1
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Scheutz F, Nielsen CH, von Mentzer A. Construction of the ETECFinder database for the characterization of enterotoxigenic Escherichia coli (ETEC) and revision of the VirulenceFinder web tool at the CGE website. J Clin Microbiol 2024:e0057023. [PMID: 38656142 DOI: 10.1128/jcm.00570-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 03/05/2024] [Indexed: 04/26/2024] Open
Abstract
The identification of pathogens is essential for effective surveillance and outbreak detection, which lately has been facilitated by the decreasing cost of whole-genome sequencing (WGS). However, extracting relevant virulence genes from WGS data remains a challenge. In this study, we developed a web-based tool to predict virulence-associated genes in enterotoxigenic Escherichia coli (ETEC), which is a major concern for human and animal health. The database includes genes encoding the heat-labile toxin (LT) (eltA and eltB), heat-stable toxin (ST) (est), colonization factors CS1 through 30, F4, F5, F6, F17, F18, and F41, as well as toxigenic invasion and adherence loci (tia, tibAC, etpBAC, eatA, yghJ, and tleA). To construct the database, we revised the existing ETEC nomenclature and used the VirulenceFinder webtool at the CGE website [VirulenceFinder 2.0 (dtu.dk)]. The database was tested on 1,083 preassembled ETEC genomes, two BioProjects (PRJNA421191 with 305 and PRJNA416134 with 134 sequences), and the ETEC reference genome H10407. In total, 455 new virulence gene alleles were added, 50 alleles were replaced or renamed, and two were removed. Overall, our tool has the potential to greatly facilitate ETEC identification and improve the accuracy of WGS analysis. It can also help identify potential new virulence genes in ETEC. The revised nomenclature and expanded gene repertoire provide a better understanding of the genetic diversity of ETEC. Additionally, the user-friendly interface makes it accessible to users with limited bioinformatics experience. IMPORTANCE Detecting colonization factors in enterotoxigenic Escherichia coli (ETEC) is challenging due to their large number, heterogeneity, and lack of standardized tests. Therefore, it is important to include these ETEC-related genes in a more comprehensive VirulenceFinder database in order to obtain a more complete coverage of the virulence gene repertoire of pathogenic types of E. coli. ETEC vaccines are of great importance due to the severity of the infections, primarily in children. A tool such as this could assist in the surveillance of ETEC in order to determine the prevalence of relevant types in different parts of the world, allowing vaccine developers to target the most prevalent types and, thus, a more effective vaccine.
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Affiliation(s)
- Flemming Scheutz
- The International Escherichia and Klebsiella Centre, Statens Serum Institut, Copenhagen, Denmark
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Camilla Hald Nielsen
- The International Escherichia and Klebsiella Centre, Statens Serum Institut, Copenhagen, Denmark
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Astrid von Mentzer
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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2
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Lindsey RL, Prasad A, Feldgarden M, Gonzalez-Escalona N, Kapsak C, Klimke W, Melton-Celsa A, Smith P, Souvorov A, Truong J, Scheutz F. Identification and Characterization of ten Escherichia coli Strains Encoding Novel Shiga Toxin 2 Subtypes, Stx2n as Well as Stx2j, Stx2m, and Stx2o, in the United States. Microorganisms 2023; 11:2561. [PMID: 37894219 PMCID: PMC10608928 DOI: 10.3390/microorganisms11102561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
The sharing of genome sequences in online data repositories allows for large scale analyses of specific genes or gene families. This can result in the detection of novel gene subtypes as well as the development of improved detection methods. Here, we used publicly available WGS data to detect a novel Stx subtype, Stx2n in two clinical E. coli strains isolated in the USA. During this process, additional Stx2 subtypes were detected; six Stx2j, one Stx2m strain, and one Stx2o, were all analyzed for variability from the originally described subtypes. Complete genome sequences were assembled from short- or long-read sequencing and analyzed for serotype, and ST types. The WGS data from Stx2n- and Stx2o-producing STEC strains were further analyzed for virulence genes pro-phage analysis and phage insertion sites. Nucleotide and amino acid maximum parsimony trees showed expected clustering of the previously described subtypes and a clear separation of the novel Stx2n subtype. WGS data were used to design OMNI PCR primers for the detection of all known stx1 (283 bp amplicon), stx2 (400 bp amplicon), intimin encoded by eae (221 bp amplicon), and stx2f (438 bp amplicon) subtypes. These primers were tested in three different laboratories, using standard reference strains. An analysis of the complete genome sequence showed variability in serogroup, virulence genes, and ST type, and Stx2 pro-phages showed variability in size, gene composition, and phage insertion sites. The strains with Stx2j, Stx2m, Stx2n, and Stx2o showed toxicity to Vero cells. Stx2j carrying strain, 2012C-4221, was induced when grown with sub-inhibitory concentrations of ciprofloxacin, and toxicity was detected. Taken together, these data highlight the need to reinforce genomic surveillance to identify the emergence of potential new Stx2 or Stx1 variants. The importance of this surveillance has a paramount impact on public health. Per our description in this study, we suggest that 2017C-4317 be designated as the Stx2n type-strain.
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Affiliation(s)
- Rebecca L. Lindsey
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (C.K.); (P.S.)
| | - Arjun Prasad
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA; (A.P.); (M.F.); (W.K.); (A.S.)
| | - Michael Feldgarden
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA; (A.P.); (M.F.); (W.K.); (A.S.)
| | - Narjol Gonzalez-Escalona
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD 20740, USA;
| | - Curtis Kapsak
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (C.K.); (P.S.)
| | - William Klimke
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA; (A.P.); (M.F.); (W.K.); (A.S.)
| | - Angela Melton-Celsa
- Department of Microbiology and Immunology, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20184, USA;
| | - Peyton Smith
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (C.K.); (P.S.)
| | - Alexandre Souvorov
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA; (A.P.); (M.F.); (W.K.); (A.S.)
| | - Jenny Truong
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA;
| | - Flemming Scheutz
- The International Escherichia and Klebsiella Centre, Statens Serum Institut, 2300 Copenhagen, Denmark;
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3
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Bai X, Scheutz F, Dahlgren HM, Hedenström I, Jernberg C. Characterization of Clinical Escherichia coli Strains Producing a Novel Shiga Toxin 2 Subtype in Sweden and Denmark. Microorganisms 2021; 9:microorganisms9112374. [PMID: 34835499 PMCID: PMC8625421 DOI: 10.3390/microorganisms9112374] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 11/16/2022] Open
Abstract
Shiga toxin (Stx) is the key virulence factor in the Shiga Toxin-Producing Escherichia coli (STEC), which can cause diarrhea and hemorrhagic colitis with potential life-threatening complications. There are two major types of Stx: Stx1 and Stx2. Several Stx1/Stx2 subtypes have been identified in E. coli, varying in sequences, toxicity and host specificity. Here, we report a novel Stx2 subtype (designated Stx2m) from three clinical E. coli strains isolated from diarrheal patients and asymptomatic carriers in Sweden and Denmark. The Stx2m toxin was functional and exhibited cytotoxicity in vitro. The two Swedish Stx2m-producing strains belonged to the same serotype O148:H39 and Multilocus Sequencing Typing (MLST) Sequence Type (ST) 5825, while the Danish strain belonged to the O96:H19 serotype and ST99 type. Whole-genome sequencing (WGS) data analysis revealed that the three Stx2m-producing strains harbored additional virulence genes and the macrolide resistance gene mdf (A). Our findings expand the pool of Stx2 subtypes and highlight the clinical significance of emerging STEC variants. Given the clinical relevance of the Stx2m-producing strains, we propose to include Stx2m in epidemiological surveillance of STEC infections and clinical diagnosis.
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Affiliation(s)
- Xiangning Bai
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, 141 52 Stockholm, Sweden;
- Division of Laboratory Medicine, Oslo University Hospital, 0372 Oslo, Norway
| | - Flemming Scheutz
- The International Escherichia and Klebsiella Centre, Statens Serum Institut, 2300 Copenhagen, Denmark;
| | - Henrik Mellström Dahlgren
- County Council Department of Communicable Disease Control and Prevention, Region Västra Götaland, 411 18 Gothenburg, Sweden;
| | | | - Cecilia Jernberg
- Public Health Agency of Sweden, 171 82 Solna, Sweden;
- Correspondence:
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Truong DTQ, Hounmanou YMG, Dang STT, Olsen JE, Truong GTH, Tran NT, Scheutz F, Dalsgaard A. Genetic Comparison of ESBL-Producing Escherichia coli from Workers and Pigs at Vietnamese Pig Farms. Antibiotics (Basel) 2021; 10:1165. [PMID: 34680746 PMCID: PMC8532784 DOI: 10.3390/antibiotics10101165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
We analyzed and compared genomes of Extended Spectrum Beta-Lactamase (ESBL)-producing Escherichia coli from pigs and pig farm workers at 116 farms in Vietnam. Analyses revealed the presence of blaCTX-M-55, blaCTX-M-27, blaCTX-M-15, blaCTX-M-14, blaCTX-M-3, blaCTX-M-65, blaCTX-M-24, blaDHA-1, and blaCMY2 in both hosts. Most strains from pigs contained quinolones (qnr) and colistin resistance genes (mcr-1 and mcr-3). Isolates predominantly harbored more than one plasmid replicon and some harbored plasmid replicons on the same contigs as the ESBL genes. Five strains from farm workers of ST38 (2), ST69 (1), and ST1722 (2) were classified as either uropathogenic E. coli (UPECHM)/extraintestinal pathogenic E. coli (ExPECJJ) or UPECHM, and the remaining were genetically distinct commensals. A high heterogeneity was found among the ESBL-producing E. coli from pigs and workers, with most isolates belonging to unrelated phylogroups, serogroups, and sequence types with >4046 Single-Nucleotide Polymorphisms-(SNPs). In comparing the genomes of pig isolates to those from humans, it appeared that ESBL-producing E. coli in workers did not predominantly originate from pigs but were rather host-specific. Nevertheless, the occurrence of ESBL-producing E. coli carrying plasmid-mediated colistin and quinolone resistance genes in pigs could represent a potential source for horizontal transmission to humans through food rather than direct contact.
