A model appropriate to the transmission of a human food-borne pathogen in a multigroup managed herd

We describe a model of microparasite transmission within a multigroup managed farming system. The model was formulated to represent transmission of Escherichia coli O157 within a typical UK dairy herd and was used to suggest possible on-farm control strategies. The model includes birth, death, maturation, the dry/lactating cycle and various types of transmission (i.e. direct, pseudovertical (representing direct faecal-oral transmission between dam and calf within the first 48 h) and indirect (via free-living infectious units in the environment)). A combination of numerical and analytical techniques was used to analyse the model. We found that pseudovertical transmission and indirect transmission via infectious units in the 'general' environment can lead to more groups being affected, but otherwise have relatively little effect on the invasion criteria. To reduce infection within the herd, we suggest that efforts be directed at reducing the opportunity for group-specific indirect transmission-particularly within the weaned group.

Nosocomial outbreak of diarrhoea by enterotoxigenic Escherichia coli among preterm neonates in a tertiary care hospital in India: pitfalls in healthcare

An outbreak of watery diarrhoea accompanied by low-grade fever and weight loss in 16 preterm neonates (age range 2-20 days) admitted to a neonatal intensive care unit (NICU) over four days in August 2000 is reported. Escherichia coli having similar antibiograms were identified on routine bacterial stool cultures in 14 (87.5%) neonates and none of the other known enteropathogens were detected. An investigation was undertaken to trace the source of infection. Surveillance cultures of swabs from the utensils used to prepare milk feed, culture of the formula feed and all items handled by one particular cook yielded growth of E. coli as did culture of his hand swabs and faecal sample. The causative agent was identified as enterotoxigenic E. coli (ETEC) as toxin production could be demonstrated by reverse passive latex agglutination in all the strains of E. coli isolated both from the infected neonates and the source of infection. The outbreak was effectively controlled by appropriate therapy and institution of proper measures of hygiene after identification of the source of infection.

Hemolytic-uremic syndrome associated with enterohemorrhagic Escherichia coli O26:H infection and consumption of unpasteurized cow's milk

BACKGROUND

Enterohemorrhagic Escherichia coli (EHEC) O26 has emerged as a significant cause of hemolytic-uremic syndrome (HUS). The source and the vehicle of contamination with EHEC O26 are not often identified. We report two Austrian cases of HUS due to E. coli O26:H- affecting an 11-month-old boy and a 28-month-old girl in which transmission through unpasteurized cow's milk was positively identified.

METHODS AND RESULTS

Using automated ribotyping and pulsed-field gel electrophoresis (PFGE), the isolates (which yielded the virulence genes stx2, eae, and hly) were indistinguishable from each other. An epidemiologic investigation revealed that the children had stayed in the same hotel. Both patients had consumed unpasteurized cow's milk from the breakfast buffet. Fecal samples were taken from the cows of the farm producing the incriminating milk, and one of three cattle EHEC O26:H- isolates had a PFGE pattern indistinguishable from that of the patients' strains.

CONCLUSIONS

These two cases of E. coli O26 infection illustrate the hazards associated with the consumption of raw milk, and underline the importance of microbiological diagnostic approaches able to detect sorbitol-fermenting, non-O157 EHEC.

Detection, isolation, and molecular subtyping of Escherichia coli O157:H7 and Campylobacter jejuni associated with a large waterborne outbreak

