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Tang B, Ni J, Lin J, Sun Y, Lin H, Wu Y, Yang H, Yue M. Genomic characterization of multidrug-resistance gene cfr in Escherichia coli recovered from food animals in Eastern China. Front Microbiol 2022; 13:999778. [PMID: 36160268 PMCID: PMC9493366 DOI: 10.3389/fmicb.2022.999778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022] Open
Abstract
The plasmid-borne cfr gene, mediating multiple drug resistance (MDR), has been observed in many Gram-positive bacteria. The prevalence of cfr and its co-occurrence with additional antimicrobial resistance (AMR) determinants in Escherichia coli is an ongoing issue. Additionally, the prevalence and transfer mechanism of the cfr gene remain partially investigated. Here, eight cfr-positive E. coli strains were screened using PCR from an extensive collection of E. coli (n = 2,165) strains isolated from pigs and chickens in 2021 in China, with a prevalence rate of 0.37%. All of them were MDR and resistant to florfenicol and tetracycline. These strains can transfer the cfr gene to E. coli J53 by conjugation (1.05 × 10−1 – 1.01 × 10−6). Moreover, the IncX4 plasmid p727A3-62 K-cfr (62,717 bp) harboring cfr in strain EC727A3 was confirmed using Oxford Nanopore Technology. The unknown type plasmid p737A1-27K-cfr (27,742 bp) harboring cfr in strain EC737A1 was also identified. Notably, it was verified by PCR that three of the eight E. coli strains were able to form the cfr-IS26 circular intermediate. It was 2,365 bp in length in strains EC727A3 and ECJHZ21-173, and 2,022 bp in length in EC737A1. Collectively, this study demonstrated that IS26 plays a vital role in transmitting the MDR gene cfr in E. coli via conjugation and provided updated knowledge regarding cfr in E. coli in Eastern China.
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Affiliation(s)
- Biao Tang
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-Products, Institute of Agro-product Safety and Nutrition, Academy of Agricultural Sciences, Hangzhou, China
| | - Juan Ni
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-Products, Institute of Agro-product Safety and Nutrition, Academy of Agricultural Sciences, Hangzhou, China
- School of Food and Pharmacy, Ningbo University, Ningbo, China
| | - Jiahui Lin
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Yangying Sun
- School of Food and Pharmacy, Ningbo University, Ningbo, China
| | - Hui Lin
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-Products, Institute of Agro-product Safety and Nutrition, Academy of Agricultural Sciences, Hangzhou, China
| | - Yuehong Wu
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Hua Yang
- State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-Products, Institute of Agro-product Safety and Nutrition, Academy of Agricultural Sciences, Hangzhou, China
- *Correspondence: Hua Yang,
| | - Min Yue
- Department of Veterinary Medicine, Institute of Preventive Veterinary Sciences, Zhejiang University College of Animal Sciences, Hangzhou, China
- Hainan Institute of Zhejiang University, Sanya, China
- Min Yue,
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Loconsole D, Giordano M, Centrone F, Accogli M, Casulli D, De Robertis AL, Morea A, Quarto M, Parisi A, Scavia G, Chironna M. Epidemiology of Shiga Toxin-Producing Escherichia coli Infections in Southern Italy after Implementation of Symptom-Based Surveillance of Bloody Diarrhea in the Pediatric Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5137. [PMID: 32708640 PMCID: PMC7400587 DOI: 10.3390/ijerph17145137] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 12/30/2022]
Abstract
Shiga toxin-producing Escherichia coli (STEC) infections result in a significant public health impact because of the severity of the disease that, in young children especially, can lead to hemolytic-uremic syndrome (HUS). A rise in the number of HUS cases was observed in the Apulia region of Italy from 2013 to 2017, and so, in 2018, a symptom-based surveillance system for children with bloody diarrhea (BD) was initiated in order to detect and manage STEC infections. The objective of the study was to describe the epidemiology of STEC infections in children from June 2018 to August 2019. Children <15 years old with BD were hospitalized and tested for STEC. Real-time PCR for virulence genes (stx1, stx2, eae) and serogroup identification tests were performed on stool samples/rectal swabs of cases. STEC infection was detected in 87 (10.6%) BD cases. The median age of STEC cases was 2.7 years, and 60 (68.9%) were <4. Of these 87 cases, 12 (13.8%) came from households with diarrhea. The reporting rate was 14.2/100,000, with the highest incidence in cases from the province of Bari (24.2/100,000). Serogroups O26 and O111 were both detected in 22/87 (25.3%) cases. Co-infections occurred in 12.6% of cases (11/87). Twenty-nine STEC were positive for stx1, stx2, and eae. Five cases (5.7%) caused by O26 (n = 2), O111 (n = 2), and O45 (n = 1) developed into HUS. A risk-oriented approach based on the testing of children with BD during the summer may represent a potentially beneficial option to improve the sensitivity of STEC surveillance, not only in Italy but also in the context of Europe as a whole.