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Affiliation(s)
- Duong Thi Quy Truong
- National Institute of Veterinary Research, Hanoi 10000, Vietnam; (D.T.Q.T.); (S.T.T.D.); (G.T.H.T.); (N.T.T.)
| | | | - Son Thi Thanh Dang
- National Institute of Veterinary Research, Hanoi 10000, Vietnam; (D.T.Q.T.); (S.T.T.D.); (G.T.H.T.); (N.T.T.)
| | - John Elmerdahl Olsen
- Department of Veterinary and Animal Sciences, University of Copenhagen, 1870 Frederiksberg C, Denmark;
| | - Giang Thi Huong Truong
- National Institute of Veterinary Research, Hanoi 10000, Vietnam; (D.T.Q.T.); (S.T.T.D.); (G.T.H.T.); (N.T.T.)
| | - Nhat Thi Tran
- National Institute of Veterinary Research, Hanoi 10000, Vietnam; (D.T.Q.T.); (S.T.T.D.); (G.T.H.T.); (N.T.T.)
| | - Flemming Scheutz
- Department of Bacteria, Parasites and Fungi, Statens Serum Institute, 2300 Copenhagen S, Denmark;
| | - Anders Dalsgaard
- Department of Veterinary and Animal Sciences, University of Copenhagen, 1870 Frederiksberg C, Denmark;
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5
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Andrews V, Hasman H, Midttun M, Feldthaus MB, Porsbo LJ, Holzknecht BJ, Scheutz F, Hess CE, Olesen B. A hospital outbreak of an NDM-producing ST167 Escherichia coli with a possible link to a toilet. J Hosp Infect 2021; 117:186-187. [PMID: 34481891 DOI: 10.1016/j.jhin.2021.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Affiliation(s)
- V Andrews
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.
| | - H Hasman
- Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - M Midttun
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - M B Feldthaus
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - L J Porsbo
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - B J Holzknecht
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - F Scheutz
- Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - C E Hess
- Department of Nephrology and Endocrinology, Copenhagen University Hospital - North Zealand Hospital, Hillerød, Denmark
| | - B Olesen
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
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Leonard MF, Rodriguez-Villalobos H, Boisen N, Scheutz F, Laterre PF, Hantson P. The causal relationship between O2:K7:H6 extra-intestinal pathogenic Escherichia coli (ExPEC) and native valve endocarditis: a case report. BMC Infect Dis 2021; 21:370. [PMID: 33879083 PMCID: PMC8056695 DOI: 10.1186/s12879-021-06066-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background Native valves infective endocarditis due to Escherichia coli is still a rare disease and a particular virulence of some E.coli isolate may be suspected. Case presentation A 79-year-old woman presented during the post-operative period of an orthopedic surgery a urinary tract infection following obstructive ureteral lithiasis. E. coli was isolated from a pure culture of urine and blood sampled simultaneously. After evidence of sustained E.coli septicemia, further investigations revealed acute cholecystitis with the same micro-organism in biliary drainage and a native valve mitral endocarditis. E.coli was identified as O2:K7:H6, phylogenetic group B2, ST141, and presented several putative and proven virulence genes. The present isolate can be classified as both extra-intestinal pathogenic E.coli (ExPECJJ) and uropathogenic E. coli (UPECHM). Conclusions The relationship between the virulent factors present in ExPEC strains and some serotypes of E. coli that could facilitate the adherence to cardiac valves warrants further investigation.
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Affiliation(s)
| | - Hector Rodriguez-Villalobos
- Department of Microbiology, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Nadia Boisen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, The International Centre for Reference and Research on Escherichia and Klebsiella, Copenhagen, Denmark
| | - Flemming Scheutz
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, The International Centre for Reference and Research on Escherichia and Klebsiella, Copenhagen, Denmark
| | - Pierre-François Laterre
- Department of Intensive Care, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Philippe Hantson
- Department of Intensive Care, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium.
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7
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Boisen N, Østerlund MT, Joensen KG, Santiago AE, Mandomando I, Cravioto A, Chattaway MA, Gonyar LA, Overballe-Petersen S, Stine OC, Rasko DA, Scheutz F, Nataro JP. Redefining enteroaggregative Escherichia coli (EAEC): Genomic characterization of epidemiological EAEC strains. PLoS Negl Trop Dis 2020; 14:e0008613. [PMID: 32898134 PMCID: PMC7500659 DOI: 10.1371/journal.pntd.0008613] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/18/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022] Open
Abstract
Although enteroaggregative E. coli (EAEC) has been implicated as a common cause of diarrhea in multiple settings, neither its essential genomic nature nor its role as an enteric pathogen are fully understood. The current definition of this pathotype requires demonstration of cellular adherence; a working molecular definition encompasses E. coli which do not harbor the heat-stable or heat-labile toxins of enterotoxigenic E. coli (ETEC) and harbor the genes aaiC, aggR, and/or aatA. In an effort to improve the definition of this pathotype, we report the most definitive characterization of the pan-genome of EAEC to date, applying comparative genomics and functional characterization on a collection of 97 EAEC strains isolated in the course of a multicenter case-control diarrhea study (Global Enteric Multi-Center Study, GEMS). Genomic analysis revealed that the EAEC strains mapped to all phylogenomic groups of E. coli. Circa 70% of strains harbored one of the five described AAF variants; there were no additional AAF variants identified, and strains that lacked an identifiable AAF generally did not have an otherwise complete AggR regulon. An exception was strains that harbored an ETEC colonization factor (CF) CS22, like AAF a member of the chaperone-usher family of adhesins, but not phylogenetically related to the AAF family. Of all genes scored, sepA yielded the strongest association with diarrhea (P = 0.002) followed by the increased serum survival gene, iss (p = 0.026), and the outer membrane protease gene ompT (p = 0.046). Notably, the EAEC genomes harbored several genes characteristically associated with other E. coli pathotypes. Our data suggest that a molecular definition of EAEC could comprise E. coli strains harboring AggR and a complete AAF(I-V) or CS22 gene cluster. Further, it is possible that strains meeting this definition could be both enteric bacteria and urinary/systemic pathogens.
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Affiliation(s)
- Nadia Boisen
- Statens Serum Institut, Department of Bacteria, Parasites and Fungi, Copenhagen, Denmark
| | - Mark T. Østerlund
- Statens Serum Institut, Department of Bacteria, Parasites and Fungi, Copenhagen, Denmark
| | - Katrine G. Joensen
- Statens Serum Institut, Department of Bacteria, Parasites and Fungi, Copenhagen, Denmark
| | - Araceli E. Santiago
- University of Virginia School of Medicine, Department of Pediatrics, Charlottesville, Virginia, United States of America
| | - Inacio Mandomando
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Alejandro Cravioto
- Universidad Nacional Autónoma de México, Faculty of Medicine, Mexico City, Mexico
| | - Marie A. Chattaway
- Public Health England, Gastrointestinal Bacteria Reference Unit (GBRU), Colindale, United Kingdom
| | - Laura A. Gonyar
- University of Virginia School of Medicine, Department of Pediatrics, Charlottesville, Virginia, United States of America
| | | | - O. Colin Stine
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland, United States of America
| | - David A. Rasko
- University of Maryland School of Medicine, Institute for Genome Sciences, Department of Microbiology and Immunology, Baltimore, Maryland, United States of America
| | - Flemming Scheutz
- Statens Serum Institut, Department of Bacteria, Parasites and Fungi, Copenhagen, Denmark
| | - James P. Nataro
- University of Virginia School of Medicine, Department of Pediatrics, Charlottesville, Virginia, United States of America
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8
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Leite FRM, Nascimento GG, Baake S, Pedersen LD, Scheutz F, López R. Impact of Smoking Cessation on Periodontitis: A Systematic Review and Meta-analysis of Prospective Longitudinal Observational and Interventional Studies. Nicotine Tob Res 2020; 21:1600-1608. [PMID: 30011036 DOI: 10.1093/ntr/nty147] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/10/2018] [Indexed: 01/20/2023]
Abstract
AIMS This systematic review aimed to estimate the effect of tobacco smoking cessation on the risk for periodontitis compared to the risk among never-smokers and to evaluate the effect of tobacco smoking cessation on the clinical outcomes of nonsurgical periodontal treatment. METHODS Electronic searches were performed in PubMed, Scopus, and Embase. Search strategy included MeSH and free terms: periodontitis, periodontal diseases, smoking, tobacco use, tobacco, tobacco products, cigarette, pipe, and cigar. Only original prospective longitudinal observational and interventional studies that investigated the association between smoking cessation and periodontitis onset or progression were included. Meta-analyses were conducted to summarize the evidence. RESULTS A total of 2743 articles were identified in electronic searches; out of which only six were included in the meta-analysis. Pooled estimates showed that the risk of periodontitis incidence or progression among those who quit smoking was not significantly different from the risk for never-smokers (risk ratio [RR] = 0.97; 95% confidence interval [CI] = 0.87% to 1.08%). Smokers had approximately 80% higher risk of periodontitis than quitters (RR = 1.79; 95% CI = 1.36% to 2.35%) and never-smokers (RR = 1.82; 95% CI = 1.43% to 2.31%). Periodontal therapy resulted in up to 0.2 mm (95% CI = -0.32% to -0.08%) higher gain in attachment level and extra 0.32 mm (95% CI = 0.07% to 0.52%) reduction in pocket depth among quitters over nonquitters after short follow-up (12-24 months). CONCLUSIONS Few studies on the topic were identified. Smoking cessation reduced the risk for periodontitis onset and progression, and improved the outcomes of nonsurgical periodontal therapy. IMPLICATIONS This review provides the first quantitative evidence of the impact of smoking cessation on the risk for periodontitis onset and progression. The findings have demonstrated that the risk for periodontitis becomes comparable to that of never-smokers and that nonsurgical periodontal treatment outcomes improve after smoking cessation. Dental professionals ought to consider smoking cessation interventions as a relevant component of the periodontal therapy.
