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Hasona IF, Helmy SM, El Gamal AM. Prevalence, virulence factors, and antimicrobial resistance profiles of Shiga toxin-producing Escherichia coli isolated from broiler chickens in Egypt. VETERINARY RESEARCH FORUM : AN INTERNATIONAL QUARTERLY JOURNAL 2023; 14:131-138. [PMID: 37033777 PMCID: PMC10073808 DOI: 10.30466/vrf.2021.539418.3233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/20/2021] [Indexed: 04/11/2023]
Abstract
Pathogenic Escherichia coli is one of the world's most important zoonotic foodborne pathogens and poses a serious threat to public health. We examined the prevalence, virulence genes, and antibiotic resistance profile of Shiga toxin (Stx)-producing E. coli (STEC) isolated from broiler chickens in the Kafr El-Sheikh governorate, Egypt. A total of 410 samples (230 cloacal swabs, 180 internal organs) were collected to isolate E. coli. A total of 29 (7.07%) E. coli isolates were recovered and identified, and 18 of them harbored Stx genes (stx). Out of 18 isolates, five (17.24%) carried the stx 1 gene, five (17.24%) carried the stx 2 gene, four (13.79%) carried both stx 1 and stx 2 genes, and four (13.79%) carried stx 1 , stx 2 , and eae A genes. Overall, complete anti-biotic resistance was observed against amoxicillin, ampicillin, cefpodoxime, and cefoperazone; high resistance was observed against ampicillin/sulbactam, nalidixic acid, cefuroxime, aztreonam, ciprofloxacin, ceftriaxone, chloramphenicol, sulfamethoxazole/trimethoprim, and ceftazidime; moderate resistance against gentamicin; low resistance against cefoxitin; lower resistance was detected against norfloxacin, cefotetan, and amikacin; and the lowest resistance against imipenem. All E. coli isolates demonstrated multidrug resistance against at least four antibiotic classes. Out of 29 E. coli isolates, STEC accounted for 18 isolates, of which the O78, O26:H11, O128:H2, O1:H7, O119:H6, and O91:H21 serogroups were predominant. All E. coli isolates were multidrug resistant and therefore pose a potential public health concern as these virulent, resistant strains may spread to humans. Thus, high levels of hygiene and biosecurity are required by chicken handlers to decrease the danger of infection spreading to humans.
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Affiliation(s)
- Ibtisam Faeq Hasona
- Department of Bacteriology, Mycology, and Immunology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt;
- Correspondence: Ibtisam Faeq Hasona. BSc, MSc, Department of Bacteriology, Mycology, and Immunology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt. E-mail:
| | - Salwa Mahmoud Helmy
- Department of Bacteriology, Mycology, and Immunology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt;
| | - Adel Mohammad El Gamal
- Unit of Bacteriology, Animal Health Research Institute, Kafr El-Sheikh Branch, Agriculture Research Center (ARC), Egypt.
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Navarro A, van der Ploeg C, Rogé A, Licona-Moreno D, Delgado G, Morales-Espinosa R, Cravioto A, Eslava C. Diversity of Potentially Pathogenic Escherichia coli O104 and O9 Serogroups Isolated before 2011 from Fecal Samples from Children from Different Geographic Regions. Microorganisms 2021; 9:2227. [PMID: 34835353 PMCID: PMC8619403 DOI: 10.3390/microorganisms9112227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/21/2022] Open
Abstract
In 2011, an outbreak of hemorrhagic colitis and hemolytic uremic syndrome (HUS) was reported in Europe that was related to a hybrid STEAEC of Escherichia coli (E. coli) O104:H4 strain. The current study aimed to analyze strains of E. coli O104 and O9 isolated before 2011. The study included 47 strains isolated from children with and without diarrhea between 1986 and 2009 from different geographic regions, as well as seven reference strains. Serotyping was carried out on 188 anti-O and 53 anti-H sera. PCR was used to identify DEC genes and phylogenetic groups. Resistance profiles to antimicrobials were determined by diffusion in agar, while PFGE was used to analyze genomic similarity. Five serotypes of E. coli O104 and nine of O9 were identified, as well as an antigenic cross-reaction with one anti-E. coli O9 serum. E. coli O104 and O9 presented diarrheagenic E. coli (DEC) genes in different combinations and were located in commensal phylogenetic groups with different antimicrobial resistance. PFGE showed that O104:H4 and O9:(H4, NM) strains from SSI, Bangladesh and México belong to a diverse group located in the same subgroup. E. coli O104 and O9 were classified as commensal strains containing DEC genes. The groups were genetically diverse with pathogenic potential making continued epidemiologic surveillance important.
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Affiliation(s)
- Armando Navarro
- Public Health Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Avenida Universidad 3000, Ciudad Universitaria, México City 04510, Mexico;
| | - Claudia van der Ploeg
- Servicio de Antígenos y Antisueros, Instituto Nacional de Producción de Biológicos (INPB)—ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires 1282, Argentina; (C.v.d.P.); (A.R.)
| | - Ariel Rogé
- Servicio de Antígenos y Antisueros, Instituto Nacional de Producción de Biológicos (INPB)—ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires 1282, Argentina; (C.v.d.P.); (A.R.)
| | - Delia Licona-Moreno
- Public Health Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Avenida Universidad 3000, Ciudad Universitaria, México City 04510, Mexico;
| | - Gabriela Delgado
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, México City 04510, Mexico; (G.D.); (R.M.-E.)
| | - Rosario Morales-Espinosa
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, México City 04510, Mexico; (G.D.); (R.M.-E.)
| | - Alejandro Cravioto
- Faculty of Medicine, Universidad Nacional Autónoma de México, México City 04510, Mexico;
| | - Carlos Eslava
- Peripheral Unit of Basic and Clinical Research in Infectious Diseases, Public Health Department, Research Division, Faculty of Medicine Universidad Nacional Autónoma de México, Bacterial Pathogenicity Laboratory, Hemato-Oncology and Research Unit, Children’s Hospital of Mexico Federico Gómez, Dr. Márquez 162, Col. De los Doctores, México City 06720, Mexico;
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Santos ACDM, Santos FF, Silva RM, Gomes TAT. Diversity of Hybrid- and Hetero-Pathogenic Escherichia coli and Their Potential Implication in More Severe Diseases. Front Cell Infect Microbiol 2020; 10:339. [PMID: 32766163 PMCID: PMC7381148 DOI: 10.3389/fcimb.2020.00339] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022] Open
Abstract
Although extraintestinal pathogenic Escherichia coli (ExPEC) are designated by their isolation site and grouped based on the type of host and the disease they cause, most diarrheagenic E. coli (DEC) are subdivided into several pathotypes based on the presence of specific virulence traits directly related to disease development. This scenario of a well-categorized E. coli collapsed after the German outbreak of 2011, caused by one strain bearing the virulence factors of two different DEC pathotypes (enteroaggregative E. coli and Shiga toxin-producing E. coli). Since the outbreak, many studies have shown that this phenomenon is more frequent than previously realized. Therefore, the terms hybrid- and hetero-pathogenic E. coli have been coined to describe new combinations of virulence factors among the classic E. coli pathotypes. In this review, we provide an overview of these classifications and highlight the E. coli genomic plasticity that results in some mixed E. coli pathotypes displaying novel pathogenic strategies, which lead to a new symptomatology related to E. coli diseases. In addition, as the capacity for genome interrogation has grown in the last few years, it is clear that genes encoding some virulence factors, such as Shiga toxin, are found among different E. coli pathotypes to which they have not traditionally been associated, perhaps foreshowing their emergence in new and severe outbreaks caused by such hybrid strains. Therefore, further studies regarding hetero-pathogenic and hybrid-pathogenic E. coli isolates are necessary to better understand and control the spread of these pathogens.
