 2 and 44% (4 of 5) in Period 3 (P = 0.317, linear-by-linear association).

CONCLUSIONS

Although the incidence of early onset sepsis caused by E. coli remained stable during the study period, antibiotic-resistant E. coli infections increased among preterm infants. On the whole these trends are reassuring with respect to GBS prophylaxis. However, the increase in the proportion of ampicillin-resistant infections in preterm infants suggests that continuing evaluation of the risks and benefits of prophylaxis in this group is critical.

Duration and magnitude of faecal shedding of Shiga toxin-producing Escherichia coli from naturally infected cattle

To clarify the epidemiological relationship between cattle and human infections of Shiga toxin-producing Escherichia coli (STEC), we studied the duration and magnitude of the excretion of STEC O157 and STEC O26 with rectal faeces from naturally infected cattle at a breeding farm in the Tohoku area of Japan, using microbiological methods. The prevalence of STEC O157 was 3.5% (11/324), whereas that of STEC O26 was 7.9% (14/178). Faecal shedding of STEC O157 persisted for < 1 week to 10 weeks, whereas STEC O26 persisted from < 1 week to < 3 weeks. The magnitude of faecal shedding (per 10 g) ranged from 4 to > 110,000 c.f.u. for STEC O157 and from 3 to 2400 c.f.u. for STEC O26. All isolates of both STEC serotypes contained the stx1 or stx2 genes. Pulsed-field electrophoretic analysis of both STEC serotypes identified predominantly STEC O157 type III and STEC O26 type I in isolates, suggesting that a single STEC strain may be mutated in the intestinal tract of calves. These results indicate that STEC O157 is secreted for longer periods and in higher numbers than STEC O26 from healthy calves with natural infections, suggesting that STEC O157 may have more opportunities than STEC O26 to induce human disease.

Outbreaks of Escherichia coli O157 infections at multiple county agricultural fairs: a hazard of mixing cattle, concession stands and children

Escherichia coli O157 infections cause an estimated 60 deaths and 73 000 illnesses annually in the United States. A marked summer peak in incidence is largely unexplained. We investigated an outbreak of E. coli O157 infections at an agricultural fair in Ohio and implicated consumption of beverages made with fairground water and sold by a geographically localized group of vendors who were all on the same branch of the fairground water distribution system. To examine county fair attendance as a risk factor for infection, we conducted two further epidemiological studies. In the first, we enhanced surveillance for E. coli O157 infections in 15 Northeast Ohio counties during the 2000 agricultural fair season and showed increased risk of E. coli O157 infection among fair attendees. In the second study, we examined Ohio Public Health Laboratory Information Service (PHLIS) data for 1999 using a time-varying covariate proportional hazards model and demonstrated an association between agricultural fairs and E. coli O157 infections, by county. Agricultural fair attendance is a risk factor for E. coli O157 infection in the United States and may contribute to the summer peak in incidence. Measures are needed to reduce transmission of enteric pathogens at agricultural fairs.

Investigation of an outbreak of Escherichia coli O157 infection caused by environmental exposure at a scout camp

In May 2000 a scout camp was held on an agricultural showground in New Deer, Aberdeenshire. There were 337 campers at the event, comprising 233 cubs, scouts, and venture scouts, and 104 adults. The event was abandoned early because of heavy rainfall. Twenty campers who became ill between 28 May and 3 June were confirmed as having E. coli O157 infection. Preliminary investigation did not suggest a food vehicle but did indicate environmental exposure at the camp as a risk factor. Subsequent investigations supported the hypothesis that transmission of E. coli O157 was from the environment to cases by contaminated hands, either directly from hand to mouth, or via food. As a result of the investigation the Aberdeenshire Council and the Scout Association jointly prepared interim guidelines to reduce the risk of E. coli O157 infection at scout camps.

Bacteriophage treatment of a severe Escherichia coli respiratory infection in broiler chickens

A bacteriophage to a serotype 02, nonmotile Escherichia coli was isolated from municipal waste treatment facilities and poultry processing plants. A study was conducted to determine the efficacy of multiple vs. single intramuscular (i.m.) injections of bacteriophage to treat a severe E. coli respiratory infection. The birds were challenged at 7 days of age by injection of 6 x 10(4) colony-forming units (cfu) of E. coli into the thoracic air sac followed by an i.m. injection into the thigh with either heat-killed or active bacteriophage. There were 16 treatments with three replicate pens of 10 birds. There were four control treatments, which included untreated birds, birds injected with either heat-killed or active bacteriophage, and birds challenged only with E. coli. In the remaining treatments, birds were injected with heat-killed or active bacteriophage either once immediately after E. coli challenge or immediately after challenge and at 8 and 9 days of age, once at 8 days of age or at 8, 9, and 10 days of age, and once at 9 days of age or at 9, 10, and 11 days of age. Mortality was significantly decreased from 57% to 13% in the birds given a single i.m. injection of bacteriophage immediately after E. coli challenge, and there was complete recovery in birds treated immediately after challenge and at 8 and 9 days of age, which was a significant improvement from the single injection treatment. There was a significant reduction in mortality from 57% to 10% in the birds treated with bacteriophage once at 8 days of age and those birds treated at 8, 9, and 10 days of age, with no difference between single or multiple treatments. The mortality in the single or multiple phage treated birds that started at 9 days of age was reduced from 57% to 28% and 27%, respectively, but was not statistically different from the control. These data suggest that bacteriophage can be an effective treatment when administered early in this experimental E. coli respiratory disease and that early multiple treatments are better than a single treatment. The efficacy of bacteriophage treatment diminishes as it is delayed, with no difference between single or multiple treatments. Bacteriophage may provide an effective alternative to antibiotics, but like and biotic therapy, the effectiveness of phage to rescue animals decreases the longer treatment is delayed in the disease process.