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Affiliation(s)
- Fábio R M Leite
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Gustavo G Nascimento
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Stina Baake
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Lisa D Pedersen
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Flemming Scheutz
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Rodrigo López
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Koutsoumanis K, Allende A, Alvarez‐Ordóñez A, Bover‐Cid S, Chemaly M, Davies R, De Cesare A, Herman L, Hilbert F, Lindqvist R, Nauta M, Peixe L, Ru G, Simmons M, Skandamis P, Suffredini E, Jenkins C, Monteiro Pires S, Morabito S, Niskanen T, Scheutz F, da Silva Felício MT, Messens W, Bolton D. Pathogenicity assessment of Shiga toxin‐producing Escherichia coli (STEC) and the public health risk posed by contamination of food with STEC. EFSA J 2020. [DOI: 10.2903/j.efsa.2020.5967] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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10
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Yang X, Bai X, Zhang J, Sun H, Fu S, Fan R, He X, Scheutz F, Matussek A, Xiong Y. Escherichia coli strains producing a novel Shiga toxin 2 subtype circulate in China. Int J Med Microbiol 2019; 310:151377. [PMID: 31757694 DOI: 10.1016/j.ijmm.2019.151377] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/25/2019] [Accepted: 10/29/2019] [Indexed: 11/16/2022] Open
Abstract
Shiga toxin (Stx) is the key virulence factor in Shiga toxin producing Escherichia coli (STEC), which can cause diarrhea and hemorrhagic colitis with life-threatening complications. Stx comprises two toxin types, Stx1 and Stx2. Several Stx1/Stx2 subtypes have been identified in E. coli, which are variable in sequences, toxicity and host specificity. Here, we report the identification of a novel Stx2 subtype, designated Stx2k, in E. coli strains widely detected from diarrheal patients, animals, and raw meats in China over time. Stx2k exhibits varied cytotoxicity in vitro among individual strains. The Stx2k converting prophages displayed considerable heterogeneity in terms of insertion site, genetic content and structure. Whole genome analysis revealed that the stx2k-containing strains were genetically heterogeneous with diverse serotypes, sequence types, and virulence gene profiles. The nine stx2k-containing strains formed two major phylogenetic clusters closely with strains belonging to STEC, enterotoxigenic E. coli (ETEC), and STEC/ETEC hybrid. One stx2k-containing strain harbored one plasmid-encoded heat-stable enterotoxin sta gene and two identical copies of chromosome-encoded stb gene, exhibiting STEC/ETEC hybrid pathotype. Our finding enlarges the pool of Stx2 subtypes and highlights the extraordinary genomic plasticity of STEC strains. Given the wide distribution of the Stx2k-producing strains in diverse sources and their pathogenic potential, Stx2k should be taken into account in epidemiological surveillance of STEC infections and clinical diagnosis.
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Affiliation(s)
- Xi Yang
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Xiangning Bai
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China; Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| | - Ji Zhang
- EpiLab, New Zealand Food Safety Science & Research Centre, School of Veterinary Science, Massey University, New Zealand
| | - Hui Sun
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Shanshan Fu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Ruyue Fan
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Xiaohua He
- Western Regional Research Center, U.S. Department of Agriculture, Agricultural Research Service, Albany, CA, USA
| | - Flemming Scheutz
- The International Centre for Reference and Research on Escherichia and Klebsiella, Unit of Foodborne Bacteria and Typing, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Andreas Matussek
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| | - Yanwen Xiong
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang Province, China.
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11
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Boisen N, Melton-Celsa AR, Hansen AM, Zangari T, Smith MA, Russo LM, Scheutz F, O'Brien AD, Nataro JP. The Role of the AggR Regulon in the Virulence of the Shiga Toxin-Producing Enteroaggregative Escherichia coli Epidemic O104:H4 Strain in Mice. Front Microbiol 2019; 10:1824. [PMID: 31456767 PMCID: PMC6700298 DOI: 10.3389/fmicb.2019.01824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/24/2019] [Indexed: 12/04/2022] Open
Abstract
An O104:H4 Shiga toxin (Stx)-producing enteroaggregative Escherichia coli (EAEC) strain caused a large outbreak of bloody diarrhea and the hemolytic uremic syndrome in 2011. We previously developed an ampicillin (Amp)-treated C57BL/6 mouse model to measure morbidity (weight loss) and mortality of mice orally infected with the prototype Stx-EAEC strain C227-11. Here, we hypothesized that mice fed C227-11 cured of the pAA plasmid or deleted for individual genes on that plasmid would display reduced virulence compared to animals given the wild-type (wt) strain. C227-11 cured of the pAA plasmid or deleted for the known pAA-encoded virulence genes aggR, aggA, sepA, or aar were fed to Amp-treated C57BL/6 mice at doses of 1010–1011CFU. Infected animals were then either monitored for morbidity and lethality for 28 days or euthanized to determine intestinal pathology and colonization levels at selected times. The pAA-cured, aggR, and aggA mutants of strain C227-11 all showed reduced colonization at various intestinal sites. However, the aggR mutant was the only mutant attenuated for virulence as it showed both reduced morbidity and mortality. The aar mutant showed increased expression of the aggregative adherence fimbriae (AAF) and caused greater systemic effects in infected mice when compared to the C227-11 wt strain. However, unexpectedly, both the aggA and aar mutants displayed increased weight loss compared to wt. The sepA mutant did not exhibit altered morbidity or mortality in the Amp-treated mouse model compared to wt. Our data suggest that the increased morbidity due to the aar mutant could possibly be via an effect on expression of an as yet unknown virulence-associated factor under AggR control.
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Affiliation(s)
- Nadia Boisen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.,Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Angela R Melton-Celsa
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Anne-Marie Hansen
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Tonia Zangari
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Mark A Smith
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Lisa M Russo
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Flemming Scheutz
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Alison D O'Brien
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - James P Nataro
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States.,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
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12
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Montero DA, Canto FD, Velasco J, Colello R, Padola NL, Salazar JC, Martin CS, Oñate A, Blanco J, Rasko DA, Contreras C, Puente JL, Scheutz F, Franz E, Vidal RM. Cumulative acquisition of pathogenicity islands has shaped virulence potential and contributed to the emergence of LEE-negative Shiga toxin-producing Escherichia coli strains. Emerg Microbes Infect 2019; 8:486-502. [PMID: 30924410 PMCID: PMC6455142 DOI: 10.1080/22221751.2019.1595985] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Shiga toxin-producing Escherichia coli (STEC) are foodborne pathogens causing severe gastroenteritis, which may lead to hemolytic uremic syndrome. The Locus of Enterocyte Effacement (LEE), a Pathogenicity Island (PAI), is a major determinant of intestinal epithelium attachment of a group of STEC strains; however, the virulence repertoire of STEC strains lacking LEE, has not been fully characterized. The incidence of LEE-negative STEC strains has increased in several countries, highlighting the relevance of their study. In order to gain insights into the basis for the emergence of LEE-negative STEC strains, we performed a large-scale genomic analysis of 367 strains isolated worldwide from humans, animals, food and the environment. We identified uncharacterized genomic islands, including two PAIs and one Integrative Conjugative Element. Additionally, the Locus of Adhesion and Autoaggregation (LAA) was the most prevalent PAI among LEE-negative strains and we found that it contributes to colonization of the mice intestine. Our comprehensive and rigorous comparative genomic and phylogenetic analyses suggest that the accumulative acquisition of PAIs has played an important, but currently unappreciated role, in the evolution of virulence in these strains. This study provides new knowledge on the pathogenicity of LEE-negative STEC strains and identifies molecular markers for their epidemiological surveillance.
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Affiliation(s)
- David Arturo Montero
- a Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile , Santiago , Chile
| | - Felipe Del Canto
- a Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile , Santiago , Chile
| | - Juliana Velasco
- b Servicio de Urgencia Infantil, Hospital Clínico de la Universidad de Chile "Dr. José Joaquín Aguirre" , Santiago , Chile
| | - Rocío Colello
- c Centro de Investigación Veterinaria Tandil, CONICET-CIC, Facultad de Ciencias Veterinarias, UNCPBA , Tandil , Argentina
| | - Nora Lia Padola
- c Centro de Investigación Veterinaria Tandil, CONICET-CIC, Facultad de Ciencias Veterinarias, UNCPBA , Tandil , Argentina
| | - Juan Carlos Salazar
- a Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile , Santiago , Chile
| | - Carla San Martin
- d Departamento de Microbiología, Facultad de Ciencias Biológicas , Universidad de Concepción , Concepción , Chile
| | - Angel Oñate
- d Departamento de Microbiología, Facultad de Ciencias Biológicas , Universidad de Concepción , Concepción , Chile
| | - Jorge Blanco
- e Laboratorio de Referencia de E. coli, Facultad de Veterinaria , Universidad de Santiago de Compostela , Lugo , España
| | - David A Rasko
- f Department of Microbiology and Immunology , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Carmen Contreras
- g Departamento de Microbiología Molecular , Instituto de Biotecnología, Universidad Nacional Autónoma de México , Cuernavaca , México
| | - Jose Luis Puente
- g Departamento de Microbiología Molecular , Instituto de Biotecnología, Universidad Nacional Autónoma de México , Cuernavaca , México
| | - Flemming Scheutz
- h Department of Bacteria, Parasites and Fungi , The International Collaborating Centre for Reference and Research on Escherichia and Klebsiella, Statens Serum Institut , Copenhagen , Denmark
| | - Eelco Franz
- i National Institute for Public Health, Centre for Infectious Disease Control , Bilthoven , The Netherlands
| | - Roberto M Vidal
- a Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile , Santiago , Chile.,j Instituto Milenio de Inmunología e Inmunoterapia, Facultad de Medicina, Universidad de Chile , Santiago , Chile
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13
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Bai X, Zhang J, Ambikan A, Jernberg C, Ehricht R, Scheutz F, Xiong Y, Matussek A. Molecular Characterization and Comparative Genomics of Clinical Hybrid Shiga Toxin-Producing and Enterotoxigenic Escherichia coli (STEC/ETEC) Strains in Sweden. Sci Rep 2019; 9:5619. [PMID: 30948755 PMCID: PMC6449507 DOI: 10.1038/s41598-019-42122-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/21/2019] [Indexed: 12/21/2022] Open
Abstract
Hybrid E. coli pathotypes are representing emerging public health threats with enhanced virulence from different pathotypes. Hybrids of Shiga toxin-producing and enterotoxigenic E. coli (STEC/ETEC) have been reported to be associated with diarrheal disease and hemolytic uremic syndrome (HUS) in humans. Here, we identified and characterized four clinical STEC/ETEC hybrids from diarrheal patients with or without fever or abdominal pain and healthy contact in Sweden. Rare stx2 subtypes were present in STEC/ETEC hybrids. Stx2 production was detectable in stx2a and stx2e containing strains. Different copies of ETEC virulence marker, sta gene, were found in two hybrids. Three sta subtypes, namely, sta1, sta4 and sta5 were designated, with sta4 being predominant. The hybrids represented diverse and rare serotypes (O15:H16, O187:H28, O100:H30, and O136:H12). Genome-wide phylogeny revealed that these hybrids exhibited close relatedness with certain ETEC, STEC/ETEC hybrid and commensal E. coli strains, implying the potential acquisition of Stx-phages or/and ETEC virulence genes in the emergence of STEC/ETEC hybrids. Given the emergence and public health significance of hybrid pathotypes, a broader range of virulence markers should be considered in the E. coli pathotypes diagnostics, and targeted follow up of cases is suggested to better understand the hybrid infection.