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Affiliation(s)
- Ana Carolina de Mello Santos
- Disciplina de Microbiologia, Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Fernanda Fernandes Santos
- Disciplina de Microbiologia, Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rosa Maria Silva
- Disciplina de Microbiologia, Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tânia Aparecida Tardelli Gomes
- Disciplina de Microbiologia, Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Lang C, Fruth A, Holland G, Laue M, Mühlen S, Dersch P, Flieger A. Novel type of pilus associated with a Shiga-toxigenic E. coli hybrid pathovar conveys aggregative adherence and bacterial virulence. Emerg Microbes Infect 2018; 7:203. [PMID: 30514915 PMCID: PMC6279748 DOI: 10.1038/s41426-018-0209-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/09/2018] [Accepted: 11/11/2018] [Indexed: 01/31/2023]
Abstract
A large German outbreak in 2011 was caused by a locus of enterocyte effacement (LEE)-negative enterohemorrhagic E. coli (EHEC) strain of the serotype O104:H4. This strain harbors markers that are characteristic of both EHEC and enteroaggregative E. coli (EAEC), including aggregative adhesion fimbriae (AAF) genes. Such rare EHEC/EAEC hybrids are highly pathogenic due to their possession of a combination of genes promoting severe toxicity and aggregative adhesion. We previously identified novel EHEC/EAEC hybrids and observed that one strain exhibited aggregative adherence but had no AAF genes. In this study, a genome sequence analysis showed that this strain belongs to the genoserotype O23:H8, MLST ST26, and harbors a 5.2 Mb chromosome and three plasmids. One plasmid carries some EAEC marker genes, such as aatA and genes with limited protein homology (11–61%) to those encoding the bundle-forming pilus (BFP) of enteropathogenic E. coli. Due to significant protein homology distance to known pili, we designated these as aggregate-forming pili (AFP)-encoding genes and the respective plasmid as pAFP. The afp operon was arranged similarly to the operon of BFP genes but contained an additional gene, afpA2, which is homologous to afpA. The deletion of the afp operon, afpA, or a nearby gene (afpR) encoding an AraC-like regulator, but not afpA2, led to a loss of pilin production, piliation, bacterial autoaggregation, and importantly, a >80% reduction in adhesion and cytotoxicity toward epithelial cells. Gene sets similar to the afp operon were identified in a variety of aatA-positive but AAF-negative intestinal pathogenic E. coli. In summary, we characterized widely distributed and novel fimbriae that are essential for aggregative adherence and cytotoxicity in a LEE-negative Shiga-toxigenic hybrid.
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Affiliation(s)
- Christina Lang
- Division of Enteropathogenic Bacteria and Legionella, Robert Koch Institut, Wernigerode, Saxony-Anhalt, 38855, Germany
| | - Angelika Fruth
- Division of Enteropathogenic Bacteria and Legionella, Robert Koch Institut, Wernigerode, Saxony-Anhalt, 38855, Germany
| | - Gudrun Holland
- Division of Advanced Light and Electron Microscopy, Robert Koch Institut, Berlin, 13353, Germany
| | - Michael Laue
- Division of Advanced Light and Electron Microscopy, Robert Koch Institut, Berlin, 13353, Germany
| | - Sabrina Mühlen
- Department of Molecular Infection Biology, Helmholtz Centre for Infection Research, Braunschweig, Lower Saxony, 38124, Germany
| | - Petra Dersch
- Department of Molecular Infection Biology, Helmholtz Centre for Infection Research, Braunschweig, Lower Saxony, 38124, Germany
| | - Antje Flieger
- Division of Enteropathogenic Bacteria and Legionella, Robert Koch Institut, Wernigerode, Saxony-Anhalt, 38855, Germany.
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Pro-inflammatory capacity of Escherichia coli O104:H4 outbreak strain during colonization of intestinal epithelial cells from human and cattle. Int J Med Microbiol 2018; 308:899-911. [PMID: 29937390 DOI: 10.1016/j.ijmm.2018.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022] Open
Abstract
In 2011, Germany was struck by the largest outbreak of hemolytic uremic syndrome. The highly virulent E. coli O104:H4 outbreak strain LB226692 possesses a blended virulence profile combining genetic patterns of human adapted enteroaggregative E. coli (EAEC), rarely detected in animal hosts before, and enterohemorrhagic E. coli (EHEC), a subpopulation of Shiga toxin (Stx)-producing E. coli (STEC) basically adapted to the ruminant host. This study aimed at appraising the relative level of adaptation of the EAEC/EHEC hybrid strain LB226692 to humans and cattle. Adherence and invasion of the hybrid strain to intestinal (jejunal and colonic) epithelial cells (IEC) of human and bovine origin was compared to that of E. coli strains representative of different pathovars and commensal E. coli by means of light and electron microscopy and culture. Strain-specific host gene transcription profiles of selected cytokines and chemokines as well as host-induced transcription of bacterial virulence genes were assessed. The release of Stx upon host cell contact was quantified. The outbreak strain's immunomodulation was assessed by cultivating primary bovine macrophages with conditioned supernatants from IEC infection studies with E. coli, serving as model for the innate immunity of the bovine gut. The outbreak strain adhered to IEC of both, human and bovine origin. Electron microscopy of infected cells revealed the strain's particular affinity to human small IEC, in contrast to few interactions with bovine small IEC. The outbreak strain possessed a high-level of adhesive power, similar to human-associated E. coli strains and in contrast to bovine-associated STEC strains. The outbreak strain displayed a non-invasive phenotype, in contrast to some bovine-associated E. coli strains, which were invasive. The outbreak strain provoked some pro-inflammatory activity in human cells, but to a lower extent as compared to other pathotypes. In contrasts to bovine-associated E. coli strains, the outbreak strain induced marked pro-inflammatory activity when interacting with bovine host cells directly (IEC) and indirectly (macrophages). Among stx2-positive strains, the human-pathogenic strains (LB226692 and EHEC strain 86-24) released higher amounts of Stx compared to bovine-associated STEC. The findings imply that the outbreak strain is rather adapted to humans than to cattle. However, the outbreak strain's potential to colonize IEC of both host species and the rather mixed reaction patterns observed for all strains under study indicate, that even STEC strains with an unusual genotype as the EHEC O104:H4 outbreak strain, i.e. with an EAEC genetic background, may be able to conquer other reservoir hosts.