The largest reported outbreak of waterborne Escherichia coli O157:H7 in the United States occurred in upstate New York following a county fair in August 1999. Culture methods were used to isolate E. coli O157:H7 from specimens from 128 of 775 patients with suspected infections. Campylobacter jejuni was also isolated from stools of 44 persons who developed diarrheal illness after attending this fair. There was one case of a confirmed coinfection with E. coli O157:H7 and C. jejuni. Molecular detection of stx(1) and stx(2) Shiga toxin genes, immunomagnetic separation (IMS), and selective culture enrichment were utilized to detect and isolate E. coli O157:H7 from an unchlorinated well and its distribution points, a dry well, and a nearby septic tank. PCR for stx(1) and stx(2) was shown to provide a useful screen for toxin-producing E. coli O157:H7, and IMS subculture improved recovery. Pulsed-field gel electrophoresis (PFGE) was used to compare patient and environmental E. coli O157:H7 isolates. Among patient isolates, 117 of 128 (91.5%) were type 1 or 1a (three or fewer bands different). Among the water distribution system isolates, 13 of 19 (68%) were type 1 or 1a. Additionally, PFGE of C. jejuni isolates revealed that 29 of 35 (83%) had indistinguishable PFGE patterns. The PFGE results implicated the water distribution system as the main source of the E. coli O157:H7 outbreak. This investigation demonstrates the potential for outbreaks involving more than one pathogen and the importance of analyzing isolates from multiple patients and environmental samples to develop a better understanding of bacterial transmission during an outbreak.

Uropathogenic Escherichia coli are more likely than commensal E. coli to be shared between heterosexual sex partners

Because uropathogenic Escherichia coli are better adapted than other E. coli to the urethra, periurethra, and vagina, the authors reasoned that uropathogenic E. coli would be more likely than commensal E. coli to be shared between sex partners. In this 1996-1999 Michigan study, the genetic identity of E. coli isolated from 166 women with E. coli urinary tract infection (UTI) and 94 women without UTI and their sex partners was determined by pulsed-field gel electrophoresis. Rectal isolates were considered uropathogenic E. coli if genetically identical to the urinary isolate causing UTI. All eight urinary isolates from men with UTI partners were identical to the E. coli found in the urine or vagina of their sex partner. When the 550 unique rectal E. coli isolates from couples were considered the unit of analysis, E. coli that caused UTI were nine times (odds ratio (OR) = 8.87, 95% confidence interval (CI): 5.41, 14.54) more likely than other E. coli to be shared between sex partners. Sharing occurred twice as frequently (OR = 1.87, 95% CI: 1.13, 3.08) if the E. coli had P pili or if the couples engaged in oral sex (OR = 2.09, 95% CI: 1.09, 4.00). Uropathogenic E. coli are more likely than commensal E. coli to be shared with a current heterosexual sex partner. Both sexual behaviors and a bacterial virulence factor, P pili, modified sharing.

Enterohemorrhagic Escherichia coli O157: epidemiology and ecology in bovine production environments

Enterohemorrhagic Escherichia coli, particularly the O157(:H7) serogroup, has become a worldwide public health concern. Since cattle feces are often implicated as the source of E. coli O157 in human infections, considerable resources have been devoted to defining the epidemiology and ecology of E. coli O157 in cattle environments so that control might begin at the farm level. Diagnostic limitations and the complexity of often interrelated microbial, animal, herd, environmental and production factors have hindered the determination of the epidemiology, ecology and subsequent farm-level control of E. coli O157. The widespread distribution of E. coli O157, the transitory nature of fecal shedding, multiple potential environmental sources, lack of species specificity, and age-, feed- and time-related differences in cattle prevalence are documented. However, the significance and/or role of these factors in the epidemiology and ecology of E. coli O157 is still unclear. Cattle are a major source of E. coli O157, but it may be simplistic to believe that most herds are relatively closed systems with small percentages of cattle serving as true reservoirs. Practical on-farm control may require explicit definitions of the seemingly complex system(s) and the microbial, animal, herd, environmental and production factors involved in themultiplication, maintenance and transmission of E. coli O157.

Survival of Escherichia coli O157:H7 in farm water: its role as a vector in the transmission of the organism within herds

AIMS

The study aimed to investigate the survival characteristics of Escherichia coli O157:H7 in farm water (FW), and in sterile distilled municipal water (SDW), stored outdoors under field conditions, with or without the addition of faeces (1% w/v), in a farmyard shed and the laboratory at 15 degrees C.