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Affiliation(s)
- Xiangning Bai
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden.,State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ji Zhang
- mEpiLab, New Zealand Food Safety Science & Research Centre, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Massey, New Zealand
| | - Anoop Ambikan
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| | | | - Ralf Ehricht
- InfectoGnostics Research Campus e.V., Philosophenweg 7, Jena, Germany.,Leibniz Institute of Photonic Technology e.V. Jena (Leibniz-IPHT), Jena, Germany
| | - Flemming Scheutz
- The International Centre for Reference and Research on Escherichia and Klebsiella, Unit of Foodborne Bacteria and Typing, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Yanwen Xiong
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Andreas Matussek
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden. .,Karolinska University Laboratory, Stockholm, Sweden. .,Department of Laboratory Medicine, Region Jönköping County, Jönköping, Sweden.
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14
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Patel IR, Gangiredla J, Lacher DW, Mammel MK, Bagi L, Baranzoni GM, Fratamico PM, Roberts EL, DebROY C, Lindsey RL, V Stoneburg D, Martin H, Smith P, Strockbine NA, Elkins CA, Scheutz F, Feng PCH. Interlaboratory Evaluation of the U.S. Food and Drug Administration Escherichia coli Identification Microarray for Profiling Shiga Toxin-Producing Escherichia coli. J Food Prot 2018; 81:1275-1282. [PMID: 29985068 PMCID: PMC6193752 DOI: 10.4315/0362-028x.jfp-18-052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The U.S. Food and Drug Administration Escherichia coli Identification (FDA-ECID) microarray provides rapid molecular characterization of E. coli. The effectiveness of the FDA-ECID for characterizing Shiga toxin-producing E. coli (STEC) was evaluated by three federal laboratories and one reference laboratory with a panel of 54 reference E. coli strains from the External Quality Assurance program. Strains were tested by FDA-ECID for molecular serotyping (O and H antigens), Shiga toxin subtyping, and the presence of the ehxA and eae genes for enterohemolysin and intimin, respectively. The FDA-ECID O typing was 96% reproducible among the four laboratories and 94% accurate compared with the reference External Quality Assurance data. Discrepancies were due to the absence of O41 target loci on the array and to two pairs of O types with identical target sequences. H typing was 96% reproducible and 100% accurate, with discrepancies due to two strains from one laboratory that were identified as mixed by FDA-ECID. Shiga toxin (Stx) type 1 subtyping was 100% reproducible and accurate, and Stx2 subtyping was 100% reproducible but only 64% accurate. FDA-ECID identified most Stx2 subtypes but had difficulty distinguishing among stx2a, stx2c, and stx2d genes because of close similarities of these sequences. FDA-ECID was 100% effective for detecting ehxA and eae and accurately subtyped the eae alleles. This interlaboratory study revealed that FDA-ECID for STEC characterization was highly reproducible for molecular serotyping, stx and eae subtyping, and ehxA detection. However, the array was less useful for distinguishing among the highly homologous O antigen genes and the stx2a, stx2c, and stx2d subtypes.
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Affiliation(s)
- Isha R Patel
- 1 U.S. Food and Drug Administration, Division of Molecular Biology, 8301 Muirkirk Road, Laurel, Maryland 20708, USA
| | - Jayanthi Gangiredla
- 1 U.S. Food and Drug Administration, Division of Molecular Biology, 8301 Muirkirk Road, Laurel, Maryland 20708, USA
| | - David W Lacher
- 1 U.S. Food and Drug Administration, Division of Molecular Biology, 8301 Muirkirk Road, Laurel, Maryland 20708, USA
| | - Mark K Mammel
- 1 U.S. Food and Drug Administration, Division of Molecular Biology, 8301 Muirkirk Road, Laurel, Maryland 20708, USA
| | - Lori Bagi
- 2 U.S. Department of Agriculture, Agricultural Research Service, Eastern Regional Research Center, 600 East Mermaid Lane, Wyndmoor, Pennsylvania 19038, USA
| | - Gian Marco Baranzoni
- 2 U.S. Department of Agriculture, Agricultural Research Service, Eastern Regional Research Center, 600 East Mermaid Lane, Wyndmoor, Pennsylvania 19038, USA
| | - Pina M Fratamico
- 2 U.S. Department of Agriculture, Agricultural Research Service, Eastern Regional Research Center, 600 East Mermaid Lane, Wyndmoor, Pennsylvania 19038, USA
| | - Elizabeth L Roberts
- 3 Escherichia coli Reference Center, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - Chitrita DebROY
- 3 Escherichia coli Reference Center, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - Rebecca L Lindsey
- 4 Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329, USA
| | - Devon V Stoneburg
- 4 Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329, USA
| | - Haley Martin
- 4 Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329, USA
| | - Peyton Smith
- 4 Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329, USA
| | - Nancy A Strockbine
- 4 Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329, USA
| | - Christopher A Elkins
- 4 Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329, USA
| | - Flemming Scheutz
- 5 WHO Collaborating Centre for Reference and Research on Escherichia and Klebsiella, Artillerivej 5, DK-2300, Copenhagen, Denmark; and
| | - Peter C H Feng
- 6 U.S. Food and Drug Administration, Division of Microbiology, 5001 Campus Drive, College Park, Maryland 20740, USA
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15
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Nascimento GG, Leite FRM, Vestergaard P, Scheutz F, López R. Does diabetes increase the risk of periodontitis? A systematic review and meta-regression analysis of longitudinal prospective studies. Acta Diabetol 2018; 55:653-667. [PMID: 29502214 DOI: 10.1007/s00592-018-1120-4] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/12/2018] [Indexed: 12/18/2022]
Abstract
AIM Even though the association between diabetes and periodontitis is taken for granted, results on this association are conflicting within the literature. This systematic review assessed whether poorly controlled diabetes was associated with periodontitis onset or progression. METHODS Electronic searches were performed in PubMed, Scopus and Embase databases. Hand search was carried out in the reference list of all articles included. Gray literature was investigated with a Google Scholar search. Prospective longitudinal studies on the association between diabetes and periodontitis were considered for this review. Studies should have presented at least two measurements of periodontal conditions over time. Data on study design, crude and adjusted estimates were collected. We used meta-analysis to estimate the pooled effect of hyperglycemia in people with diabetes on periodontitis onset or progression. Meta-regression and subgroup analyses were employed to investigate potential sources of heterogeneity between studies. RESULTS Thirteen studies matched the inclusion criteria, comprising 49,262 individuals, including 3197 diagnosed with diabetes. Meta-analyses of adjusted estimates showed that diabetes increased the risk of incidence or progression of periodontitis by 86% (RR 1.86 [95% CI 1.3-2.8]). However, there is scarce information on the association between diabetes and periodontal destruction. CONCLUSIONS This study provides evidence that diabetes is associated with increased risk of periodontitis onset and progression in adults. Upcoming prospective longitudinal studies ought to overcome methodological caveats identified in this review.
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Affiliation(s)
- Gustavo G Nascimento
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus C, Denmark.
| | - Fábio R M Leite
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus C, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center, Aalborg University Hospital, Aalborg, Denmark
| | - Flemming Scheutz
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus C, Denmark
| | - Rodrigo López
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus C, Denmark
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16
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Schneider UV, Mikkelsen ND, Scheutz F, Friis-Møller A, Lisby G. Nonaplex PCR using Cliffhanger primers to identify diarrhoeagenic Escherichia coli from crude lysates of human faecal samples. PLoS One 2018; 13:e0199766. [PMID: 29944710 PMCID: PMC6019694 DOI: 10.1371/journal.pone.0199766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/13/2018] [Indexed: 02/04/2023] Open
Abstract
Sensitive, probe-based detection of multiple DNA targets is limited by the competitive reannealing of the antiparallel duplex DNA helix with the complementary DNA strand. To address this, we developed Cliffhanger primers, which create single-stranded DNA overhangs on PCR amplicons while simultaneously increasing the multiplex PCR efficacy and allowing PCR amplification using crude lysates of human faecal samples. A multiplex PCR that targeted eight genes from diarrhoeagenic Escherichia coli plus an internal control was performed and compared to a routine method that consisted of culture followed by multiplex PCR with fragment length separation. A total of 2515 clinical faecal samples from patients with diarrhoea were tested using both methods, and there was a significant increase in clinical sensitivity and negative predictive value with the Cliffhanger method for seven out of eight genes. All Cliffhanger-only positive samples were confirmed by Sanger sequencing of the PCR amplicon. Notably, the Cliffhanger method reduced the total sample turn-around time in the laboratory from 20 hours to 6 hours. Hence, use of Cliffhanger primers increased assay robustness, decreased turn-around time and increased PCR efficacy. This increased the overall clinical sensitivity without the loss of specificity for a heavily multiplexed PCR assay.
