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Greig DR, Quinn OI, Rodwell EV, Olonade I, Swift C, Douglas A, Balasegram S, Jenkins C. Genomic analysis of an outbreak of Shiga toxin-producing Escherichia coli O183:H18 in the United Kingdom, 2023. Microb Genom 2024; 10:001243. [PMID: 38771013 PMCID: PMC11165631 DOI: 10.1099/mgen.0.001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
In June 2023, UKHSA surveillance systems detected an outbreak of severe gastrointestinal symptoms caused by a rare serotype of Shiga toxin-producing Escherichia coli, STEC O183:H18. There were 26 cases aged 6 months to 74 years (42 % cases were aged 0-9 years), distributed across the UK with onset dates range between 22 May 2023 and 4 July 2023. The epidemiological and food chain investigations were inconclusive, although meat products made from beef mince were implicated as a potential vehicle. The outbreak strain belonged to sequence type (ST) 657 and harboured a Shiga toxin (stx) subtype stx2a located on a prophage that was unique in the UKHSA stx-encoding bacteriophage database. Plasmid encoded, putative virulence genes subA, ehxA, saa, iha, lpfA and iss were detected, however, the established STEC virulence genes involved in attachment to the gut mucosa (eae and aggR) were absent. The acquisition of stx across the global population structure of ST657 appeared to correspond with the presence of subA, ehxA, saa, iha, lpfA and iss. During the outbreak investigation, we used long read sequencing to characterise the plasmid and prophage content of this atypical STEC, to look for evidence to explain its recent emergence. Although we were unable to determine source and transmission route of the outbreak strain, the genomic analysis revealed potential clues as to how novel strains for STEC evolve. With the implementation of PCR capable of detecting all STEC, and genome sequencing for typing and virulence profiling, we have the tools to enable us to monitor the changing landscape of STEC. Improvements in the standardised collection of epidemiological data and trace-back strategies within the food industry, will ensure we have a surveillance system capable of alerting us to emerging threats to public health.
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Affiliation(s)
- David R. Greig
- Gastrointestinal Bacteria Reference Unit, Public Health Microbiology, UK Health Security Agency, London, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Orlagh I. Quinn
- Gastrointestinal Infections & Food Safety (One Health), Clinical & Public Health, UK Health Security Agency, London, UK
| | - Ella V. Rodwell
- Gastrointestinal Bacteria Reference Unit, Public Health Microbiology, UK Health Security Agency, London, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Israel Olonade
- Gastrointestinal Bacteria Reference Unit, Public Health Microbiology, UK Health Security Agency, London, UK
| | - Craig Swift
- Gastrointestinal Bacteria Reference Unit, Public Health Microbiology, UK Health Security Agency, London, UK
| | - Amy Douglas
- Gastrointestinal Infections & Food Safety (One Health), Clinical & Public Health, UK Health Security Agency, London, UK
| | - Sooria Balasegram
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Gastrointestinal Infections & Food Safety (One Health), Clinical & Public Health, UK Health Security Agency, London, UK
| | - Claire Jenkins
- Gastrointestinal Bacteria Reference Unit, Public Health Microbiology, UK Health Security Agency, London, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
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Rodwell EV, Greig DR, Godbole G, Jenkins C. Clinical and public health implications of increasing notifications of LEE-negative Shiga toxin-producing Escherichia coli in England, 2014-2022. J Med Microbiol 2024; 73. [PMID: 38299580 DOI: 10.1099/jmm.0.001790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Introduction. Shiga toxin-producing Escherichia coli (STEC) belong to a diverse group of gastrointestinal pathogens. The pathogenic potential of STEC is enhanced by the presence of the pathogenicity island called the Locus of Enterocyte Effacement (LEE), including the intimin encoding gene eae.Gap statement. STEC serotypes O128:H2 (Clonal Complex [CC]25), O91:H14 (CC33), and O146:H21 (CC442) are consistently in the top five STEC serotypes isolated from patients reporting gastrointestinal symptoms in England. However, they are eae/LEE-negative and perceived to be a low risk to public health, and we know little about their microbiology and epidemiology.Aim. We analysed clinical outcomes and genome sequencing data linked to patients infected with LEE-negative STEC belonging to CC25 (O128:H2, O21:H2), CC33 (O91:H14) and, and CC442 (O146:H21, O174:H21) in England to assess the risk to public health.Results. There was an almost ten-fold increase between 2014 and 2022 in the detection of all STEC belonging to CC25, CC33 and CC442 (2014 n=38, 2022 n=336), and a total of 1417 cases. There was a higher proportion of female cases (55-70 %) and more adults than children, with patients aged between 20-40 and >70 most at risk across the different serotypes. Symptoms were consistent across the three dominant serotypes O91:H14 (CC33), O146:H21 (CC442) and O128:H2 (CC25) (diarrhoea >75 %; bloody diarrhoea 25-32 %; abdominal pain 64-72 %; nausea 37-45 %; vomiting 10-24 %; and fever 27-30 %). Phylogenetic analyses revealed multiple events of acquisition and loss of different stx-encoding prophage. Additional putative virulence genes were identified including iha, agn43 and subA.Conclusions. Continued monitoring and surveillance of LEE-negative STEC infections is essential due to the increasing burden of infectious intestinal disease, and the risk that highly pathogenic strains may emerge following acquisition of the Shiga toxin subtypes associated with the most severe clinical outcomes.