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Affiliation(s)
- Daniela Loconsole
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
| | - Mario Giordano
- Pediatric Nephrology and Dialysis Unit, Pediatric Hospital “Giovanni XXIII”, Via Giovanni Amendola, 207, 70126 Bari, Italy;
| | - Francesca Centrone
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
| | - Marisa Accogli
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
| | - Daniele Casulli
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
| | - Anna Lisa De Robertis
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
| | - Anna Morea
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
| | - Michele Quarto
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
| | - Antonio Parisi
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Via Manfredonia, 20, 71121 Foggia, Italy;
| | - Gaia Scavia
- Food Safety, Nutrition and Veterinary Public Health Department, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy;
| | - Maria Chironna
- Department of Biomedical Sciences and Human Oncology-Hygiene Section, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.L.); (F.C.); (M.A.); (D.C.); (A.L.D.R.); (A.M.); (M.Q.)
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McFarland N, Bundle N, Jenkins C, Godbole G, Mikhail A, Dallman T, O'Connor C, McCarthy N, O'Connell E, Treacy J, Dabke G, Mapstone J, Landy Y, Moore J, Partridge R, Jorgensen F, Willis C, Mook P, Rawlings C, Acornley R, Featherstone C, Gayle S, Edge J, McNamara E, Hawker J, Balasegaram S. Recurrent seasonal outbreak of an emerging serotype of Shiga toxin-producing Escherichia coli (STEC O55:H7 Stx2a) in the south west of England, July 2014 to September 2015. ACTA ACUST UNITED AC 2018; 22:30610. [PMID: 28920571 PMCID: PMC5685211 DOI: 10.2807/1560-7917.es.2017.22.36.30610] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 05/14/2017] [Indexed: 11/22/2022]
Abstract
The first documented British outbreak of Shiga toxin-producing Escherichia coli (STEC) O55:H7 began in the county of Dorset, England, in July 2014. Since then, there have been a total of 31 cases of which 13 presented with haemolytic uraemic syndrome (HUS). The outbreak strain had Shiga toxin (Stx) subtype 2a associated with an elevated risk of HUS. This strain had not previously been isolated from humans or animals in England. The only epidemiological link was living in or having close links to two areas in Dorset. Extensive investigations included testing of animals and household pets. Control measures included extended screening, iterative interviewing and exclusion of cases and high risk contacts. Whole genome sequencing (WGS) confirmed that all the cases were infected with similar strains. A specific source could not be identified. The combination of epidemiological investigation and WGS indicated, however, that this outbreak was possibly caused by recurrent introductions from a local endemic zoonotic source, that a highly similar endemic reservoir appears to exist in the Republic of Ireland but has not been identified elsewhere, and that a subset of cases was associated with human-to-human transmission in a nursery.