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Affiliation(s)
- Uffe Vest Schneider
- Anapa Biotech A/S, Hørsholm, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Denmark
- Statens Serum Institut, Copenhagen, Denmark
- * E-mail:
| | | | - Flemming Scheutz
- The International Collaborating Centre for Reference and Research on Escherichia and Klebsiella, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Alice Friis-Møller
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Denmark
| | - Gorm Lisby
- Anapa Biotech A/S, Hørsholm, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Denmark
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17
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18
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Pedersen RM, Nielsen MTK, Möller S, Ethelberg S, Skov MN, Kolmos HJ, Scheutz F, Holt HM, Rosenvinge FS. Shiga toxin-producing Escherichia coli: incidence and clinical features in a setting with complete screening of patients with suspected infective diarrhoea. Clin Microbiol Infect 2017; 24:635-639. [PMID: 29030168 DOI: 10.1016/j.cmi.2017.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/27/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Shiga toxin-producing Escherichia coli (STEC) causes diarrhoeal disease, bloody diarrhoea, and haemolytic uraemic syndrome. The aim of this study was to describe the incidence of STEC and the clinical features of STEC patients from a well-defined Danish population in which all fecal samples of patients with suspected infective gastroenteritis were analysed for STEC. METHODS In this population-based cohort study, all stool samples referred to two clinical microbiology laboratories were screened for STEC by culture and/or PCR. Epidemiological (n=170) and clinical (n=209) characteristics were analysed using data from local and national registries. RESULTS Overall, 75,132 samples from 30,073 patients were screened resulting in 217 unique STEC-isolates. The epidemiological analysis showed an incidence of 10.1 cases per 100,000 person-years, which was more than twofold higher than the incidence in the rest of Denmark (3.4 cases per 100,000 person-years, p <0.001). Three groups were associated with a higher incidence: age <5 years (n=28, p <0.001), age ≥65 years (n=38, p 0.045), and foreign ethnicity (n=27, p 0.003). In the clinical analysis, patients with STEC harbouring only the Shiga toxin 1 gene (stx1-only isolates) showed a lower frequency of acute (n=11, p <0.05) and bloody diarrhoea (n=5, p <0.05) and a higher frequency of gastrointestinal symptoms for ≥3 months (n=8, p <0.05) than the other STEC patients. CONCLUSIONS We report a more than twofold higher incidence in the project area compared with the rest of Denmark, indicating that patients remain undiagnosed when selective STEC screening is used. We found an association between patients with stx1-only isolates and long-term gastrointestinal symptoms.
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Affiliation(s)
- R M Pedersen
- Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark.
| | - M T K Nielsen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - S Möller
- OPEN - Odense Patient Data Explorative Network, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S Ethelberg
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - M N Skov
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - H J Kolmos
- Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - F Scheutz
- The International Collaborating Centre for Reference and Research on Escherichia and Klebsiella, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - H M Holt
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - F S Rosenvinge
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
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19
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Jønsson R, Struve C, Boll EJ, Boisen N, Joensen KG, Sørensen CA, Jensen BH, Scheutz F, Jenssen H, Krogfelt KA. A Novel pAA Virulence Plasmid Encoding Toxins and Two Distinct Variants of the Fimbriae of Enteroaggregative Escherichia coli. Front Microbiol 2017; 8:263. [PMID: 28275371 PMCID: PMC5320562 DOI: 10.3389/fmicb.2017.00263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/07/2017] [Indexed: 11/29/2022] Open
Abstract
Enteroaggregative Escherichia coli (EAEC) is an increasingly recognized pathogen associated with acute and persistent diarrhea worldwide. While EAEC strains are considered highly heterogeneous, aggregative adherence fimbriae (AAFs) are thought to play a pivotal role in pathogenicity by facilitating adherence to the intestinal mucosa. In this study, we optimized an existing multiplex PCR to target all known AAF variants, which are distinguished by differences in their pilin subunits. We applied the assay on a collection of 162 clinical Danish EAEC strains and interestingly found six, by SNP analysis phylogenetically distinct, strains harboring the major pilin subunits from both AAF/III and AAF/V. Whole-genome and plasmid sequencing revealed that in these six strains the agg3A and agg5A genes were located on a novel pAA plasmid variant. Moreover, the plasmid also encoded several other virulence genes including some not previously found on pAA plasmids. Thus, this plasmid endows the host strains with a remarkably high number of EAEC associated virulence genes hereby likely promoting strain pathogenicity.
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Affiliation(s)
- Rie Jønsson
- Department of Science and Environment, Roskilde UniversityRoskilde, Denmark; Department of Microbiology and Infection Control, Statens Serum InstitutCopenhagen, Denmark
| | - Carsten Struve
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
| | - Erik J Boll
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
| | - Nadia Boisen
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
| | - Katrine G Joensen
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
| | - Camilla A Sørensen
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
| | - Betina H Jensen
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
| | - Flemming Scheutz
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
| | - Håvard Jenssen
- Department of Science and Environment, Roskilde University Roskilde, Denmark
| | - Karen A Krogfelt
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
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Hebbelstrup Jensen B, Stensvold CR, Struve C, Olsen KEP, Scheutz F, Boisen N, Röser D, Andreassen BU, Nielsen HV, Schønning K, Petersen AM, Krogfelt KA. Enteroaggregative Escherichia coli in Daycare-A 1-Year Dynamic Cohort Study. Front Cell Infect Microbiol 2016; 6:75. [PMID: 27468409 PMCID: PMC4942469 DOI: 10.3389/fcimb.2016.00075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 06/29/2016] [Indexed: 12/24/2022] Open
Abstract
Enteroaggregative Escherichia coli (EAEC) has been associated with persistent diarrhea, reduced growth acceleration, and failure to thrive in children living in developing countries and with childhood diarrhea in general in industrialized countries. The clinical implications of an EAEC carrier-status in children in industrialized countries warrants clarification. To investigate the pathological significance of an EAEC carrier-state in the industrialized countries, we designed a 1-year dynamic cohort study and performed follow-up every second month, where the study participants submitted a stool sample and answered a questionnaire regarding gastrointestinal symptoms and exposures. Exposures included foreign travel, consumption of antibiotics, and contact with a diseased animal. In the capital area of Denmark, a total of 179 children aged 0–6 years were followed in a cohort study, in the period between 2009 and 2013. This is the first investigation of the incidence and pathological significance of EAEC in Danish children attending daycare facilities. Conventional microbiological detection of enteric pathogens was performed at Statens Serum Institute, Copenhagen, Denmark, and at Hvidovre Hospital, Copenhagen, Denmark. Parents completed questionnaires regarding gastrointestinal symptoms. The EAEC strains were further characterized by serotyping, phylogenetic analysis, and susceptibility testing. EAEC was detected in 25 (14%) of the children during the observational period of 1 year. One or more gastrointestinal symptoms were reported from 56% of the EAEC-positive children. Diarrhea was reported in six (24%) of the EAEC positive children, but no cases of weight loss, and general failure to thrive were observed. The EAEC strains detected comprised a large number of different serotypes, confirming the genetic heterogeneity of this pathotype. EAEC was highly prevalent (n = 25, 14%) in Danish children in daycare centers and was accompanied by gastrointestinal symptoms in 56% of the infected children. No serotype or phylogenetic group was specifically linked to children with disease.
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Affiliation(s)
| | - Christen R Stensvold
- Department of Microbiology and Infection Control, Statens Serum Institute Copenhagen, Denmark
| | - Carsten Struve
- Department of Microbiology and Infection Control, Statens Serum Institute Copenhagen, Denmark
| | - Katharina E P Olsen
- Department of Microbiology and Infection Control, Statens Serum Institute Copenhagen, Denmark
| | - Flemming Scheutz
- Department of Microbiology and Infection Control, Statens Serum Institute Copenhagen, Denmark
| | - Nadia Boisen
- Department of Microbiology and Infection Control, Statens Serum Institute Copenhagen, Denmark
| | - Dennis Röser
- Department of Microbiology and Infection Control, Statens Serum InstituteCopenhagen, Denmark; Department of Pediatrics, Copenhagen University Hospital HvidovreCopenhagen, Denmark
| | - Bente U Andreassen
- Department of Pediatrics, H.C. Andersen's Hospital, University of Odense Odense, Denmark
| | - Henrik V Nielsen
- Department of Microbiology and Infection Control, Statens Serum Institute Copenhagen, Denmark
| | - Kristian Schønning
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre Copenhagen, Denmark
| | - Andreas M Petersen
- Department of Microbiology and Infection Control, Statens Serum InstituteCopenhagen, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital HvidovreCopenhagen, Denmark; Department of Gastroenterology, Copenhagen University Hospital HvidovreCopenhagen, Denmark
| | - Karen A Krogfelt
- Department of Microbiology and Infection Control, Statens Serum Institute Copenhagen, Denmark
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21
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Cassini A, Hathaway S, Havelaar A, Koopmans M, Koutsoumanis K, Messens W, Müller‐Seitz G, Nørrung B, Rizzi V, Scheutz F. Microbiological risk assessment. EFSA J 2016. [DOI: 10.2903/j.efsa.2016.s0507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | | | | | | | - Winy Messens
- European Food Safety Authority (EFSA) Parma, Italy
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22
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Joensen KG, Tetzschner AMM, Iguchi A, Aarestrup FM, Scheutz F. Rapid and Easy In Silico Serotyping of Escherichia coli Isolates by Use of Whole-Genome Sequencing Data. J Clin Microbiol 2015; 53:2410-26. [PMID: 25972421 PMCID: PMC4508402 DOI: 10.1128/jcm.00008-15] [Citation(s) in RCA: 562] [Impact Index Per Article: 62.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/02/2015] [Indexed: 11/20/2022] Open
Abstract
Accurate and rapid typing of pathogens is essential for effective surveillance and outbreak detection. Conventional serotyping of Escherichia coli is a delicate, laborious, time-consuming, and expensive procedure. With whole-genome sequencing (WGS) becoming cheaper, it has vast potential in routine typing and surveillance. The aim of this study was to establish a valid and publicly available tool for WGS-based in silico serotyping of E. coli applicable for routine typing and surveillance. A FASTA database of specific O-antigen processing system genes for O typing and flagellin genes for H typing was created as a component of the publicly available Web tools hosted by the Center for Genomic Epidemiology (CGE) (www.genomicepidemiology.org). All E. coli isolates available with WGS data and conventional serotype information were subjected to WGS-based serotyping employing this specific SerotypeFinder CGE tool. SerotypeFinder was evaluated on 682 E. coli genomes, 108 of which were sequenced for this study, where both the whole genome and the serotype were available. In total, 601 and 509 isolates were included for O and H typing, respectively. The O-antigen genes wzx, wzy, wzm, and wzt and the flagellin genes fliC, flkA, fllA, flmA, and flnA were detected in 569 and 508 genome sequences, respectively. SerotypeFinder for WGS-based O and H typing predicted 560 of 569 O types and 504 of 508 H types, consistent with conventional serotyping. In combination with other available WGS typing tools, E. coli serotyping can be performed solely from WGS data, providing faster and cheaper typing than current routine procedures and making WGS typing a superior alternative to conventional typing strategies.