METHODS AND RESULTS

Water samples were inoculated with E. coli O157:H7 at 10(3) and 10(6) ml(-1), and sampled over a 31-day period. In FW stored outdoors in a field, E. coli O157:H7 survived for 14 days at temperatures <15 degrees C, at both inoculation levels, while in the laboratory at 15 degrees C, the organism was still detectable at low levels (<1 log10 cfu ml(-1)) after 31 days. The addition of bovine faeces to water outdoors (1% w/v) resulted in survival for 24 days. In SDW inoculated at 10(6) ml(-1) and stored in the laboratory (15 degrees C), only a 2.5 log reduction was observed after 31 days, while the organism could not be detected after 17 days in the field. Preliminary screening of water samples stored outdoors isolated a bacterium which exhibited antimicrobial activity towards E. coli O157:H7.

CONCLUSIONS

The survival of E. coli O157:H7 observed in this study illustrates the potential of farm water to act as a vehicle in the transfer of the organism across a herd.

SIGNIFICANCE AND IMPACT OF THE STUDY

The difficulty in extrapolating results from controlled laboratory situations to on-farm conditions is also highlighted in this study.

Prevalence and characteristics of intimin- and Shiga toxin-producing Escherichia coli from gulls, pigeons and broilers in Finland

The role of birds as sources of Shiga toxin-and intimin-producing Escherichia coli was studied. Fecal samples from live gulls (n=86), pigeons (n=33) and broiler chickens (n=199) from 23 flocks were analyzed for stx and eae by PCR. No stx positive samples were detected. In contrast, eae E. coli were highly prevalent among gulls (40%), and was also found in pigeons (7%) and chickens (57% of the flocks contaminated). The eae positive isolates were analyzed genetically and O-serogrouped. One isolate from a pigeon was found to have stx (2f). The isolates of gulls differed from those of pigeons and chickens, and all eae E. coli isolates from birds differed from human pathogenic strains by the lack of EHEC-hlyA and bfp/EAF as well as distribution of O-serogroups. Thus, birds cannot be regarded as important carriers of zoonotic stx or eae E. coli in Finland.

Long-term excretion of Shiga toxin-producing Escherichia coli (STEC) and experimental infection of a sheep with O157

To investigate a long-term shedding of Shiga toxin (Stx)-producing Escherichia coli (STEC) from sheep, a fifteen-month study for STEC isolation from a sheep, which had yielded STEC before, was attempted. The sheep continued to shed STEC and 39 STEC were isolated. The number of STEC in the feces was estimated at 1.7 x 10(3) per gram. In addition, although Stx1-negative O157 and stx2-encoding bacteriophage were experimentally infected to the sheep, Stx-positive O157 or Stx2- producing bacterial cells were not detected. The genetical and biochemical characterization of those 39 STEC strains showed that all STEC strains produced Shiga toxin 1 (Stx1) and were divided into three classes (I to III). From phylogenetic analysis of their amino acid sequences, class-I STEC was classified as group 1 comprising mainly human STEC, and classes II/III were as group 2 comprising sheep STEC. Our results suggest that STEC easily colonized in sheep and that the sheep continued to shed STEC, showing that sheep might be an important reservoir for human STEC infection.

[Development and application of a method for isolating Escherichia coli O157:H7 in the city of Gualeguaychú]

Culture media, reagents, and commercial kits were compared on artificially contaminated food samples. The objective was to find an isolation method for Escherichia coli O157:H7 sensitive, specific and accessible in terms of cost, requirements of equipments and qualification of the analyst. The adopted scheme consisted in a selective enrichment at 42 degrees C during 18 to 24 h, using an appropriate medium, in accordance with the nature of the sample, followed by a step of immunomagnetic separation and simultaneous isolation on a chromogenic agar and MacConkey sorbitol agar with potassium tellurite and cefixime, during 18-24 h at 37 degrees C. The presumptive colonies were confirmed as E. coli O157 by serological and biochemical tests. Secondly, this methodology was applied to food samples, water, bovine gastric content and manure. A total of 410 samples were studied: 279 from meat, 54 milk and dairy products, 6 from vegetables, 27 water samples and 44 bovine gastric content and manure. The frequency of isolation of E. coli O157:H7 was of 3.9%. The phenotypic and genotypic characterization of the isolates was performed. A simple isolation methodology for E. coli O157 was developed, which proved accessible to food laboratories of lower complexity. This methodology allowed the detection of this pathogen in food and environmental samples in Gualeguaychú City. The role of water as vehicle of infection was also established. The strains harbored the same virulence factors as those recovered from human disease.