Ice as a vehicle for diarrheagenic Escherichia coli

In a recent study of the microbiological quality of commercial ice, 50 Escherichia coli isolates belonging to different serotypes were found. The potential hazard from these isolates was examined by testing their adherence patterns in HeLa cells and searching for the presence of DNA sequences related to E. coli virulence properties. Twelve potentially diarrheagenic isolates were found and classified as enteroaggregative E. coli (EAEC) based on their ability to produce aggregative adherence to HeLa cells. The remaining isolates were devoid of the virulence properties searched for. The EAEC isolates belonged to 10 different serotypes, among which O128ab:H35 is often found in diarrheic feces. None of these isolates reacted with a specific EAEC DNA probe or carried any of the known EAEC virulence genes. These data indicate that ice may be an important vehicle for transmission of enteropathogens, especially of the EAEC group.

EHEC outbreak among staff at a children's hospital--use of PCR for verocytotoxin detection and PFGE for epidemiological investigation

This is the first report of a major foodborne outbreak of enterohaemorrhagic Escherichia coli (EHEC) in Sweden. It occurred among the nursing staff at a children's hospital with approximately 1600 employees. Contaminated lettuce was the most likely source of infection. Nine persons were culture-positive for Escherichia coli (E. coli) O157 and verocytotoxin-positive by PCR and a further two were verocytotoxin-positive by PCR only. All 11 EHEC-positive individuals had attended a party for approximately 250 staff members, which was held at the hospital. In a questionnaire 37 persons stated that they had symptoms consistent with EHEC infection during the weeks after the party. There was no evidence of secondary transmission from staff to patients. The value of PCR as a sensitive and fast method for diagnosis is discussed in this paper. Pulsed-field gel electrophoresis (PFGE) was used to ascertain that staff members were infected by the same clone, and that two patients with E. coli O157 infection were not.

Bacterial isolation rate from fertile eggs, hatching eggs, and neonatal broilers with yolk sac infection

Yolk sac infection (YSI) is a major cause of mortality of broilers during the first week post-hatching. The aim of the present-study was to analyze the possible sources of fertile egg contamination and to establish the etiology of YSI. Sixty fertile eggs, sixty sawdust samples from the nest, sixty nonfertile 19 to 21 day old incubation eggs and liver and yolk sac samples from 216 dead, 1 to 7 day old chicks, were cultured. Five hundred and eighty eight colonies were isolated and further characterized using biochemical tests. Escherichia coli was the most common bacterium recovered from all samples except the sawdust and fertile eggs collected from the nest. Fertile egg contamination at breeder farm level was found to be minimal. In broilers, both mortality and the rate of E. coli isolation were increased with the time. These results suggest that egg contamination does not occur at the breeders farm, as previously has been reported. Bacterial contamination causing YSI in vertically integrated operations can occur at a latter stage. It can be considered that the main etiologic agent of YSI is E. coli, since YSI mortality was highly correlated with E. coli isolation.

[Enterohemorrhagic Escherichia coli and hemolytic-uremic syndrome in Argentina]

The hemolytic-uremic syndrome (HUS) is a multisystemic disorder that is characterized by the onset of acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. It is the most common cause of acute renal failure and the second cause of chronic renal failure and renal transplantation in children in Argentina. Our country has the highest incidence of HUS in the world, with approximately 420 new cases observed each year with an incidence of 12.2 cases per 100,000 children in the age group 0-5 years. Numerous etiologic factors have been associated with HUS but the infection with enterohemorrhagic Escherichia coli (EHEC) is considered the most common cause. The majority of outbreaks and sporadic cases in humans have been associated with serotype O157:H7, although other O:H serotypes have been isolated, and they are a subgroup of Verocytotoxin-producing Escherichia coli (VTEC). Cattle are the principal reservoir of VTEC. Infections in humans are a consequence of consumption of undercooked meat, raw milk and other contaminated food or water. Direct contact with animals or people infected is another source of infection.