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Affiliation(s)
- Ella V Rodwell
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
| | - David R Greig
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Gauri Godbole
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Claire Jenkins
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
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Purk L, Kitsiou M, Ioannou C, El Kadri H, Costello KM, Gutierrez Merino J, Klymenko O, Velliou EG. Unravelling the impact of fat content on the microbial dynamics and spatial distribution of foodborne bacteria in tri-phasic viscoelastic 3D models. Sci Rep 2023; 13:21811. [PMID: 38071223 PMCID: PMC10710490 DOI: 10.1038/s41598-023-48968-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
The aim of the current study is to develop and characterise novel complex multi-phase in vitro 3D models, for advanced microbiological studies. More specifically, we enriched our previously developed bi-phasic polysaccharide (Xanthan Gum)/protein (Whey Protein) 3D model with a fat phase (Sunflower Oil) at various concentrations, i.e., 10%, 20%, 40% and 60% (v/v), for better mimicry of the structural and biochemical composition of real food products. Rheological, textural, and physicochemical analysis as well as advanced microscopy imaging (including spatial mapping of the fat droplet distribution) of the new tri-phasic 3D models revealed their similarity to industrial food products (especially cheese products). Furthermore, microbial growth experiments of foodborne bacteria, i.e., Listeria monocytogenes, Escherichia coli, Pseudomonas aeruginosa and Lactococcus lactis on the surface of the 3D models revealed very interesting results, regarding the growth dynamics and distribution of cells at colony level. More specifically, the size of the colonies formed on the surface of the 3D models, increased substantially for increasing fat concentrations, especially in mid- and late-exponential growth phases. Furthermore, colonies formed in proximity to fat were substantially larger as compared to the ones that were located far from the fat phase of the models. In terms of growth location, the majority of colonies were located on the protein/polysaccharide phase of the 3D models. All those differences at microscopic level, that can directly affect the bacterial response to decontamination treatments, were not captured by the macroscopic kinetics (growth dynamics), which were unaffected from changes in fat concentration. Our findings demonstrate the importance of developing structurally and biochemically complex 3D in vitro models (for closer proximity to industrial products), as well as the necessity of conducting multi-level microbial analyses, to better understand and predict the bacterial behaviour in relation to their biochemical and structural environment. Such studies in advanced 3D environments can assist a better/more accurate design of industrial antimicrobial processes, ultimately, improving food safety.
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Affiliation(s)
- Lisa Purk
- Bioprocess and Biochemical Engineering Group (BioProChem), Department of Chemical and Process Engineering, University of Surrey, Guildford, GU2 7XH, UK
- Centre for 3D Models of Health and Disease, Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, Fitzrovia, London, W1W 7TY, UK
| | - Melina Kitsiou
- Bioprocess and Biochemical Engineering Group (BioProChem), Department of Chemical and Process Engineering, University of Surrey, Guildford, GU2 7XH, UK
- Centre for 3D Models of Health and Disease, Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, Fitzrovia, London, W1W 7TY, UK
| | - Christina Ioannou
- Bioprocess and Biochemical Engineering Group (BioProChem), Department of Chemical and Process Engineering, University of Surrey, Guildford, GU2 7XH, UK
| | - Hani El Kadri
- Bioprocess and Biochemical Engineering Group (BioProChem), Department of Chemical and Process Engineering, University of Surrey, Guildford, GU2 7XH, UK
| | - Katherine M Costello
- Bioprocess and Biochemical Engineering Group (BioProChem), Department of Chemical and Process Engineering, University of Surrey, Guildford, GU2 7XH, UK
| | | | - Oleksiy Klymenko
- Bioprocess and Biochemical Engineering Group (BioProChem), Department of Chemical and Process Engineering, University of Surrey, Guildford, GU2 7XH, UK
| | - Eirini G Velliou
- Bioprocess and Biochemical Engineering Group (BioProChem), Department of Chemical and Process Engineering, University of Surrey, Guildford, GU2 7XH, UK.
- Centre for 3D Models of Health and Disease, Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, Fitzrovia, London, W1W 7TY, UK.