An outbreak of Escherichia coli O157:H7 infections among visitors to a dairy farm

BACKGROUND

Outbreaks of Escherichia coli O157:H7 infections have involved direct transmission from animals and their environment to humans. We describe an outbreak among visitors to a Pennsylvania dairy and petting farm that provides public access to animals.

METHODS

We conducted both a case-control study among visitors to a farm to identify risk factors for infection and a household survey to determine the rates of diarrheal illness among these visitors. We performed an extensive environmental study to identify sources of E. coli O157:H7 on the farm.

RESULTS

Fifty-one patients with confirmed or suspected E. coli O157:H7 infection were enrolled in the case-control study. The median age of the patients was four years, and the hemolytic-uremic syndrome developed in eight. Contact with calves and their environment was associated with an increased risk of infection, whereas hand washing was protective. The household survey indicated that visitors to the farm during the outbreak had higher than expected rates of diarrhea. Environmental studies showed that 28 of the 216 cattle on the farm (13 percent) were colonized with E. coli O157:H7 that had the same distinct pattern on pulsed-field gel electrophoresis that was found in isolates from the patients. This organism was also recovered from surfaces that were accessible to the public.

CONCLUSIONS

In a large outbreak of E. coli O157:H7 infections among visitors to a dairy farm, predominantly children, high rates of carriage of E. coli O157:H7 among calves and young cattle most likely resulted in contamination of both the animals' hides and the environment.

Emerging foodborne pathogens: keeping your patients and your families safe

Changes in food production and societal pressures have led to a continuing increase in the incidence of foodborne illness. Many pathogens are associated with specific foods, e.g., E. coli O157:H7 with hamburgers or Salmonella with eggs. The U.S. Food and Drug Administration has recently approved irradiation for sterilization of meat, but public acceptance of irradiated food is low. Because contaminated foods are seldom detected before they reach store shelves, care in food preparation by professional and home cooks is crucial.

Horizontal transmission of Shiga toxin-producing Escherichia coli within groups of dairy calves

To examine the dissemination of Shiga-toxigenic Escherichia coli (STEC) within cattle groups, dairy calves on two farms utilizing different calf-rearing practices were exposed to a traceable STEC strain. Test strain dissemination differed significantly between farms, with a higher prevalence being associated with group penning. Pen floors and calf hides may be the main environmental mechanisms of transmission. Dairy calf husbandry represents a control point for reducing on-farm STEC prevalence.

Enteric pathogens in Mexican sauces of popular restaurants in Guadalajara, Mexico, and Houston, Texas

BACKGROUND

The transmission of traveler's diarrhea is primarily foodborne.

OBJECTIVE

To examine the level of microbial contamination of tabletop sauces found in Mexican-style restaurants.

DESIGN

Cross-sectional study of Mexican sauces.

SETTING

Mexican restaurants in Guadalajara, Mexico, and Houston, Texas, during the summer of 1998.

MEASUREMENTS

71 sauces from Guadalajara and 25 sauces from Houston were examined. The number of sauces contaminated with Escherichia coli, the median number of E. coli colonies per gram of sauce, and enteropathogens were identified.

RESULTS

47 of 71 sauces from Guadalajara were contaminated with E. coli versus 10 of 25 sauces from Houston (P = 0.03); the median number of E. coli colonies per gram of sauce was 1000 in the Guadalajara sauces versus 0.0 in the Houston sauces (P = 0.007). Among sauces from Guadalajara tested for diarrheogenic E. coli, 4 of 43 sauces contained enterotoxigenic E. coli and 14 of 32 contained enteroaggregative E. coli.