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Affiliation(s)
- Katrine G Joensen
- National Food Institute, Division for Epidemiology and Microbial Genomics, Technical University of Denmark, Kgs. Lyngby, Denmark WHO Collaborating Centre for Reference and Research on Escherichia and Klebsiella, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Anna M M Tetzschner
- WHO Collaborating Centre for Reference and Research on Escherichia and Klebsiella, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Atsushi Iguchi
- Department of Animal and Grassland Sciences, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - Frank M Aarestrup
- National Food Institute, Division for Epidemiology and Microbial Genomics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Flemming Scheutz
- WHO Collaborating Centre for Reference and Research on Escherichia and Klebsiella, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
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23
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Agger M, Scheutz F, Villumsen S, Mølbak K, Petersen AM. Antibiotic treatment of verocytotoxin-producingEscherichia coli(VTEC) infection: a systematic review and a proposal. J Antimicrob Chemother 2015; 70:2440-6. [DOI: 10.1093/jac/dkv162] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/22/2015] [Indexed: 11/12/2022] Open
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24
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Abstract
In 2011, a Shiga toxin (Stx) type 2a-producing enteroaggregative E. coli (EAEC) strain of serotype O104:H4 caused a large lethal outbreak in Northern Europe. Until recently, the pathogenic mechanisms explaining the high virulence of the strain have remained unclear. Our laboratories have shown that EAEC genes encoded on the pAA virulence plasmid, particularly the AggR-regulated AAF/I fimbriae, enhance inflammation and enable the outbreak strain to both adhere to epithelial cells and translocate Stx2a across the intestinal epithelium, possibly explaining the high incidence of the life threatening post-diarrheal sequelae of hemolytic uremic syndrome. Epidemiologic evidence supports a model of EAEC pathogenesis comprising the concerted action of multiple virulence factors along with induction of inflammation. Here, we suggest a model for the pathogenesis of the O104:H4 outbreak strain that includes contributions from EAEC alone, but incorporating additional injury induced by Stx2a.
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Affiliation(s)
- Nadia Boisen
- Statens Serum Institut; Department of Microbiology and Clinical Control; Copenhagen, Denmark,Correspondence to: Nadia Boisen;
| | - Angela R Melton-Celsa
- Statens Serum Institut; Department of Microbiology and Clinical Control; Copenhagen, Denmark
| | - Flemming Scheutz
- Statens Serum Institut; Department of Microbiology and Clinical Control; Copenhagen, Denmark
| | - Alison D O'Brien
- Department of Microbiology and Immunology; Uniformed Services University of the Health Sciences; Bethesda, MD USA
| | - James P Nataro
- Department of Pediatrics; University of Virginia School of Medicine; Charlottesville, VA USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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26
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Michelacci V, Tozzoli R, Caprioli A, Martínez R, Scheutz F, Grande L, Sánchez S, Morabito S. A new pathogenicity island carrying an allelic variant of the Subtilase cytotoxin is common among Shiga toxin producing Escherichia coli of human and ovine origin. Clin Microbiol Infect 2013; 19:E149-56. [PMID: 23331629 DOI: 10.1111/1469-0691.12122] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 11/30/2012] [Accepted: 12/02/2012] [Indexed: 11/26/2022]
Abstract
Subtilase (SubAB) is a cytotoxin elaborated by some Shiga Toxin (Stx)-producing Escherichia coli (STEC) strains usually lacking the locus of enterocyte effacement (LEE). Two variants of SubAB coding genes have been described: subAB(1) , located on the plasmid of the STEC O113 98NK2 strain, and subAB(2) , located on a pathogenicity island (PAI) together with the tia gene, encoding an invasion determinant described in enterotoxigenic E. coli. In the present study, we determined the entire nucleotide sequence of the PAI containing the subAB(2) operon, termed Subtilase-Encoding PAI (SE-PAI), and identified its integration site in the pheV tRNA locus. In addition, a PCR strategy for discriminating the two subAB allelic variants was developed and used to investigate their presence in E. coli strains belonging to different pathotypes and in a large collection of LEE-negative STEC of human and ovine origin. The results confirmed that subAB genes are carried predominantly by STEC and showed their presence in 72% and 86% of the LEE-negative strains from human cases of diarrhoea and from healthy sheep respectively. Most of the subAB-positive strains (98%) identified possessed the subAB(2) allelic variant and were also positive for tia, suggesting the presence of SE-PAI. Altogether, our observations indicate that subAB(2) is the prevalent SubAB-coding operon in LEE-negative STEC circulating in European countries, and that sheep may represent an important reservoir for human infections with these strains. Further studies are needed to assess the role of tia and/or other genes carried by SE-PAI in the colonization of the host intestinal mucosa.
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Affiliation(s)
- V Michelacci
- European Reference Laboratory for Escherichia coli, Istituto Superiore di Sanità, Dipartimento di Sanità Pubblica Veterinaria e Sicurezza Alimentare, Rome, Italy
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28
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Torpdahl M, Nielsen EM, Scheutz F, Olesen B, Hansen DS, Hasman H. Detection of a Shiga toxin- and extended-spectrum- -lactamase-producing Escherichia coli O157:H7 human clinical isolate. J Antimicrob Chemother 2013; 68:1203-4. [DOI: 10.1093/jac/dks516] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Soborg B, Lassen SG, Muller L, Jensen T, Ethelberg S, Mølbak K, Scheutz F. A verocytotoxin-producing E. coli outbreak with a surprisingly high risk of haemolytic uraemic syndrome, Denmark, September-October 2012. Euro Surveill 2013. [DOI: 10.2807/ese.18.02.20350-en] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Denmark faced an outbreak of verocytotoxin-producing E. coli (VTEC) O157:H7 infections in autumn 2012. Thirteen cases were diagnosed of which eight had haemolytic uraemic syndrome (HUS). Epidemiological investigations suggested ground beef as the vehicle of the outbreak. The outbreak strain had a rare toxin gene subtype profile: eae, vtx1a and vtx2a, and a high proportion of HUS (62%) among cases, a finding previously linked with the outbreak subtype profile. Toxin subtyping can be useful to identify high risk VTEC strains.
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Affiliation(s)
- B Soborg
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - S G Lassen
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - L Muller
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - T Jensen
- The Danish Veterinary and Food Administration, Copenhagen, Denmark
| | - S Ethelberg
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - K Mølbak
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - F Scheutz
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
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30
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Soborg B, Lassen SG, Müller L, Jensen T, Ethelberg S, Mølbak K, Scheutz F. A verocytotoxin-producing E. coli outbreak with a surprisingly high risk of haemolytic uraemic syndrome, Denmark, September-October 2012. Euro Surveill 2013; 18:20350. [PMID: 23324425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Denmark faced an outbreak of verocytotoxin-producing E. coli (VTEC) O157:H7 infections in autumn 2012. Thirteen cases were diagnosed of which eight had haemolytic uraemic syndrome (HUS). Epidemiological investigations suggested ground beef as the vehicle of the outbreak. The outbreak strain had a rare toxin gene subtype profile: eae, vtx1a and vtx2a, and a high proportion of HUS (62%) among cases, a finding previously linked with the outbreak subtype profile. Toxin subtyping can be useful to identify high risk VTEC strains.
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Affiliation(s)
- B Soborg
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark.
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31
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Steyert SR, Sahl JW, Fraser CM, Teel LD, Scheutz F, Rasko DA. Comparative genomics and stx phage characterization of LEE-negative Shiga toxin-producing Escherichia coli. Front Cell Infect Microbiol 2012; 2:133. [PMID: 23162798 PMCID: PMC3491183 DOI: 10.3389/fcimb.2012.00133] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 10/11/2012] [Indexed: 01/01/2023] Open
Abstract
Infection by Escherichia coli and Shigella species are among the leading causes of death due to diarrheal disease in the world. Shiga toxin-producing E. coli (STEC) that do not encode the locus of enterocyte effacement (LEE-negative STEC) often possess Shiga toxin gene variants and have been isolated from humans and a variety of animal sources. In this study, we compare the genomes of nine LEE-negative STEC harboring various stx alleles with four complete reference LEE-positive STEC isolates. Compared to a representative collection of prototype E. coli and Shigella isolates representing each of the pathotypes, the whole genome phylogeny demonstrated that these isolates are diverse. Whole genome comparative analysis of the 13 genomes revealed that in addition to the absence of the LEE pathogenicity island, phage-encoded genes including non-LEE encoded effectors, were absent from all nine LEE-negative STEC genomes. Several plasmid-encoded virulence factors reportedly identified in LEE-negative STEC isolates were identified in only a subset of the nine LEE-negative isolates further confirming the diversity of this group. In combination with whole genome analysis, we characterized the lambdoid phages harboring the various stx alleles and determined their genomic insertion sites. Although the integrase gene sequence corresponded with genomic location, it was not correlated with stx variant, further highlighting the mosaic nature of these phages. The transcription of these phages in different genomic backgrounds was examined. Expression of the Shiga toxin genes, stx(1) and/or stx(2), as well as the Q genes, were examined with quantitative reverse transcriptase polymerase chain reaction assays. A wide range of basal and induced toxin induction was observed. Overall, this is a first significant foray into the genome space of this unexplored group of emerging and divergent pathogens.