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Affiliation(s)
- Noëleen McFarland
- Health Protection Team (Fareham), Public Health England South East Centre, Fareham, United Kingdom.,These authors contributed equally to this article and share first authorship
| | - Nick Bundle
- These authors contributed equally to this article and share first authorship.,UK Field Epidemiology Training Programme, Public Health England, London, United Kingdom.,Field Epidemiology Services, National Infection Service, Public Health England, London, United Kingdom.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Claire Jenkins
- Gastrointestinal Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Gauri Godbole
- Reference Microbiology Services, National infection Service, Public Health England, London, United Kingdom
| | - Amy Mikhail
- Gastrointestinal Infection Department, National Infection Service, Public Health England, London, United Kingdom
| | - Tim Dallman
- Gastrointestinal Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Catherine O'Connor
- Emerging Infections and Zoonoses, National infection Service, Public Health England, London, United Kingdom
| | - Noel McCarthy
- Field Epidemiology Services, National Infection Service, Public Health England, London, United Kingdom.,University of Warwick, Coventry, United Kingdom.,National Institute Health Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, London, United Kingdom
| | - Emer O'Connell
- Field Epidemiology Services, National Infection Service, Public Health England, London, United Kingdom.,UK Public Health Training Scheme, London, United Kingdom
| | - Juli Treacy
- Health Protection Team (Fareham), Public Health England South East Centre, Fareham, United Kingdom
| | - Girija Dabke
- Health Protection Team (Fareham), Public Health England South East Centre, Fareham, United Kingdom
| | - James Mapstone
- Public Health England South of England Region, Bristol, United Kingdom
| | - Yvette Landy
- Bournemouth Borough Council, Bournemouth, United Kingdom
| | - Janet Moore
- Weymouth & Portland Borough Council and West Dorset District Council, Weymouth, United Kingdom
| | | | - Frieda Jorgensen
- Food Water and Environmental Microbiology Laboratory, National Infection Service, Public Health England, Salisbury, United Kingdom
| | - Caroline Willis
- Food Water and Environmental Microbiology Laboratory, National Infection Service, Public Health England, Salisbury, United Kingdom
| | - Piers Mook
- Field Epidemiology Services, National Infection Service, Public Health England, London, United Kingdom.,University of Warwick, Coventry, United Kingdom
| | - Chas Rawlings
- Field Epidemiology Services, National Infection Service, Public Health England, London, United Kingdom
| | | | | | | | - Joanne Edge
- Food Standards Agency, London, United Kingdom
| | - Eleanor McNamara
- Public Health Laboratory, Health Service Executive, Dublin, Republic of Ireland
| | - Jeremy Hawker
- Field Epidemiology Services, National Infection Service, Public Health England, London, United Kingdom.,Gastrointestinal Infection Department, National Infection Service, Public Health England, London, United Kingdom.,National Institute Health Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, London, United Kingdom
| | - Sooria Balasegaram
- Field Epidemiology Services, National Infection Service, Public Health England, London, United Kingdom
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4
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Rastawicki W, Chróst A, Gielarowiec K. Development and evaluation of latex agglutination tests for the detection of human antibodies to the lipopolysaccharides of verocytotoxin-producing Escherichia coli (VTEC) serogroups O157 and non-O157. METHODS IN MICROBIOLOGY 2017; 140:74-76. [DOI: 10.1016/j.mimet.2017.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 12/19/2022]
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Ryan MO, Haas CN, Gurian PL, Gerba CP, Panzl BM, Rose JB. Application of quantitative microbial risk assessment for selection of microbial reduction targets for hard surface disinfectants. Am J Infect Control 2014; 42:1165-72. [PMID: 25241163 DOI: 10.1016/j.ajic.2014.07.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 07/18/2014] [Accepted: 07/21/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND This quantitative microbial risk assessment (QMRA) included problem formulation for fomites and hazard identification for 7 microorganisms, including pathogenic Escherichia coli and E coli 0157:H7, Listeria monocytogenes, norovirus, Pseudomonas spp, Salmonella spp, and Staphylococcus aureus. The goal was to address a risk-based process for choosing the log10 reduction recommendations, in contrast to the current US Environmental Protection Agency requirements. METHOD For each microbe evaluated, the QMRA model included specific dose-response models, occurrence determination of aerobic bacteria and specific organisms on fomites, exposure assessment, risk characterization, and risk reduction. Risk estimates were determined for a simple scenario using a single touch of a contaminated surface and self-inoculation. A comparative analysis of log10 reductions, as suggested by the US Environmental Protection Agency, and the risks based on this QMRA approach was also undertaken. RESULTS The literature review and meta-analysis showed that aerobic bacteria were the most commonly studied on fomites, averaging 100 colony-forming units (CFU)/cm(2). Pseudomonas aeruginosa was found at a level of 3.3 × 10(-1) CFU/cm(2); methicillin-resistant S aureus (MRSA), at 6.4 × 10(-1) CFU/cm(2). Risk estimates per contact event ranged from a high of 10(-3) for norovirus to a low of 10(-9) for S aureus. CONCLUSION This QMRA analysis suggests that a reduction in bacterial numbers on a fomite by 99% (2 logs) most often will reduce the risk of infection from a single contact to less than 1 in 1 million.