CONCLUSIONS

Contamination with E. coli was common in samples of Mexican tabletop sauces from Guadalajara restaurants. These sauces commonly contained enteric pathogens.

Faecal carriage of verocytotoxin-producing Escherichia coli O157 in cattle and sheep at slaughter in Great Britain

A 12-month abattoir survey was conducted between January 1999 and January 2000, to determine the prevalence of faecal carriage of verocytotoxin-producing Escherichia coli O157 (VTEC O157) in cattle and sheep slaughtered for human consumption in Great Britain. Samples of rectum containing faeces were collected from 3939 cattle and 4171 sheep at 118 abattoirs, in numbers proportional to the throughput of the premises. The annual prevalence of faecal carriage of VTEC O157 was 4.7 per cent (95 per cent confidence interval 4.1 to 5.4) for cattle and 1.7 per cent (1.3 to 2.1) for sheep, values which were statistically significantly different from each other (P < 0.001). The organisms were recovered from both cattle and sheep slaughtered throughout the year and at abattoirs in all regions of the country, but the highest prevalence was in the summer. The most frequency recovered VTEC O157 isolates were phage types 2, 8 and 21/28 in cattle and 4 and 32 in sheep, the five most frequently isolated phage types associated with illness in people in Great Britain during the same period.

Quantitative risk assessment of human infection from Escherichia coli O157 associated with recreational use of animal pasture

A quantitative microbial risk assessment incorporating Monte Carlo simulations is described which estimates the probability of Escherichia coli O157 infection of humans by visiting pasture previously grazed by cattle. The risk assessment is performed for a number of scenarios including a variation in the grazing period prior to the human visit, the duration of visit (8-h day or 24-h camp) and the level of E. coli O157 shed by the cattle. Assuming the cattle have been on the field for 28 days, followed directly by a human visit, and the proportion of animals shedding the organism are as described in previous surveys 5 +/- 1% (Synge, B.A., Gunn, G.J., Ternent, H.E., Hopkins, G.F., Thomson-Carter, F., Foster, G., Chase-Topping, M., McKendrick, I., 2001). Prevalence and factors affecting the shedding of verocytotoxin producing Escherichia coli O157 in beef cattle in Scotland. In: Concerted Action CT98-3935 Veroctotoxigenic E. coli in Europe, 5. Epidemiology of Verocytotoxigenic E. coli, Dublin, pp. 98-103.), a probability of infection of 0.1% is attained for 8- and 24-h periods when the cattle are shedding approximately 10(3) and 10(4) CFU g(-1), respectively. Monte Carlo simulations demonstrated that risk mitigation strategies of removing cattle from the pasture 4 weeks prior to the human visit in addition to physical removal of faeces showed significant reductions in potential infection rates.

Deer meat as the source for a sporadic case of Escherichia coli O157:H7 infection, Connecticut

We report a case of Escherichia coli O157:H7, which was acquired by eating wild White-Tailed deer (Odocoileus virginianus). DNA fingerprint analysis verified venison as the source of infection. This pediatric case emphasizes the need for dissemination of information to hunters regarding the safe handling and processing of venison.

Shiga toxin-producing Escherichia coli infection and antibodies against Stx2 and Stx1 in household contacts of children with enteropathic hemolytic-uremic syndrome