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Kintz E, Brainard J, Vanderes M, Vivancos R, Byrne L, Butt S, Jenkins C, Elson R, Lake I, Hunter P. Animal and environmental risk factors for sporadic Shiga toxin-producing Escherichia coli (STEC) infection in England: a case control study for O157, O26 and other STEC serotypes. Pathog Glob Health 2023; 117:655-663. [PMID: 37016510 PMCID: PMC10498794 DOI: 10.1080/20477724.2023.2197672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
Most Shiga toxin-producing E. coli (STEC) infections are sporadic. Routine enhanced surveillance questionnaires of confirmed STEC cases in England contained promising data to conduct a case-control study to identify non-food exposures linked to the risk of becoming infected with different STEC serotypes, including O157, O26 and all others; this study pulled eligible cases from the recorded enhanced surveillance data. Controls were recruited from the general population and answered a comparable postal questionnaire. Logistic regression was performed to identify risk factors associated with STEC infection for O157, O26 and other serotype cases. In adjusted models, travel outside of the U.K. and childcare occupations raised the risk of infection for all serotypes. Day trips within the UK, exposure to dogs and contact with soil were linked to lower infection risk. Resident region within England was often linked to decreased risk. Summer season was linked to O157 and O26, but not other STEC. Swimming in the sea was linked to increased risk of infection by O157, but not other types of STEC. Correlations between exposures and infection were similar when the analysis was repeated excluding participants with a history of foreign travel. As the first case-control study in England to include sporadic non-O157 STEC, the varying risk factors between O157 and non-O157 cases suggest there are potentially unique reservoirs for different serotypes.
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Affiliation(s)
- Erica Kintz
- Norwich Medical School, University of East Anglia, Norwich, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Julii Brainard
- Norwich Medical School, University of East Anglia, Norwich, UK
- NIHR Health Protection Research Unit in Emergency Preparedness, University of East Anglia, Norwich, UK
| | - Mike Vanderes
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Field Epidemiology Services, UK Health Security Agency, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Lisa Byrne
- Gastrointestinal Pathogens Unit, UK Health Security Agency, London, UK
| | - Saira Butt
- Gastrointestinal Pathogens Unit, UK Health Security Agency, London, UK
| | - Claire Jenkins
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- Gastrointestinal Pathogens Unit, UK Health Security Agency, London, UK
| | - Richard Elson
- Gastrointestinal Pathogens Unit, UK Health Security Agency, London, UK
- School of Environmental Sciences, University of East Anglia, Norwich, UK
| | - Iain Lake
- NIHR Health Protection Research Unit in Emergency Preparedness, University of East Anglia, Norwich, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- School of Environmental Sciences, University of East Anglia, Norwich, UK
| | - Paul Hunter
- Norwich Medical School, University of East Anglia, Norwich, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emergency Preparedness, University of East Anglia, Norwich, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
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Rodwell EV, Simpson A, Chan YW, Godbole G, McCarthy ND, Jenkins C. The epidemiology of Shiga toxin-producing Escherichia coli O26:H11 (clonal complex 29) in England, 2014-2021. J Infect 2023; 86:552-562. [PMID: 37060924 DOI: 10.1016/j.jinf.2023.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVES We aimed to describe the genomic epidemiology of the foodborne gastrointestinal pathogen, Shiga toxin-producing Escherichia coli (STEC) serotype O26:H11 belonging to clonal complex 29 (CC29) in England. METHODS Between 01 January 2014 and 31 December 2021, 834 human isolates belonging to CC29 were sequenced at the UK Health Security Agency, and the genomic data was integrated with epidemiological data. RESULTS Diagnoses of STEC O26:H11 in England have increased each year from 19 in 2014 to 144 in 2021. Most isolates had the Shiga toxin subtype profiles stx1a (47%), stx1a,stx2a (n=24%) or stx2a (n=28%). Most cases were female (57%), and the highest proportion of cases belonged to the 0-5 age group (38%). Clinical symptoms included diarrhoea (93%), blood-stained stool (48%), and abdominal pain (74%). Haemolytic Uraemic Syndrome (HUS) was diagnosed in 40/459 (9%) cases and three children died. All isolates causing STEC-HUS had stx2a either alone (n=33) or in combination with stx1a (n=7). CONCLUSIONS STEC O26:H11 are a clinically significant, emerging threat to public health in England. Determining the true incidence and prevalence is challenging due to inconsistent national surveillance strategies. Improved diagnostics and surveillance algorithms are required to monitor the true burden, detect outbreaks and to implement effective interventions.
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Affiliation(s)
- Ella V Rodwell
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK; Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK; NIHR HPRU in Gastrointestinal Infections at University of Liverpool, UK
| | - Alex Simpson
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Yung-Wai Chan
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Gauri Godbole
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK
| | - Noel D McCarthy
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, UK
| | - Claire Jenkins
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK; NIHR HPRU in Gastrointestinal Infections at University of Liverpool, UK
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Whole-Genome Analysis of Escherichia Phage vB_EcoM-S1P5QW, Isolated from Manures Collected from Cattle Farms in Maine. Microbiol Resour Announc 2022; 11:e0004122. [PMID: 35254108 PMCID: PMC9022588 DOI: 10.1128/mra.00041-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Here, we report a complete genome sequence of Escherichia phage vB_EcoM-S1P5QW, a T4-like bacteriophage that was isolated from manures collected from cattle farms in Maine. Escherichia phage vB_EcoM-S1P5QW can infect Escherichia coli O26:H11 strains and is devoid of virulence, antibiotic resistance, and lysogeny-associated genes, which may be meaningful for further biocontrol studies.
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