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Köckerling E, Karrasch L, Schweitzer A, Razum O, Krause G. Public Health Research Resulting from One of the World's Largest Outbreaks Caused by Entero-Hemorrhagic Escherichia coli in Germany 2011: A Review. Front Public Health 2017; 5:332. [PMID: 29312915 PMCID: PMC5732330 DOI: 10.3389/fpubh.2017.00332] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 11/23/2017] [Indexed: 02/04/2023] Open
Abstract
In 2011, Germany experienced one of the largest outbreaks of entero-hemorrhagic Escherichia coli (EHEC) ever reported. Four years thereafter, we systematically searched for scientific publications in PubMed and MEDPILOT relating to this outbreak in order to assess the pattern of respective research activities and to assess the main findings and recommendations in the field of public health. Following PRISMA guidelines, we selected 133 publications, half of which were published within 17 months after outbreak onset. Clinical medicine was covered by 71, microbiology by 60, epidemiology by 46, outbreak reporting by 11, and food safety by 9 papers. Those on the last three topics drew conclusions on methods in surveillance, diagnosis, and outbreak investigation, on resources in public health, as well as on inter-agency collaboration, and public communication. Although the outbreak primarily affected Germany, most publications were conducted by multinational cooperations. Our findings document how soon and in which fields research was conducted with respect to this outbreak.
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Affiliation(s)
- Elena Köckerling
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany.,Department Münster, Institute for Rehabilitation Research IfR, Münster, Germany
| | - Laura Karrasch
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - Aparna Schweitzer
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Hannover Medical School, Hannover, Germany
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Genetic makeup of Shiga toxin-producing Escherichia coli in relation to clinical symptoms and duration of shedding: a microarray analysis of isolates from Swedish children. Eur J Clin Microbiol Infect Dis 2017; 36:1433-1441. [PMID: 28421309 PMCID: PMC5524872 DOI: 10.1007/s10096-017-2950-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/24/2017] [Indexed: 12/19/2022]
Abstract
Shiga toxin (Stx)-producing Escherichia coli (STECs) cause non-bloody diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome, and are the primary cause of acute renal failure in children worldwide. This study investigated the correlation of genetic makeup of STEC strains as revealed by DNA microarray to clinical symptoms and the duration of STEC shedding. All STEC isolated (n = 96) from patients <10 years of age in Jönköping County, Sweden from 2003 to 2015 were included. Isolates were characterized by DNA microarray, including almost 280 genes. Clinical data were collected through a questionnaire and by reviewing medical records. Of the 96 virulence genes (including stx) in the microarray, 62 genes were present in at least one isolate. Statistically significant differences in prevalence were observed for 21 genes when comparing patients with bloody diarrhea (BD) and with non-bloody stool (18 of 21 associated with BD). Most genes encode toxins (e.g., stx2 alleles, astA, toxB), adhesion factors (i.e. espB_O157, tir, eae), or secretion factors (e.g., espA, espF, espJ, etpD, nleA, nleB, nleC, tccP). Seven genes were associated with prolonged stx shedding; the presence of three genes (lpfA, senB, and stx1) and the absence of four genes (espB_O157, espF, astA, and intI1). We found STEC genes that might predict severe disease outcome already at diagnosis. This can be used to develop diagnostic tools for risk assessment of disease outcome. Furthermore, genes associated with the duration of stx shedding were detected, enabling a possible better prediction of length of STEC carriage after infection.
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Zolfo M, Tett A, Jousson O, Donati C, Segata N. MetaMLST: multi-locus strain-level bacterial typing from metagenomic samples. Nucleic Acids Res 2016; 45:e7. [PMID: 27651451 PMCID: PMC5314789 DOI: 10.1093/nar/gkw837] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 08/31/2016] [Accepted: 09/10/2016] [Indexed: 12/14/2022] Open
Abstract
Metagenomic characterization of microbial communities has the potential to become a tool to identify pathogens in human samples. However, software tools able to extract strain-level typing information from metagenomic data are needed. Low-throughput molecular typing schema such as Multilocus Sequence Typing (MLST) are still widely used and provide a wealth of strain-level information that is currently not exploited by metagenomic methods. We introduce MetaMLST, a software tool that reconstructs the MLST loci of microorganisms present in microbial communities from metagenomic data. Tested on synthetic and spiked-in real metagenomes, the pipeline was able to reconstruct the MLST sequences with >98.5% accuracy at coverages as low as 1×. On real samples, the pipeline showed higher sensitivity than assembly-based approaches and it proved successful in identifying strains in epidemic outbreaks as well as in intestinal, skin and gastrointestinal microbiome samples.
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Affiliation(s)
- Moreno Zolfo
- Centre for Integrative Biology, University of Trento, Trento, TN 38123, Italy
| | - Adrian Tett
- Centre for Integrative Biology, University of Trento, Trento, TN 38123, Italy
| | - Olivier Jousson
- Centre for Integrative Biology, University of Trento, Trento, TN 38123, Italy
| | - Claudio Donati
- Computational Biology Unit, Research and Innovation Centre, Fondazione Edmund Mach, Via Edmund Mach 1, San Michele all'Adige 38010, Italy
| | - Nicola Segata
- Centre for Integrative Biology, University of Trento, Trento, TN 38123, Italy
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Trends in ExPEC serogroups in the UK and their significance. Eur J Clin Microbiol Infect Dis 2016; 35:1661-6. [PMID: 27329302 PMCID: PMC5035653 DOI: 10.1007/s10096-016-2707-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/06/2016] [Indexed: 11/20/2022]
Abstract
Extra-intestinal pathogenic Escherichia coli are a significant cause of urinary tract infection and bacteraemia within the UK. We sought to identify the serogroups of 658 E. coli isolates collected in the UK between January 2011 and March 2012, to better understand the ExPEC population and understand the relevance of serogroups in this pathotype. Isolates were typed and serogroup identified using established phenotypic and molecular methods. Sixty-two serogroups were identified; 54 among urinary isolates and 35 among bloodstream isolates. However, serogroups O25, O6, and O2 dominated both infection types. These serogroups were linked to the major ExPEC STs as follows: ST131-O25, ST73-O6, ST127-O6, and ST95-O2. The serogroup data from this study have increased our understanding of the ExPEC population in the UK, but also highlighted key ST–serogroup relationships within the major ExPEC clones. These data can be used to guide vaccine design and in the development of laboratory diagnostic tests targeting the ExPEC population.