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Affiliation(s)
- Michael O Ryan
- Department of Civil, Architectural, and Environmental Engineering, Drexel University, Philadelphia, PA.
| | - Charles N Haas
- Department of Civil, Architectural, and Environmental Engineering, Drexel University, Philadelphia, PA
| | - Patrick L Gurian
- Department of Civil, Architectural, and Environmental Engineering, Drexel University, Philadelphia, PA
| | - Charles P Gerba
- Department of Soil, Water, and Environmental Science, University of Arizona, Tucson, AZ
| | - Brian M Panzl
- Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI
| | - Joan B Rose
- Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI
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6
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Lupindu AM, Olsen JE, Ngowi HA, Msoffe PLM, Mtambo MM, Scheutz F, Dalsgaard A. Occurrence and characterization of Shiga toxin-producing Escherichia coli O157:H7 and other non-sorbitol-fermenting E. coli in cattle and humans in urban areas of Morogoro, Tanzania. Vector Borne Zoonotic Dis 2014; 14:503-10. [PMID: 24901881 DOI: 10.1089/vbz.2013.1502] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Escherichia coli strains such as Shiga toxin-producing E. coli (STEC), enteropathogenic E. coli, enterotoxigenic, attaching, and effacing E. coli, and enteroinvasive E. coli cause diarrhea in humans. Although other serotypes exist, the most commonly reported STEC in outbreaks is O157:H7. A cross-sectional study was conducted to isolate and characterize non-sorbitol-fermenting (NSF) E. coli O157:H7 from urban and periurban livestock settings of Morogoro, Tanzania. Human stool, cattle feces, and soil and water samples were collected. Observations and questionnaire interview studies were used to gather information about cattle and manure management practices in the study area. E. coli were isolated on sorbitol MacConkey agar and characterized by conventional biochemical tests. Out of 1049 samples, 143 (13.7%) yielded NSF E. coli. Serological and antimicrobial tests and molecular typing were performed to NSF E. coli isolates. These procedures detected 10 (7%) pathogenic E. coli including STEC (n=7), enteropathogenic E. coli (EPEC) (n=2), and attaching and effacing E. coli (A/EEC) (n=1) strains. The STEC strains had the ability to produce VT1 and different VT2 toxin subtypes that caused cytopathic effects on Vero cells. The prevalence of STEC in cattle was 1.6%, out of which 0.9% was serotype O157:H7 and the overall prevalence of diarrheagenic E. coli in cattle was 2.2%. The serotypes O157:H7, O142:H34, O113:H21, O+:H-, O+:H16, and O25:H4 were identified. One ESBL-producing isolate showed the MLST type ST131. To our knowledge, this is the first finding in Tanzania of this recently emerged worldwide pandemic clonal group, causing widespread antimicrobial-resistant infections, and adds knowledge of the geographical distribution of ST131. Cattle manure was indiscriminately deposited within residential areas, and there was direct contact between humans and cattle feces during manure handling. Cattle and manure management practices expose humans, animals, and the environment to pathogenic E. coli and other manure-borne pathogens. Therefore, there is a need to improve manure management practices in urban and periurban areas to prevent pathogen spread and associated human health risks.