Ninety-five household contacts (aged 2 months to 73 years) of patients with enteropathic hemolytic-uremic syndrome (HUS) were investigated for the presence of immunoglobulin (Ig) G antibodies to Shiga toxins Stx2 and Stx1 by Western blot assay. Thirty-one percent of the household contacts and 19% of 327 controls had anti-Stx2 IgG (heavy and light chain [H + L]), 5 and 8%, respectively, had anti-Stx1 IgG (H + L), and 3 and 2%, respectively, had both anti-Stx2 and anti-Stx1 IgG (H + L). The incidence of infections with Stx-producing Escherichia coli (STEC) was determined based on the following diagnostic criteria: STEC isolation, detection of stx gene sequences, free fecal Stx in stool filtrates, and serum IgM antibodies against E. coli O157 lipopolysaccharide. Evidence of STEC infection was observed in 25 household contacts, of whom 18 (72%) were asymptomatic and represented a potential source of infection. Six of 13 (46%) household contacts with Stx2-producing E. coli O157:H7 in stool culture developed anti-Stx2 IgG (H + L), compared to 71% of Stx2-associated HUS cases. In individuals showing anti-Stx2 IgG (H + L), the antibody response was directed against the B subunit in 69% of household contacts and 71% of controls, in contrast to 28% of HUS patients. In this investigation controls had a significant increase of the median of IgM antibodies to O157 lipopolysaccharide (LPS) with age, up to the fifth decade. The lack of disease in household contacts with B subunit-specific antibodies, as well as the significantly higher median of anti-O157 LPS IgM antibodies in controls beyond 4.9 years of age, suggests a protective role for anti-Stx and anti-O157 LPS antibodies.

Shedding of Escherichia coli O157:H7 in dairy cattle housed in a confined environment following waterborne inoculation

A study of Escherichia coli O157:H7 transmission and shedding was conducted with bull calves housed in individual pens within a confined environment. For comparative purposes, the numbers and duration of E. coli O157:H7 shedding in naturally infected calves were monitored after a single purchased calf (calf 156) tested positive prior to inoculation. During the next 8 days, the calves in adjacent pens and a pen directly across a walkway from calf 156 began to shed this serotype O157:H7 strain. Five of the eight calves in this room shed this O157:H7 strain at some time during the following 8 weeks. The numbers of E. coli O157:H7 isolates shed in these calves varied from 60 to 10(5) CFU/g of feces, and the duration of shedding ranged from 17 to >31 days. The genomic DNAs from isolates recovered from these calves were indistinguishable when compared by using XbaI digestion and pulsed-field gel electrophoresis. Inoculation of calves with 1 liter of water containing ca. 10(3) to 10(4) CFU of E. coli O157:H7/ml resulted in shedding in 10 of 12 calves (trial 1, 4 of 4 calves; trial 2, 6 of 8 calves). The inoculated calves shed the inoculation strain (FRIK 1275) as early as 24 h after administration. The duration of shedding varied from 18 to >43 days at levels from 10(2) to 10(6) CFU/g of feces. The numbers of doses necessary to initiate shedding varied among calves, and two calves in trial 2 never shed FRIK 1275 after four doses (ca. 10(6) CFU per dose). Results from this study confirm previous reports of animal-to-animal and waterborne dissemination of E. coli O157:H7 and highlight the need for an effective water treatment to reduce the spread of this pathogen in cattle.

Outbreak of Vero cytotoxin-producing Escherichia coli O157 in a child day care facility

In December 1998, an outbreak of Vero cytotoxin-producing Escherichia coli (VTEC) O157 in a crèche affected ten out of 45 children and one out of five staff members. Eight cases were symptomatic and three were asymptomatic. There were two asymptomatic adult family contacts of child cases. All specimens were identified as VTEC O157:H7, phage type 32. None of the cases were seriously ill and none developed haemolytic uraemic syndrome (HUS). One child continued to excrete the organism for 14 weeks. The origin of the outbreak was not found but epidemiological investigation was suggestive of person-to-person spread. All children and staff were screened and excluded from the crèche until microbiological clearance was obtained. An inspection of the crèche revealed overcrowding and inadequacies in cleaning and in the food preparation facilities. These problems were remedied before children were re-admitted to the crèche. This outbreak demonstrates the ease with which VTEC O157 can be transmitted between small children. Two specific features of this outbreak were notable: (1) the mild self-limiting nature of the illness and (2) the prolonged shedding of the bacterium by one child.