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Escherichia coli O104:H4 Pathogenesis: an Enteroaggregative E. coli/Shiga Toxin-Producing E. coli Explosive Cocktail of High Virulence. Microbiol Spectr 2016; 2. [PMID: 26104460 DOI: 10.1128/microbiolspec.ehec-0008-2013] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A major outbreak caused by Escherichia coli of serotype O104:H4 spread throughout Europe in 2011. This large outbreak was caused by an unusual strain that is most similar to enteroaggregative E. coli (EAEC) of serotype O104:H4. A significant difference, however, is the presence of a prophage encoding the Shiga toxin, which is characteristic of enterohemorrhagic E. coli (EHEC) strains. This combination of genomic features, associating characteristics from both EAEC and EHEC, represents a new pathotype. The 2011 E. coli O104:H4 outbreak of hemorrhagic diarrhea in Germany is an example of the explosive cocktail of high virulence and resistance that can emerge in this species. A total of 46 deaths, 782 cases of hemolytic-uremic syndrome, and 3,128 cases of acute gastroenteritis were attributed to this new clone of EAEC/EHEC. In addition, recent identification in France of similar O104:H4 clones exhibiting the same virulence factors suggests that the EHEC O104:H4 pathogen has become endemically established in Europe after the end of the outbreak. EAEC strains of serotype O104:H4 contain a large set of virulence-associated genes regulated by the AggR transcription factor. They include, among other factors, the pAA plasmid genes encoding the aggregative adherence fimbriae, which anchor the bacterium to the intestinal mucosa (stacked-brick adherence pattern on epithelial cells). Furthermore, sequencing studies showed that horizontal genetic exchange allowed for the emergence of the highly virulent Shiga toxin-producing EAEC O104:H4 strain that caused the German outbreak. This article discusses the role these virulence factors could have in EAEC/EHEC O104:H4 pathogenesis.
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Tietze E, Dabrowski PW, Prager R, Radonic A, Fruth A, Auraß P, Nitsche A, Mielke M, Flieger A. Comparative genomic analysis of two novel sporadic Shiga toxin-producing Escherichia coli O104:H4 strains isolated 2011 in Germany. PLoS One 2015; 10:e0122074. [PMID: 25836671 PMCID: PMC4383531 DOI: 10.1371/journal.pone.0122074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/11/2015] [Indexed: 02/02/2023] Open
Abstract
A large outbreak of gastrointestinal disease occurred in 2011 in Germany which resulted in almost 4000 patients with acute gastroenteritis or hemorrhagic colitis, 855 cases of a hemolytic uremic syndrome and 53 deaths. The pathogen was an uncommon, multiresistant Escherichia coli strain of serotype O104:H4 which expressed a Shiga toxin characteristic of enterohemorrhagic E. coli and in addition virulence factors common to enteroaggregative E. coli. During post-epidemic surveillance of Shiga toxin-producing E. coli (STEC) all but two of O104:H4 isolates were indistinguishable from the epidemic strain. Here we describe two novel STEC O104:H4 strains isolated in close spatiotemporal proximity to the outbreak which show a virulence gene panel, a Shiga toxin-mediated cytotoxicity towards Vero cells and aggregative adherence to Hep-2 cells comparable to the outbreak strain. They differ however both from the epidemic strain and from each other, by their antibiotic resistance phenotypes and some other features as determined by routine epidemiological subtyping methods. Whole genome sequencing of these two strains, of ten outbreak strain isolates originating from different time points of the outbreak and of one historical sporadic EHEC O104:H4 isolate was performed. Sequence analysis revealed a clear phylogenetic distance between the two variant strains and the outbreak strain finally identifying them as epidemiologically unrelated isolates from sporadic cases. These findings add to the knowledge about this emerging pathogen, illustrating a certain diversity within the bacterial core genome as well as loss and gain of accessory elements. Our results do also support the view that distinct new variants of STEC O104:H4 repeatedly might originate from yet unknown reservoirs, rather than that there would be a continuous diversification of a single epidemic strain established and circulating in Germany after the large outbreak in 2011.
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Affiliation(s)
- Erhard Tietze
- Department of Infectious Diseases, Division of Enteropathogenic Bacteria and Legionella, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Wernigerode Branch of Robert Koch-Institute, Berlin, Germany
- * E-mail:
| | | | - Rita Prager
- Department of Infectious Diseases, Division of Enteropathogenic Bacteria and Legionella, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Wernigerode Branch of Robert Koch-Institute, Berlin, Germany
| | - Aleksandar Radonic
- Centre for Biological Threats and Special Pathogens, Robert Koch-Institute, Berlin, Germany
| | - Angelika Fruth
- Department of Infectious Diseases, Division of Enteropathogenic Bacteria and Legionella, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Wernigerode Branch of Robert Koch-Institute, Berlin, Germany
| | - Philipp Auraß
- Department of Infectious Diseases, Division of Enteropathogenic Bacteria and Legionella, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Wernigerode Branch of Robert Koch-Institute, Berlin, Germany
| | - Andreas Nitsche
- Centre for Biological Threats and Special Pathogens, Robert Koch-Institute, Berlin, Germany
| | - Martin Mielke
- Department of Infectious Diseases, Robert Koch-Institute, Berlin, Germany
| | - Antje Flieger
- Department of Infectious Diseases, Division of Enteropathogenic Bacteria and Legionella, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Wernigerode Branch of Robert Koch-Institute, Berlin, Germany
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12
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Zhou K, Ferdous M, de Boer RF, Kooistra-Smid AMD, Grundmann H, Friedrich AW, Rossen JWA. The mosaic genome structure and phylogeny of Shiga toxin-producing Escherichia coli O104:H4 is driven by short-term adaptation. Clin Microbiol Infect 2014; 21:468.e7-18. [PMID: 25656624 DOI: 10.1016/j.cmi.2014.12.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 01/23/2023]
Abstract
Shiga toxin-producing Escherichia coli (STEC) O104:H4 emerged as an important pathogen when it caused a large outbreak in Germany in 2011. Little is known about the evolutionary history and genomic diversity of the bacterium. The current communication describes a comprehensive analysis of STEC O104:H4 genomes from the 2011 outbreak and other non-outbreak-related isolates. Outbreak-related isolates formed a tight cluster that shared a monophyletic relation with two non-outbreak clusters, suggesting that all three clusters originated from a common ancestor. Eight single nucleotide polymorphisms, seven of which were non-synonymous, distinguished outbreak from non-outbreak isolates. Lineage-specific markers indicated that recent partitions were driven by selective pressures associated with niche adaptation. Based on the results, an evolutionary model for STEC O104:H4 is proposed. Our analysis provides the evolutionary context at population level and describes the emergence of clones with novel properties, which is necessary for developing comprehensive approaches to early warning and control.
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Affiliation(s)
- K Zhou
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - M Ferdous
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R F de Boer
- Certe Laboratory for Infectious Diseases, Groningen, The Netherlands
| | - A M D Kooistra-Smid
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Certe Laboratory for Infectious Diseases, Groningen, The Netherlands
| | - H Grundmann
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A W Friedrich
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - J W A Rossen
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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13
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De Rauw K, Vincken S, Garabedian L, Levtchenko E, Hubloue I, Verhaegen J, Craeghs J, Glupczynski Y, Mossong J, Piérard D. Enteroaggregative Shiga toxin-producing Escherichia coli of serotype O104:H4 in Belgium and Luxembourg. New Microbes New Infect 2014; 2:138-43. [PMID: 25356363 PMCID: PMC4184478 DOI: 10.1002/nmi2.58] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/26/2014] [Accepted: 07/04/2014] [Indexed: 11/29/2022] Open
Abstract
In 2011, a large outbreak of infections caused by Shiga toxin-producing Escherichia coli (STEC) O104:H4 occurred in Germany. This exceptionally virulent strain combined virulence factors of enteroaggregative E. coli (EAggEC) and STEC. After the outbreak only a few sporadic cases of infection with this rare serotype were reported, most of which were related to travel to the Middle East or North Africa. Here we describe two cases of enteroaggregative STEC (Agg-STEC) O104:H4 infection that occurred in Belgium in 2012 and 2013 respectively. In both cases travel in a Mediterranean country preceded the infection. The first strain was isolated from the stool of a 42-year-old woman presenting bloody diarrhoea, who had travelled to Tunisia the week before. The second case involves a 14-year-old girl who, upon her return from Turkey to Belgium, suffered from an episode of bloody diarrhoea and haemolytic uraemic syndrome. Extended typing of the isolates with pulsed field gel electrophoresis revealed that the strains were closely related, though not exactly the same as the 2011 outbreak strain. This report supports the previously made hypothesis that Agg-STEC has a human reservoir and might be imported by travellers coming from an area where the pathogen is endemic. Furthermore, it emphasizes the concern that these bacteria may cause future outbreaks as evenly virulent O104:H4 isolates seem to be widespread.