Microbial cross-contamination by airborne dispersion and contagion during defeathering of poultry

1. A readily identifiable strain of Escherichia coli K12 was used as a 'marker' organism to determine the sources, routes and patterns of microbial cross-contamination during mechanical defeathering of broiler chicken carcases. 2. Inoculation of scald water with the marker organism led to a relatively even pattern of carcase contamination during subsequent defeathering. Microbial cross-contamination was greater by this route of inoculation than by either surface inoculation of a 'seeder' carcase or oral inoculation of a live bird one day before slaughter. 3. Dispersal of the marker organism was strongly influenced by the mechanical action of the defeathering machines. Forward transmission of the marker occurred by aerosol or large airborne droplets and particulates such as feathers. Moving carcases through the defeathering machines when these were non-operational clearly reduced backward transmission of the marker. 4. Although microbial dispersal was unaffected by increasing the spacing between individual carcases or installing a water curtain at the entry and exit of the defeathering machines, shielding of carcases with aluminium baffles reduced counts of the marker organism from contaminated carcases by > 90%. 5. The results imply that microbial cross-contamination of broiler chicken carcases during defeathering occurs mainly via the airborne route, which could be contained by physical means.

Transfer of a rifampicin-resistant Escherichia coli strain among feedlot cattle

AIMS

To determine the incidence of transfer of a naturally occurring rifampicin-resistant strain of Escherichia coli (RREC) among cattle in a research feedlot.

METHODS AND RESULTS

During three separate experiments, steers in three different pens were orally inoculated with RREC originally isolated from bovine faeces. Faecal swabs were performed on all steers in the feedlot at approximately 5 week intervals thereafter. Faecal grab samples were collected from steers in the inoculated and the immediately adjacent pens for up to 4 months. In all three experiments, the inoculated steers and penmates shed RREC within 48 h, and then shed intermittently throughout the sampling periods. Transfer of RREC to steers in an adjacent pen was confirmed only during the first experiment, but never to those in non-adjacent pens. All recovered RREC isolates were compared with the inoculated strain using multiple methods indicating that all RREC isolates were descendants of the original inoculated strain.

CONCLUSIONS

Detection of the RREC strain on the pen floor and within the animal handling system, but not in the feed troughs or water bowls, suggests faecal-oral to be the primary mode of transmission among animals.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results suggest that in the absence of selective pressure, antibiotic-resistant bacteria may persist in cattle for a short duration but widespread transfer among cattle in a feedlot environment may be an exception rather than the norm. Modifications to feedlot management are discussed.

Animal host associated differences in Shiga toxin-producing Escherichia coli isolated from sheep and cattle on the same farm

AIMS

To investigate if cattle on the same farm as sheep are a possible risk factor for stx in sheep and to determine whether or not sheep and cattle on the same farm share the same stx pool.

METHODS AND RESULTS

Faecal samples from sheep and cattle were screened for stx by polymerase chain reaction (PCR). Of these samples, 87.6 and 64.6% were stx positive in sheep and cattle, respectively. There was no difference in stx occurrence in sheep from farms with or without cattle. From stx positive samples, 118 Shiga toxin-producing Escherichia coli (STEC) isolates were recovered by a filter-hybridization method. Serotyping, PCR and pulsed-field gel electrophoresis (PFGE) showed that there was a distinct association between serotypes, stx profiles and animal species.

CONCLUSIONS

Keeping animals together in pens, which enhances faecal-oral contact, is suggested as a possible explanation for the differences seen in stx occurrence. Sheep and cattle isolates are distinctly different in serotype and stx profile although isolated from the same farm, and are more related to isolates within the same serotype with the same stx profile than to isolates with different serotype from the same farm.

SIGNIFICANCE AND IMPACT OF STUDY

The study supports the animal-host relationship hypothesis suggested in other studies and indicates that the STEC sheep reservoir in Norway may not pose a serious public health risk.

Verocytoxigenic Escherichia coli in animal faeces, manures and slurries

Animal wastes and effluents from farming operations, including manures and slurries, are frequently applied as fertilizer to land used for crop or silage production and cattle grazing. It is well documented that potentially harmful pathogens including verocytoxigenic Escherichia coli (VTEC) are shed in animal faeces and there is growing concern in many countries about the number of sporadic and outbreak cases of VTEC attributable to direct contact with faecal material either as a result of handling contaminated mud in fields or ingestion of produce grown in contaminated manures or slurries. VTEC has been detected in the faeces of ruminant and non-ruminant farmed animals, wild animals, domestic pets and birds and the pathogen appears to be well adapted to survive in animal faeces and can persist for extended periods ranging from several weeks to many months. Because of this persistence these materials are important as potential vehicles for transmission within herds, farms, the fresh food chain and the wider environment. Appropriate handling of bovine faeces is necessary to control spread of this pathogen and to limit the significant risks of human infection. It may be necessary to hold manure/slurry for extended periods prior to spreading on farmland, or for use in the production of food crops, particularly foods that are to be consumed in the raw or minimally processed state. Alternatively, it may be necessary to apply processes such as composting, heat drying or digestion which can expedite the decline of pathogens including VTEC in manures. However, there is a need for research work to develop economical and practical systems for treatment of manures and slurries. The risk from direct contact with faecal material at farms and petting zoos is also recognized and many public health authorities have put forward measures for strict practices to limit the risk of infection, particularly for young children visiting these environments.