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Affiliation(s)
- Susan R Steyert
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Institute for Genome Sciences Baltimore, MD, USA
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32
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Skjøt-Rasmussen L, Olsen SS, Jakobsen L, Ejrnaes K, Scheutz F, Lundgren B, Frimodt-Møller N, Hammerum AM. Escherichia coli clonal group A causing bacteraemia of urinary tract origin. Clin Microbiol Infect 2012; 19:656-61. [PMID: 22784317 DOI: 10.1111/j.1469-0691.2012.03961.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Escherichia coli clonal group A (CgA) causes disease in humans. This is the first study investigating the prevalence of CgA among E. coli from non-urine, extraintestinal infections in a northern European country. E. coli blood (n = 196) and paired urine (n = 195) isolates from the same patients with bacteraemia of urinary tract origin were analysed. The isolates were collected from January 2003 through May 2005 at four hospitals in Copenhagen, Denmark. Pulsed-field gel electrophoresis (PFGE) patterns, antimicrobial resistance and patient characteristics were determined for all CgA isolates; presence of virulence-associated genes (VAGs) and serotypes were determined for the blood CgA isolates. Thirty blood isolates (15%) belonged to CgA. CgA blood isolates were associated with female patients and sulfamethoxazole-trimethoprim resistance and they harboured a distinctive VAG profile. The blood and urine isolates from each pair were found to be related in 26 of 27 CgA blood/urine pairs, confirming a urinary tract origin of infection. Furthermore, a relationship between the PFGE patterns of CgA blood/urine isolates and CgA isolates from UTI patients in general practice and a CgA isolate from a community-dwelling human reported previously, was found, suggesting a community origin of CgA. The finding of CgA strains in 15% of the E. coli bloodstream infections with a urinary tract origin in Denmark suggests that CgA constitutes an important clonal lineage among extraintestinal pathogenic E. coli. A reservoir of this pathogenic E. coli group in the community causing not only UTI but also more severe infections such as bacteraemia has implications for public health.
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Affiliation(s)
- L Skjøt-Rasmussen
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
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33
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Olsen RH, Chadfield MS, Christensen JP, Scheutz F, Christensen H, Bisgaard M. Clonality and virulence traits of Escherichia coli associated with haemorrhagic septicaemia in turkeys. Avian Pathol 2012; 40:587-95. [PMID: 22107093 DOI: 10.1080/03079457.2011.618942] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fifty-five clinical isolates of avian pathogenic Escherichia coli (APEC) from seven outbreaks of acute haemorrhagic septicaemia in turkeys were characterized by serotyping, plasmid profiling including restriction analysis with HindIII, ribotyping with EcoRI and HindIII, multilocus sequence typing (MLST) and virulence profiling. A clonal relationship was demonstrated for each outbreak according to serotype, plasmid profiling, ribotyping, and MLST. In addition, isolates demonstrated highly similar virulence profiles, as all isolates were positive for F11 pili and possessed genes encoding aerobactin (iucD), increased serum survival (iss), temperature-sensitive haemagglutinin (tsh) and colicin V plasmid operon genes (cva/cvi). However, only 20% of the isolates produced colicin V and 42% exhibited serum resistance. All strains with O group O111 and a single O18ac strain (demonstrating non-clonal DNA profiles) were positive for enteroaggregative heat-stabile toxin (EAST1), while isolates of a single outbreak all possessed the enteroaggregative toxin gene (astA). All isolates were negative for genes encoding verocytotoxins (vtx/stx), iron-repressible protein (irp2), P-fimbria (papC), invasion plasmid antigen (ipaH), attaching and effacing gene (eae), enterohaemolysin (ehxA), and enterotoxins LT, STIa (ST(p)) and STIb (ST(h)). In conclusion, highly similar virulence profiles were demonstrated for isolates of E. coli associated with a single well-defined lesion type of colibacillosis in turkeys; acute haemorrhagic septicaemia. The isolates obtained, however, demonstrated a different phylogenetic background, underlining the importance of using well-defined strain collections for characterization of APEC pathotypes.
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Affiliation(s)
- R H Olsen
- Department of Veterinary Disease Biology, LIFE Science, Copenhagen University, Frederiksberg C, Denmark
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34
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Boisen N, Scheutz F, Rasko DA, Redman JC, Persson S, Simon J, Kotloff KL, Levine MM, Sow S, Tamboura B, Toure A, Malle D, Panchalingam S, Krogfelt KA, Nataro JP. Genomic characterization of enteroaggregative Escherichia coli from children in Mali. J Infect Dis 2011; 205:431-44. [PMID: 22184729 PMCID: PMC3256949 DOI: 10.1093/infdis/jir757] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background. Enteroaggregative Escherichia coli (EAEC) is a cause of epidemic and sporadic diarrhea, yet its role as an enteric pathogen is not fully understood. Methods. We characterized 121 EAEC strains isolated in 2008 as part of a case-control study of moderate to severe acute diarrhea among children 0–59 months of age in Bamako, Mali. We applied multiplex polymerase chain reaction and comparative genome hybridization to identify potential virulence factors among the EAEC strains, coupled with classification and regression tree modeling to reveal combinations of factors most strongly associated with illness. Results. The gene encoding the autotransporter protease SepA, originally described in Shigella species, was most strongly associated with diarrhea among the EAEC strains tested (odds ratio, 5.6 [95% confidence interval, 1.92–16.17]; P = .0006). In addition, we identified 3 gene combinations correlated with diarrhea: (1) a clonal group positive for sepA and a putative hemolysin; (2) a group harboring the EAST-1 enterotoxin and the flagellar type H33 but no other previously identified EAEC virulence factor; and (3) a group carrying several of the typical EAEC virulence genes. Conclusion. Our data suggest that only a subset of EAEC strains are pathogenic in Mali and suggest that sepA may serve as a valuable marker for the most virulent isolates.
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Affiliation(s)
- Nadia Boisen
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
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Rasko DA, Webster DR, Sahl JW, Bashir A, Boisen N, Scheutz F, Paxinos EE, Sebra R, Chin CS, Iliopoulos D, Klammer A, Peluso P, Lee L, Kislyuk AO, Bullard J, Kasarskis A, Wang S, Eid J, Rank D, Redman JC, Steyert SR, Frimodt-Møller J, Struve C, Petersen AM, Krogfelt KA, Nataro JP, Schadt EE, Waldor MK. Origins of the E. coli strain causing an outbreak of hemolytic-uremic syndrome in Germany. N Engl J Med 2011; 365:709-17. [PMID: 21793740 PMCID: PMC3168948 DOI: 10.1056/nejmoa1106920] [Citation(s) in RCA: 588] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND A large outbreak of diarrhea and the hemolytic-uremic syndrome caused by an unusual serotype of Shiga-toxin-producing Escherichia coli (O104:H4) began in Germany in May 2011. As of July 22, a large number of cases of diarrhea caused by Shiga-toxin-producing E. coli have been reported--3167 without the hemolytic-uremic syndrome (16 deaths) and 908 with the hemolytic-uremic syndrome (34 deaths)--indicating that this strain is notably more virulent than most of the Shiga-toxin-producing E. coli strains. Preliminary genetic characterization of the outbreak strain suggested that, unlike most of these strains, it should be classified within the enteroaggregative pathotype of E. coli. METHODS We used third-generation, single-molecule, real-time DNA sequencing to determine the complete genome sequence of the German outbreak strain, as well as the genome sequences of seven diarrhea-associated enteroaggregative E. coli serotype O104:H4 strains from Africa and four enteroaggregative E. coli reference strains belonging to other serotypes. Genomewide comparisons were performed with the use of these enteroaggregative E. coli genomes, as well as those of 40 previously sequenced E. coli isolates. RESULTS The enteroaggregative E. coli O104:H4 strains are closely related and form a distinct clade among E. coli and enteroaggregative E. coli strains. However, the genome of the German outbreak strain can be distinguished from those of other O104:H4 strains because it contains a prophage encoding Shiga toxin 2 and a distinct set of additional virulence and antibiotic-resistance factors. CONCLUSIONS Our findings suggest that horizontal genetic exchange allowed for the emergence of the highly virulent Shiga-toxin-producing enteroaggregative E. coli O104:H4 strain that caused the German outbreak. More broadly, these findings highlight the way in which the plasticity of bacterial genomes facilitates the emergence of new pathogens.
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Affiliation(s)
- David A Rasko
- University of Maryland School of Medicine, Institute for Genome Sciences and Department of Microbiology, Baltimore, USA
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Scheutz F, Nielsen EM, Frimodt-Møller J, Boisen N, Morabito S, Tozzoli R, Nataro JP, Caprioli A. Characteristics of the enteroaggregative Shiga toxin/verotoxin-producing Escherichia coli O104:H4 strain causing the outbreak of haemolytic uraemic syndrome in Germany, May to June 2011. ACTA ACUST UNITED AC 2011; 16. [PMID: 21699770 DOI: 10.2807/ese.16.24.19889-en] [Citation(s) in RCA: 181] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Escherichia coli strain causing a large outbreak of haemolytic uraemic syndrome and bloody diarrhoea in Germany in May and June 2011 possesses an unusual combination of pathogenic features typical of enteroaggregative E. coli together with the capacity to produce Shiga toxin. Through rapid national and international exchange of information and strains the known occurrence in humans was quickly assessed.We describe simple diagnostic screening tools to detect the outbreak strain in clinical specimens and a novel real-time PCR for its detection in foods.
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Affiliation(s)
- F Scheutz
- World Health Organization Collaborating Centre for Reference and Research on Escherichia and Klebsiella, Department of Microbiological Surveillance and Research, Copenhagen, Denmark.