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Affiliation(s)
- K De Rauw
- National Reference Centre for STEC/VTEC, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB)Brussels, Belgium
- Department of Microbiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB)Brussels, Belgium
| | - S Vincken
- Department of Internal Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB)Brussels, Belgium
| | - L Garabedian
- Department of Pediatric Nephrology, Universitair Ziekenhuis Leuven, Katholieke Universiteit Leuven (KUL)Leuven, Belgium
| | - E Levtchenko
- Department of Pediatric Nephrology, Universitair Ziekenhuis Leuven, Katholieke Universiteit Leuven (KUL)Leuven, Belgium
| | - I Hubloue
- Department of Emergency, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB)Brussels, Belgium
| | - J Verhaegen
- Department of Microbiology, Universitair Ziekenhuis Leuven, Katholieke Universiteit Leuven (KUL)Leuven, Belgium
| | - J Craeghs
- Department of Microbiology, Algemeen Ziekenhuis VesaliusTongeren, Belgium
| | - Y Glupczynski
- National Reference Centre ESBL and carbapenemase-producing Enterobacteriaceae, CHU Dinant-Godinne|UCL Namur, Université Catholique de Louvain (UCL)Yvoir, Belgium
| | - J Mossong
- Surveillance & Epidemiology of Infectious Diseases, National Health LaboratoryDudelange, Luxembourg
| | - D Piérard
- National Reference Centre for STEC/VTEC, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB)Brussels, Belgium
- Department of Microbiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB)Brussels, Belgium
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14
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Development of a rapid microarray-based DNA subtyping assay for the alleles of Shiga toxins 1 and 2 of Escherichia coli. J Clin Microbiol 2014; 52:2898-904. [PMID: 24899022 DOI: 10.1128/jcm.01048-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
In this study, we developed a new rapid, economic, and automated microarray-based genotyping test for the standardized subtyping of Shiga toxins 1 and 2 of Escherichia coli. The microarrays from Alere Technologies can be used in two different formats, the ArrayTube and the ArrayStrip (which enables high-throughput testing in a 96-well format). One microarray chip harbors all the gene sequences necessary to distinguish between all Stx subtypes, facilitating the identification of single and multiple subtypes within a single isolate in one experiment. Specific software was developed to automatically analyze all data obtained from the microarray. The assay was validated with 21 Shiga toxin-producing E. coli (STEC) reference strains that were previously tested by the complete set of conventional subtyping PCRs. The microarray results showed 100% concordance with the PCR results. Essentially identical results were detected when the standard DNA extraction method was replaced by a time-saving heat lysis protocol. For further validation of the microarray, we identified the Stx subtypes or combinations of the subtypes in 446 STEC field isolates of human and animal origin. In summary, this oligonucleotide array represents an excellent diagnostic tool that provides some advantages over standard PCR-based subtyping. The number of the spotted probes on the microarrays can be increased by additional probes, such as for novel alleles, species markers, or resistance genes, should the need arise.
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15
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Prager R, Lang C, Aurass P, Fruth A, Tietze E, Flieger A. Two novel EHEC/EAEC hybrid strains isolated from human infections. PLoS One 2014; 9:e95379. [PMID: 24752200 PMCID: PMC3994036 DOI: 10.1371/journal.pone.0095379] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/26/2014] [Indexed: 12/14/2022] Open
Abstract
The so far highest number of life-threatening hemolytic uremic syndrome was associated with a food-borne outbreak in 2011 in Germany which was caused by an enterohemorrhagic Escherichia coli (EHEC) of the rare serotype O104:H4. Most importantly, the outbreak strain harbored genes characteristic of both EHEC and enteroaggregative E. coli (EAEC). Such strains have been described seldom but due to the combination of virulence genes show a high pathogenicity potential. To evaluate the importance of EHEC/EAEC hybrid strains in human disease, we analyzed the EHEC strain collection of the German National Reference Centre for Salmonella and other Bacterial Enteric Pathogens (NRC). After exclusion of O104:H4 EHEC/EAEC strains, out of about 2400 EHEC strains sent to NRC between 2008 and 2012, two strains exhibited both EHEC and EAEC marker genes, specifically were stx2 and aatA positive. Like the 2011 outbreak strain, one of the novel EHEC/EAEC harbored the Shiga toxin gene type stx2a. The strain was isolated from a patient with bloody diarrhea in 2010, was serotyped as O59:H−, belonged to MLST ST1136, and exhibited genes for type IV aggregative adherence fimbriae (AAF). The second strain was isolated from a patient with diarrhea in 2012, harbored stx2b, was typed as Orough:H−, and belonged to MLST ST26. Although the strain conferred the aggregative adherence phenotype, no known AAF genes corresponding to fimbrial types I to V were detected. In summary, EHEC/EAEC hybrid strains are currently rarely isolated from human disease cases in Germany and two novel EHEC/EAEC of rare serovars/MLST sequence types were characterized.
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Affiliation(s)
- Rita Prager
- Divison of Enteropathogenic Bacteria and Legionella, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Robert Koch-Institut, Wernigerode, Germany
| | - Christina Lang
- Divison of Enteropathogenic Bacteria and Legionella, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Robert Koch-Institut, Wernigerode, Germany
| | - Philipp Aurass
- Divison of Enteropathogenic Bacteria and Legionella, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Robert Koch-Institut, Wernigerode, Germany
| | - Angelika Fruth
- Divison of Enteropathogenic Bacteria and Legionella, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Robert Koch-Institut, Wernigerode, Germany
| | - Erhard Tietze
- Divison of Enteropathogenic Bacteria and Legionella, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Robert Koch-Institut, Wernigerode, Germany
| | - Antje Flieger
- Divison of Enteropathogenic Bacteria and Legionella, National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Robert Koch-Institut, Wernigerode, Germany
- * E-mail:
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16
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Bibbal D, Kérourédan M, Loukiadis E, Scheutz F, Oswald E, Brugère H. Slaughterhouse effluent discharges into rivers not responsible for environmental occurrence of enteroaggregative Escherichia coli. Vet Microbiol 2013; 168:451-4. [PMID: 24388632 DOI: 10.1016/j.vetmic.2013.11.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/18/2013] [Accepted: 11/30/2013] [Indexed: 10/25/2022]
Abstract
Enteroaggregative Shiga-toxin-producing Escherichia coli strains were responsible for a massive outbreak in Europe in 2011, and had been previously isolated from French patients. The objective of this study was to investigate the presence of enteroaggregative E. coli (EAEC) in slaughterhouse effluents (wastewater, slurry, sludge and effluents), and in river waters near these slaughterhouses. A total of 10,618 E. coli isolates were screened by PCR for the presence of EAEC-associated genetic markers (aggR, aap and aatA). None of these markers was detected in E. coli isolated from slaughterhouse samples. A unique enteroaggregative E. coli (EAEC) O126:H8 was detected in river water sampled upstream from slaughterhouse effluent discharge. These results confirmed that animals might not be reservoirs of EAEC, and that further studies are required to evaluate the role of the environment in the transmission of EAEC to humans.