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Affiliation(s)
- Athumani M Lupindu
- 1 Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture , Morogoro, Tanzania
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7
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Scientific Opinion on VTEC‐seropathotype and scientific criteria regarding pathogenicity assessment. EFSA J 2013. [DOI: 10.2903/j.efsa.2013.3138] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Boyer O, Niaudet P. Hemolytic uremic syndrome: new developments in pathogenesis and treatment. Int J Nephrol 2011; 2011:908407. [PMID: 21876803 PMCID: PMC3159990 DOI: 10.4061/2011/908407] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 06/14/2011] [Indexed: 12/27/2022] Open
Abstract
Hemolytic uremic syndrome is defined by the characteristic triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. In children, most cases of HUS are caused by Shiga-toxin-producing bacteria, especially Escherichia coli O157:H7. Common vehicles of transmission include ground beef, unpasteurized milk, and municipal or swimming water. Shiga-toxin-associated HUS is a main cause of acute renal failure in young children. Management remains supportive as there is at present no specific therapy to ameliorate the prognosis. Immediate outcome is most often favourable but long-term renal sequelae are frequent due to nephron loss. Atypical HUS represents 5% of cases. In the past 15 years, mutations in complement regulators of the alternative pathway have been identified in almost 60% of cases, leading to excessive complement activation. The disease has a relapsing course and more than half of the patients either die or progress to end-stage renal failure. Recurrence after renal transplantation is frequent.
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Affiliation(s)
- Olivia Boyer
- Service de Néphrologie Pédiatrique, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
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Chart H, Cheasty T. Human infections with verocytotoxin-producing Escherichia coli O157--10 years of E. coli O157 serodiagnosis. J Med Microbiol 2008; 57:1389-1393. [PMID: 18927417 DOI: 10.1099/jmm.0.2008/003632-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
From 1997 to 2007, the Laboratory of Enteric Pathogens (LEP), Health Protection Agency, UK, received sera from 2148 patients for testing for antibodies to the LPS of verocytotoxin-producing Escherichia coli (VTEC) O157. A total of 676 (31.5 %) sera had antibodies binding the LPS of E. coli O157 and the majority of patients were below the age of 10 years, a trend observed for both males and females. Antibody-positive patients had haemolytic uraemic syndrome (HUS) in 79.3 % of cases and most of these presented with the atypical (D-) form of HUS. Nine patients were shown to have antibodies to the LPS of E. coli belonging to serogroups O26 (4), O103 (2), O111 (1) and O145 (2) and one patient had antibodies to the somatic antigens of both E. coli O26 and O103. The serodiagnosis of infections with E. coli O157 and other VTEC continues to be an important adjunct to bacteriology. Where clinicians suspect the involvement of a VTEC in disease, patients' sera should be submitted to the LEP for analysis without delay.
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Affiliation(s)
- Henrik Chart
- Laboratory of Enteric Pathogens, Department of Gastrointestinal, Emerging and Zoonotic Infections, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Thomas Cheasty
- Laboratory of Enteric Pathogens, Department of Gastrointestinal, Emerging and Zoonotic Infections, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK
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10
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Abstract
Haemolytic uraemic syndrome (HUS) is the most common cause of acute renal failure in children. The syndrome is defined by triad of microangiopathic haemolytic anaemia, thrombocytopenia and acute renal failure (ARF). Incomplete HUS is ARF with either haemolytic anaemia or thrombocytopenia. HUS is classified into two subgroups. Typical HUS usually occurs after a prodrome of diarrhoea (D+HUS), and atypical (sporadic) HUS (aHUS), which is not associated with diarrhoea (D-HUS). The majority of D+HUS worldwide is caused by Shiga toxin-producing Esherichia coli (STEC), type O157:H7, transmitted to humans via different vehicles. Currently there are no specific therapies preventing or ameliorating the disease course. Although there are new therapeutic modalities in the horizon for D+HUS, present recommended therapy is merely symptomatic. Parenteral volume expansion may counteract the effect of thrombotic process before development of HUS and attenuate renal injury. Use of antibiotics, antimotility agents, narcotics and non-steroidal anti-inflammatory drugs should be avoided during the acute phase. Prevention is best done by preventing primary STEC infection. Underlying aetiology in many cases of aHUS is unknown. A significant number may result from underlying infectious diseases, namely Streptococcus pneumoniae and human immunedeficiency virus. Variety of genetic forms include HUS due to deficiencies of factor H, membrane cofactor protein, Von Willebrand factor-cleaving protease (ADAMTS 13) and intracellular defect in vitamin B12 metabolism. There are cases of aHUS with autosomal recessive and dominant modes of inheritance. Drug-induced aHUS in post-transplantation is due to calcineurin-inhibitors. Systemic lupus erythematosus and catastrophic antiphospholipid syndrome may also present with aHUS. Therapy is directed mainly towards underlying cause.