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Affiliation(s)
- Delphine Bibbal
- INSERM UMR1043, INRA USC1360, Université de Toulouse, INPT, ENVT, Toulouse, France.
| | - Monique Kérourédan
- INSERM UMR1043, INRA USC1360, Université de Toulouse, INPT, ENVT, Toulouse, France
| | - Estelle Loukiadis
- Université de Lyon, VetAgro Sup, LMAP Laboratory, National Reference Laboratory for Escherichia coli including VTEC, Marcy l'Etoile, France
| | - Flemming Scheutz
- WHO Collaborating Centre for Reference and Research on Escherichia and Klebsiella, Statens Serum Institut (SSI), Copenhagen, Denmark
| | - Eric Oswald
- INSERM UMR1043, INRA USC1360, CHU de Toulouse, Hôpital Purpan, Toulouse, France
| | - Hubert Brugère
- INSERM UMR1043, INRA USC1360, Université de Toulouse, INPT, ENVT, Toulouse, France
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17
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Miko A, Delannoy S, Fach P, Strockbine NA, Lindstedt BA, Mariani-Kurkdjian P, Reetz J, Beutin L. Genotypes and virulence characteristics of Shiga toxin-producing Escherichia coli O104 strains from different origins and sources. Int J Med Microbiol 2013; 303:410-21. [DOI: 10.1016/j.ijmm.2013.05.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 05/07/2013] [Accepted: 05/20/2013] [Indexed: 02/03/2023] Open
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18
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Sjödin A, Broman T, Melefors Ö, Andersson G, Rasmusson B, Knutsson R, Forsman M. The Need for High-Quality Whole-Genome Sequence Databases in Microbial Forensics. Biosecur Bioterror 2013; 11 Suppl 1:S78-86. [DOI: 10.1089/bsp.2013.0007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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19
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Jandhyala DM, Vanguri V, Boll EJ, Lai Y, McCormick BA, Leong JM. Shiga toxin-producing Escherichia coli O104:H4: an emerging pathogen with enhanced virulence. Infect Dis Clin North Am 2013; 27:631-49. [PMID: 24011834 PMCID: PMC3800737 DOI: 10.1016/j.idc.2013.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pathogenic Escherichia coli are genetically diverse and encompass a broad variety of pathotypes, such as enteroaggregative E. coli (EAEC) or enterohemorrhagic E. coli (EHEC), which cause distinct clinical syndromes. The historically large 2011 German outbreak of hemolytic uremic syndrome (HUS), caused by a Shiga-toxin producing E. coli (STEC) of the serotype O104:H4, illustrated the emerging importance of non-O157 STEC. STEC O104:H4, with features characteristic of both enteroaggregative E. coli and enterohemorrhagic E. coli, represents a unique and highly virulent pathotype. The German outbreak both allowed for the evaluation of several potential therapeutic approaches to STEC-induced HUS and emphasizes the importance of early and specific detection of both O157 and non-O157 STEC.
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Affiliation(s)
- Dakshina M Jandhyala
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, 750 Washington Street, Boston, MA 02111, USA.
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20
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Zhang W, Bielaszewska M, Kunsmann L, Mellmann A, Bauwens A, Köck R, Kossow A, Anders A, Gatermann S, Karch H. Lability of the pAA Virulence Plasmid in Escherichia coli O104:H4: Implications for Virulence in Humans. PLoS One 2013; 8:e66717. [PMID: 23805269 PMCID: PMC3689698 DOI: 10.1371/journal.pone.0066717] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 05/10/2013] [Indexed: 11/24/2022] Open
Abstract
Background Escherichia coli O104:H4 that caused the large German outbreak in 2011 is a highly virulent hybrid of enterohemorrhagic (EHEC) and enteroaggregative (EAEC) E. coli. The strain displays “stacked-brick” aggregative adherence to human intestinal epithelial cells mediated by aggregative adherence fimbriae I (AAF/I) encoded on the pAA plasmid. The AAF/I-mediated augmented intestinal adherence might facilitate systemic absorption of Shiga toxin, the major virulence factor of EHEC, presumably enhancing virulence of the outbreak strain. However, the stability of pAA in the outbreak strain is unknown. We therefore tested outbreak isolates for pAA, monitored pAA loss during infection, and determined the impact of pAA loss on adherence and clinical outcome of infection. Methodology/Principal Findings E. coli O104:H4 outbreak isolates from 170 patients (128 with hemolytic uremic syndrome [HUS] and 42 with diarrhea without HUS) were tested for pAA using polymerase chain reaction and plasmid profiling. pAA-harboring bacteria in stool samples were quantified using colony blot hybridization, and adherence to HCT-8 cells was determined. Isolates from 12 (7.1%) patients lacked pAA. Analyses of sequential stool samples demonstrated that the percentages of pAA-positive populations in the initial stools were significantly higher than those in the follow-up stools collected two to eight days later in disease (P≤0.01). This indicates a rapid loss of pAA during infections of humans. The pAA loss was associated with loss of the aggregative adherence phenotype and significantly reduced correlation with HUS (P = 0.001). Conclusions/Significance The pAA plasmid can be lost by E. coli O104:H4 outbreak strain in the human gut in the course of disease. pAA loss might attenuate virulence and diminish the ability to cause HUS. The pAA instability has clinical, diagnostic, epidemiologic, and evolutionary implications.
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Affiliation(s)
- Wenlan Zhang
- Institute of Hygiene and the National Consulting Laboratory for Hemolytic Uremic Syndrome, University of Münster, Münster, Germany
| | - Martina Bielaszewska
- Institute of Hygiene and the National Consulting Laboratory for Hemolytic Uremic Syndrome, University of Münster, Münster, Germany
| | - Lisa Kunsmann
- Institute of Hygiene and the National Consulting Laboratory for Hemolytic Uremic Syndrome, University of Münster, Münster, Germany
| | - Alexander Mellmann
- Institute of Hygiene and the National Consulting Laboratory for Hemolytic Uremic Syndrome, University of Münster, Münster, Germany
- Interdisciplinary Center of Clinical Research (IZKF), University of Münster, Münster, Germany
| | - Andreas Bauwens
- Institute of Hygiene and the National Consulting Laboratory for Hemolytic Uremic Syndrome, University of Münster, Münster, Germany
| | - Robin Köck
- Institute of Hygiene and the National Consulting Laboratory for Hemolytic Uremic Syndrome, University of Münster, Münster, Germany
| | - Annelene Kossow
- Institute of Hygiene and the National Consulting Laboratory for Hemolytic Uremic Syndrome, University of Münster, Münster, Germany
| | - Agnes Anders
- Institute of Hygiene and Microbiology, University of Bochum, Bochum, Germany
| | - Sören Gatermann
- Institute of Hygiene and Microbiology, University of Bochum, Bochum, Germany
| | - Helge Karch
- Institute of Hygiene and the National Consulting Laboratory for Hemolytic Uremic Syndrome, University of Münster, Münster, Germany
- Interdisciplinary Center of Clinical Research (IZKF), University of Münster, Münster, Germany
- * E-mail:
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Abstract
In 2011, an outbreak linked to a entero-haemorrhagic Escherichia coli strain, affecting adults more frequently, occurred in Germany, with 4320 bloody diarrhea cases, 850 cases of hemolytic uremic syndrome (HUS) and 82 deaths. Meanwhile, an epidemic affecting 24 patients took place in Bègle with similar epidemiological characteristics. These two strains were associated with consumption of contaminated seeds fenugreck by a particularly virulent strain belonging to a rare serotype, E. coli serotype O104:H4. This strain is a triple hybrid : it produces a shigatoxin, the adhesion at the gastrointestinal mucosa is related to the presence of fimbriae as enteroaggregants E. coli (ECAA), and has virulence factors of E. coli outer intestinal (EXPEC). In addition, it produced a ß-lactamasetype extended-spectrum CTXM15.
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Affiliation(s)
- P Mariani-Kurkdjian
- CNR associé E. coli-Shigella, Service de Microbiologie, Université Paris-Diderot, Hôpital Robert Debré, 48, boulevard Sérurier, 75935 Paris cedex 19, France.
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22
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Comparative genomics of recent Shiga toxin-producing Escherichia coli O104:H4: short-term evolution of an emerging pathogen. mBio 2013; 4:e00452-12. [PMID: 23341549 PMCID: PMC3551546 DOI: 10.1128/mbio.00452-12] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The large outbreak of diarrhea and hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli O104:H4 in Europe from May to July 2011 highlighted the potential of a rarely identified E. coli serogroup to cause severe disease. Prior to the outbreak, there were very few reports of disease caused by this pathogen and thus little known of its diversity and evolution. The identification of cases of HUS caused by E. coli O104:H4 in France and Turkey after the outbreak and with no clear epidemiological links raises questions about whether these sporadic cases are derived from the outbreak. Here, we report genome sequences of five independent isolates from these cases and results of a comparative analysis with historical and 2011 outbreak isolates. These analyses revealed that the five isolates are not derived from the outbreak strain; however, they are more closely related to the outbreak strain and each other than to isolates identified prior to the 2011 outbreak. Over the short time scale represented by these closely related organisms, the majority of genome variation is found within their mobile genetic elements: none of the nine O104:H4 isolates compared here contain the same set of plasmids, and their prophages and genomic islands also differ. Moreover, the presence of closely related HUS-associated E. coli O104:H4 isolates supports the contention that fully virulent O104:H4 isolates are widespread and emphasizes the possibility of future food-borne E. coli O104:H4 outbreaks. In the summer of 2011, a large outbreak of bloody diarrhea with a high rate of severe complications took place in Europe, caused by a previously rarely seen Escherichia coli strain of serogroup O104:H4. Identification of subsequent infections caused by E. coli O104:H4 raised questions about whether these new cases represented ongoing transmission of the outbreak strain. In this study, we sequenced the genomes of isolates from five recent cases and compared them with historical isolates. The analyses reveal that, in the very short term, evolution of the bacterial genome takes place in parts of the genome that are exchanged among bacteria, and these regions contain genes involved in adaptation to local environments. We show that these recent isolates are not derived from the outbreak strain but are very closely related and share many of the same disease-causing genes, emphasizing the concern that these bacteria may cause future severe outbreaks.
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23
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Naseer U, Olsson-Liljequist BE, Woodford N, Dhanji H, Cantón R, Sundsfjord A, Lindstedt BA. Multi-locus variable number of tandem repeat analysis for rapid and accurate typing of virulent multidrug resistant Escherichia coli clones. PLoS One 2012; 7:e41232. [PMID: 22859970 PMCID: PMC3407997 DOI: 10.1371/journal.pone.0041232] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 06/19/2012] [Indexed: 11/18/2022] Open
Abstract
One hundred E. coli isolates from Norway
(n = 37), Sweden (n = 24), UK
(n = 20) and Spain (n = 19), producing
CTX-M-type - (n = 84), or SHV-12
(n = 4) extended spectrum β-lactamases, or the plasmid
mediated AmpC, CMY-2 (n = 12), were typed using multi-locus
sequence typing (MLST) and multi-locus variable number of tandem repeat analysis
(MLVA). Isolates clustered into 33 Sequence Types (STs) and 14 Sequence Type
Complexes (STCs), and 58 MLVA-Types (MTs) and 25 different MLVA-Type Complexes
(MTCs). A strong agreement between the MLST profile and MLVA typing results was
observed, in which all ST131-isolates (n = 39) and most of
the STC-648 (n = 10), STC-38 (n = 9),
STC-10 (n = 9), STC-405 (n = 8) and
STC-23 (n = 6) isolates were clustered distinctly into
MTC-29, -36, -20, -14, -10 and -39, respectively. MLVA is a rapid and accurate
tool for genotyping isolates of globally disseminated virulent multidrug
resistant E. coli lineages, including ST131.
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Affiliation(s)
- Umaer Naseer
- Research Group for Host-Microbe Interactions, Department of Medical Biology, University of Tromsø, Tromsø, Norway.
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Wu G, Ehricht R, Mafura M, Stokes M, Smith N, Pritchard GC, Woodward MJ. Escherichia coli isolates from extraintestinal organs of livestock animals harbour diverse virulence genes and belong to multiple genetic lineages. Vet Microbiol 2012; 160:197-206. [PMID: 22766078 DOI: 10.1016/j.vetmic.2012.05.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/20/2012] [Accepted: 05/22/2012] [Indexed: 11/26/2022]
Abstract
Escherichia coli, the most common cause of bacteraemia in humans in the UK, can also cause serious diseases in animals. However the population structure, virulence and antimicrobial resistance genes of those from extraintestinal organs of livestock animals are poorly characterised. The aims of this study were to investigate the diversity of these isolates from livestock animals and to understand if there was any correlation between the virulence and antimicrobial resistance genes and the genetic backbone of the bacteria and if these isolates were similar to those isolated from humans. Here 39 E. coli isolates from liver (n=31), spleen (n=5) and blood (n=3) of cattle (n=34), sheep (n=3), chicken (n=1) and pig (n=1) were assigned to 19 serogroups with O8 being the most common (n=7), followed by O101, O20 (both n=3) and O153 (n=2). They belong to 29 multi-locus sequence types, 20 clonal complexes with ST23 (n=7), ST10 (n=6), ST117 and ST155 (both n=3) being most common and were distributed among phylogenetic group A (n=16), B1 (n=12), B2 (n=2) and D (n=9). The pattern of a subset of putative virulence genes was different in almost all isolates. No correlation between serogroups, animal hosts, MLST types, virulence and antimicrobial resistance genes was identified. The distributions of clonal complexes and virulence genes were similar to other extraintestinal or commensal E. coli from humans and other animals, suggesting a zoonotic potential. The diverse and various combinations of virulence genes implied that the infections were caused by different mechanisms and infection control will be challenging.