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Affiliation(s)
- Iradj Amirlak
- Department of Paediatrics, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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11
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Lynn RM, O'Brien SJ, Taylor CM, Adak GK, Chart H, Cheasty T, Coia JE, Gillespie IA, Locking ME, Reilly WJ, Smith HR, Waters A, Willshaw GA. Childhood hemolytic uremic syndrome, United Kingdom and Ireland. Emerg Infect Dis 2005; 11:590-6. [PMID: 15829199 PMCID: PMC3320351 DOI: 10.3201/eid1104.040833] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The risk for diarrhea-associated HUS was higher for children infected with Escherichia coli O157 phage type (PT) 2 and PT21/28 than for those infected with other PTs. We conducted prospective surveillance of childhood hemolytic uremic syndrome (HUS) from 1997 to 2001 to describe disease incidence and clinical, epidemiologic and microbiologic characteristics. We compared our findings, where possible, with those of a previous study conducted from 1985 to 1988. The average annual incidence of HUS for the United Kingdom and Ireland (0.71/100,000) was unchanged from 1985 to 1988. The overall early mortality had halved, but the reduction in mortality was almost entirely accounted for by improved outcome in patients with diarrhea-associated HUS. The principal infective cause of diarrhea-associated HUS was Shiga toxin–producing Escherichia coli O157 (STEC O157), although in the 1997–2001 survey STEC O157 phage type (PT) 21/28 had replaced STEC O157 PT2 as the predominant PT. The risk of developing diarrhea-associated HUS was significantly higher in children infected with STEC O157 PT 2 and PT 21/28 compared with other PTs. Hypertension as a complication of HUS was greatly reduced in patients with diarrhea-associated HUS.
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Affiliation(s)
- Richard M Lynn
- Royal College of Paediatrics and Child Health, London, United Kingdom
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12
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Deisingh AK, Thompson M. Strategies for the detection of Escherichia coli O157:H7 in foods. J Appl Microbiol 2004; 96:419-29. [PMID: 14962121 DOI: 10.1111/j.1365-2672.2003.02170.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- A K Deisingh
- Department of Chemistry, University of Toronto, Toronto, Ontario, Canada.
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White SM. Chemical and biological weapons. Implications for anaesthesia and intensive care. Br J Anaesth 2002; 89:306-24. [PMID: 12378672 DOI: 10.1093/bja/aef168] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
In the wake of recent atrocities there has been renewed apprehension regarding the possibility of chemical and biological weapon (CBW) deployment by terrorists. Despite various international agreements that proscribe their use, certain states continue to develop chemical and biological weapons of mass destruction. Of greater concern, recent historical examples support the prospect that state-independent organizations have the capability to produce such weapons. Indeed, the deliberate deployment of anthrax has claimed several lives in the USA since September 11, 2001. In the event of a significant CBW attack, medical services would be stretched. However, victim survival may be improved by the prompt, coordinated response of military and civil authorities, in conjunction with appropriate medical care. In comparison with most other specialties, anaesthetists have the professional academic background in physiology and pharmacology to be able to understand the nature of the injuries caused by CBWs. Anaesthetists, therefore, play a vital role both in the initial resuscitation of casualties and in their continued treatment in an intensive care setting. This article assesses the current risk of CBW deployment by terrorists, considers factors which would affect the severity of an attack, and discusses the pathophysiology of those CBWs most likely to be used. The specific roles of the anaesthetist and intensivist in treatment are highlighted.
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Affiliation(s)
- S M White
- Department of Anaesthesia, Guy's and St Thomas' Hospital Trust, St Thomas' Street, London SE1 9RT, UK
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Weir E. Escherichia coli O157:H7. CMAJ 2000; 163:205. [PMID: 10934989 PMCID: PMC80231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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