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Affiliation(s)
- Guanghui Wu
- Epidemiology, Surveilance and Risk Group, Animal Health and Veterinary Laboratories Agency, New Haw, Addlestone, Surrey KT15 3NB, UK.
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Shiga toxin-producing Escherichia coli O104:H4: a new challenge for microbiology. Appl Environ Microbiol 2012; 78:4065-73. [PMID: 22504816 DOI: 10.1128/aem.00217-12] [Citation(s) in RCA: 152] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
In 2011, Germany experienced the largest outbreak with a Shiga toxin-producing Escherichia coli (STEC) strain ever recorded. A series of environmental and trace-back and trace-forward investigations linked sprout consumption with the disease, but fecal-oral transmission was also documented. The genome sequences of the pathogen revealed a clonal outbreak with enteroaggregative E. coli (EAEC). Some EAEC virulence factors are carried on the virulence plasmid pAA. From an unknown source, the epidemic strains acquired a lambdoid prophage carrying the gene for the Shiga toxin. The resulting strains therefore possess two different mobile elements, a phage and a plasmid, contributing essential virulence genes. Shiga toxin is released by decaying bacteria in the gut, migrates through the intestinal barrier, and is transported via the blood to target organs, like the kidney. In a mouse model, probiotic bifidobacteria interfered with transport of the toxin through the gut mucosa. Researchers explored bacteriophages, bacteriocins, and low-molecular-weight inhibitors against STEC. Randomized controlled clinical trials of enterohemorrhagic E. coli (EHEC)-associated hemolytic uremic syndrome (HUS) patients found none of the interventions superior to supportive therapy alone. Antibodies against one subtype of Shiga toxin protected pigs against fatal neurological infection, while treatment with a toxin receptor decoy showed no effect in a clinical trial. Likewise, a monoclonal antibody directed against a complement protein led to mixed results. Plasma exchange and IgG immunoadsoprtion ameliorated the condition in small uncontrolled trials. The epidemic O104:H4 strains were resistant to all penicillins and cephalosporins but susceptible to carbapenems, which were recommended for treatment.
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Genomic epidemiology of the Escherichia coli O104:H4 outbreaks in Europe, 2011. Proc Natl Acad Sci U S A 2012; 109:3065-70. [PMID: 22315421 DOI: 10.1073/pnas.1121491109] [Citation(s) in RCA: 197] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The degree to which molecular epidemiology reveals information about the sources and transmission patterns of an outbreak depends on the resolution of the technology used and the samples studied. Isolates of Escherichia coli O104:H4 from the outbreak centered in Germany in May-July 2011, and the much smaller outbreak in southwest France in June 2011, were indistinguishable by standard tests. We report a molecular epidemiological analysis using multiplatform whole-genome sequencing and analysis of multiple isolates from the German and French outbreaks. Isolates from the German outbreak showed remarkably little diversity, with only two single nucleotide polymorphisms (SNPs) found in isolates from four individuals. Surprisingly, we found much greater diversity (19 SNPs) in isolates from seven individuals infected in the French outbreak. The German isolates form a clade within the more diverse French outbreak strains. Moreover, five isolates derived from a single infected individual from the French outbreak had extremely limited diversity. The striking difference in diversity between the German and French outbreak samples is consistent with several hypotheses, including a bottleneck that purged diversity in the German isolates, variation in mutation rates in the two E. coli outbreak populations, or uneven distribution of diversity in the seed populations that led to each outbreak.
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Marejková M, Roháčová H, Reisingerová M, Petráš P. An imported case of bloody diarrhea in the Czech Republic caused by a hybrid enteroaggregative hemorrhagic Escherichia coli (EAHEC) O104:H4 strain associated with the large outbreak in Germany, May 2011. Folia Microbiol (Praha) 2012; 57:85-9. [PMID: 22258751 DOI: 10.1007/s12223-011-0095-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 12/15/2011] [Indexed: 11/26/2022]
Abstract
A large outbreak caused by a rare Shiga toxin-producing Escherichia coli serotype O104:H4 occurred in Germany in May to July 2011. The National Reference Laboratory for E. coli and Shigella investigated the stool sample from an American tourist with bloody diarrhea who arrived in the Czech Republic from Germany where she consumed salads with raw vegetable a week ago. Using culture of the enriched stool on extended-spectrum β-lactamase agar, we isolated E. coli strain which belonged to serotype O104:H4 as determined by conventional and molecular serotyping. The strain contained the major virulence characteristics of enterohemorrhagic E. coli (stx (2) encoding Shiga toxin 2) and enteroaggregative E. coli (aggA encoding aggregative adherence fimbriae I). This unique combination of virulence traits demonstrated that this strain belongs to the hybrid enteroaggregative hemorrhagic E. coli clone which caused the German outbreak. Using advanced culture and molecular biological approaches is the prerequisite for identification of new, unusual pathogens.
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Affiliation(s)
- M Marejková
- National Reference Laboratory for E. coli and Shigella, National Institute of Public Health, Šrobárova 48, 100 42, Prague 10, Czech Republic.
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Cheung MK, Li L, Nong W, Kwan HS. 2011 German Escherichia coli O104:H4 outbreak: whole-genome phylogeny without alignment. BMC Res Notes 2011; 4:533. [PMID: 22166159 DOI: 10.1186/1756-0500-4-533] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 12/13/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A large-scale Escherichia coli O104:H4 outbreak occurred in Germany from May to July 2011, causing numerous cases of hemolytic-uremic syndrome (HUS) and deaths. Genomes of ten outbreak isolates and a historical O104:H4 strain isolated in 2001 were sequenced using different new generation sequencing platforms. Phylogenetic analyses were performed using various approaches which either are not genome-wide or may be subject to errors due to poor sequence alignment. Also, detailed pathogenicity analyses on the 2001 strain were not available. FINDINGS We reconstructed the phylogeny of E. coli using the genome-wide and alignment-free feature frequency profile method and revealed the 2001 strain to be the closest relative to the 2011 outbreak strain among all available E. coli strains at present and confirmed findings from previous alignment-based phylogenetic studies that the HUS-causing O104:H4 strains are more closely related to typical enteroaggregative E. coli (EAEC) than to enterohemorrhagic E. coli. Detailed re-examination of pathogenicity-related virulence factors and secreted proteins showed that the 2001 strain possesses virulence factors shared between typical EAEC and the 2011 outbreak strain. CONCLUSIONS Our study represents the first attempt to elucidate the whole-genome phylogeny of the 2011 German outbreak using an alignment-free method, and suggested a direct line of ancestry leading from a putative EAEC-like ancestor through the 2001 strain to the 2011 outbreak strain.
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Affiliation(s)
- Man Kit Cheung
- School of Life Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
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