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Ethelberg S, Lisby M, Bottiger B, Schultz AC, Villif A, Jensen T, Olsen KE, Scheutz F, Kjelso C, Muller L. Outbreaks of gastroenteritis linked to lettuce, Denmark, January 2010. Euro Surveill 2010; 15:19484. [PMID: 20158982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
At least 11 linked outbreaks of gastroenteritis with a total of 260 cases have occurred in Denmark in mid January 2010. Investigations showed that the outbreaks were caused by norovirus of several genotypes and by enterotoxigenic Escherichia coli. Lettuce of the lollo bionda type grown in France was found to be the vehicle.
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Affiliation(s)
- S Ethelberg
- Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark.
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Ethelberg S, Lisby M, Böttiger B, Schultz AC, Villif A, Jensen T, Olsen KE, Scheutz F, Kjelsø C, Muller L. Outbreaks of gastroenteritis linked to lettuce, Denmark, January 2010. Euro Surveill 2010. [DOI: 10.2807/ese.15.06.19484-en] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
At least 11 linked outbreaks of gastroenteritis with a total of 260 cases have occurred in Denmark in mid January 2010. Investigations showed that the outbreaks were caused by norovirus of several genotypes and by enterotoxigenic Escherichia coli. Lettuce of the lollo bionda type grown in France was found to be the vehicle.
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Affiliation(s)
- S Ethelberg
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - M Lisby
- Regional Veterinary and Food Control Authority East, Ringsted, Denmark
| | - B Böttiger
- Department of Virology, Statens Serum Institut, Copenhagen, Denmark
| | - A C Schultz
- National Food Institute, Technical University, Copenhagen, Denmark
| | - A Villif
- Regional Veterinary and Food Control Authority East, Ringsted, Denmark
| | - T Jensen
- Danish Veterinary and Food Administration, Copenhagen, Denmark
| | - K E Olsen
- Department of Microbiological Diagnostics, Statens Serum Institut, Copenhagen, Denmark
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - F Scheutz
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - C Kjelsø
- Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - L Muller
- Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
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Newell DG, Koopmans M, Verhoef L, Duizer E, Aidara-Kane A, Sprong H, Opsteegh M, Langelaar M, Threfall J, Scheutz F, van der Giessen J, Kruse H. Food-borne diseases - the challenges of 20 years ago still persist while new ones continue to emerge. Int J Food Microbiol 2010; 139 Suppl 1:S3-15. [PMID: 20153070 PMCID: PMC7132498 DOI: 10.1016/j.ijfoodmicro.2010.01.021] [Citation(s) in RCA: 594] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 12/07/2009] [Accepted: 01/18/2010] [Indexed: 12/18/2022]
Abstract
The burden of diseases caused by food-borne pathogens remains largely unknown. Importantly data indicating trends in food-borne infectious intestinal disease is limited to a few industrialised countries, and even fewer pathogens. It has been predicted that the importance of diarrhoeal disease, mainly due to contaminated food and water, as a cause of death will decline worldwide. Evidence for such a downward trend is limited. This prediction presumes that improvements in the production and retail of microbiologically safe food will be sustained in the developed world and, moreover, will be rolled out to those countries of the developing world increasingly producing food for a global market. In this review evidence is presented to indicate that the microbiological safety of food remains a dynamic situation heavily influenced by multiple factors along the food chain from farm to fork. Sustaining food safety standards will depend on constant vigilance maintained by monitoring and surveillance but, with the rising importance of other food-related issues, such as food security, obesity and climate change, competition for resources in the future to enable this may be fierce. In addition the pathogen populations relevant to food safety are not static. Food is an excellent vehicle by which many pathogens (bacteria, viruses/prions and parasites) can reach an appropriate colonisation site in a new host. Although food production practices change, the well-recognised food-borne pathogens, such as Salmonella spp. and Escherichia coli, seem able to evolve to exploit novel opportunities, for example fresh produce, and even generate new public health challenges, for example antimicrobial resistance. In addition, previously unknown food-borne pathogens, many of which are zoonotic, are constantly emerging. Current understanding of the trends in food-borne diseases for bacterial, viral and parasitic pathogens has been reviewed. The bacterial pathogens are exemplified by those well-recognized by policy makers; i.e. Salmonella, Campylobacter, E. coli and Listeria monocytogenes. Antimicrobial resistance in several bacterial food-borne pathogens (Salmonella, Campylobacter, Shigella and Vibrio spp., methicillin resistant Staphylcoccus aureas, E. coli and Enterococci) has been discussed as a separate topic because of its relative importance to policy issues. Awareness and surveillance of viral food-borne pathogens is generally poor but emphasis is placed on Norovirus, Hepatitis A, rotaviruses and newly emerging viruses such as SARS. Many food-borne parasitic pathogens are known (for example Ascaris, Cryptosporidia and Trichinella) but few of these are effectively monitored in foods, livestock and wildlife and their epidemiology through the food-chain is poorly understood. The lessons learned and future challenges in each topic are debated. It is clear that one overall challenge is the generation and maintenance of constructive dialogue and collaboration between public health, veterinary and food safety experts, bringing together multidisciplinary skills and multi-pathogen expertise. Such collaboration is essential to monitor changing trends in the well-recognised diseases and detect emerging pathogens. It will also be necessary understand the multiple interactions these pathogens have with their environments during transmission along the food chain in order to develop effective prevention and control strategies.
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Boisen N, Ruiz-Perez F, Scheutz F, Krogfelt KA, Nataro JP. Short report: high prevalence of serine protease autotransporter cytotoxins among strains of enteroaggregative Escherichia coli. Am J Trop Med Hyg 2009; 80:294-301. [PMID: 19190229 PMCID: PMC2660206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Enteroaggregative Escherichia coli (EAEC) pathogenesis is thought to comprise intestinal colonization followed by the release of enterotoxins and cytotoxins. Here, we use a polymerase chain reaction (PCR) to determine the prevalence of 10 genes encoding serine protease autotransporter toxins (SPATEs) in a collection of clinical EAEC isolates. Eighty-six percent of EAEC strains harbored genes encoding one or more class I cytotoxic SPATE proteins (Pet, Sat, EspP, or SigA). Two Class II, non-cytotoxic, SPATE genes were found among EAEC strains: pic and sepA, each originally described in Shigella flexneri 2a. Using a multiplex PCR for five SPATE genes (pet, sat, sigA, pic, and sepA), we found that most of the Shigella isolates also harbored more than one SPATE, whereas members of most other E. coli pathotypes rarely harbored a cytotoxic SPATE gene. SPATEs may be relevant to the pathogenesis of both EAEC and Shigella spp.
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Affiliation(s)
- Nadia Boisen
- Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark
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41
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Boisen N, Nataro JP, Scheutz F, Krogfelt KA, Ruiz-Perez F. High Prevalence of Serine Protease Autotransporter Cytotoxins among Strains of Enteroaggregative Escherichia coli. Am J Trop Med Hyg 2009. [DOI: 10.4269/ajtmh.2009.80.294] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Simon ENM, Matee MI, Scheutz F. Oral health status of handicapped primary school pupils in Dar es Salaam, Tanzania. East Afr Med J 2008; 85:113-117. [PMID: 18663883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND There is hardly any information regarding oral health status of handicapped primary school pupils in Tanzania. Determination of their oral health status could help in planning sustainable intervention programmes for this disadvantaged group. OBJECTIVES To determine caries and periodontal status and treatment needs of handicapped primary school pupils in Dar es Salaam, Tanzania. DESIGN A descriptive cross-sectional study. SETTING Uhuru Mchanganyiko and Buguruni special schools, Dar es Salaam. RESULTS The sample consisted of 179 (55.8%) males and 142 (44.2%) females aged between 7 and 22 years. Majority (71%) were deaf followed by blind (17.8%) and mentally retarded (8.7%). Six (1.9%) pupils were both deaf and blind, while one (0.3%) pupil was blind and mentally retarded. Forty one (12.8%) pupils had at least one decayed deciduous tooth, with the mean (dmfs) ranging from 0.25 to 3.24. The deaf had the highest mean decayed surfaces, followed by the mentally retarded and the blind. There was only one (0.3%) pupil who had a filled deciduous tooth. Thirty three (10.3%) pupils had decayed permanent teeth and 31 (9.7%) had missing permanent teeth. None of the decayed permanent teeth were restored. The blind had the lowest mean deciduous surfaces (DS) scores of between 0 and 1.0. In the mentally retarded group the mean DS ranged from 0.25 to 1.75. About 73.5% of the studied group had bleeding of the gums, with the blind having the highest mean bleeding index scores (p < 0.001) and about 82.8% of the pupils had calculus, with highest mean scores mainly among the blind (p = 0.008). CONCLUSION The caries prevalence among handicapped primary school pupils was quite low. However, there was relatively high level of gingival bleeding and calculus. Regarding treatment needs, 23% required dental fillings mainly of one and two surface restorations and 82% required scaling and polishing. Despite these treatment needs these pupils had not received any dental attention.
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Affiliation(s)
- E N M Simon
- Department of Oral Surgery and Oral Pathology, School of Dentistry, Muhimbili University of Health and Allied Sciences, P. O. Box 65014, Dar es Salaam, Tanzania
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Scheutz F, Matee MI, Poulsen S, Frydenberg M. Caries risk factors in the permanent dentition of Tanzanian children: a cohort study (1997–2003). Community Dent Oral Epidemiol 2007; 35:500-6. [DOI: 10.1111/j.1600-0528.2006.00365.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jensen C, Ethelberg S, Olesen B, Schiellerup P, Olsen KEP, Scheutz F, Nielsen EM, Neimann J, Høgh B, Gerner-Smidt P, Mølbak K, Krogfelt KA. Attaching and effacing Escherichia coli isolates from Danish children: clinical significance and microbiological characteristics. Clin Microbiol Infect 2007; 13:863-72. [PMID: 17686138 DOI: 10.1111/j.1469-0691.2007.01773.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study describes the prevalence, clinical manifestations and microbiological characteristics of attaching and effacing Escherichia coli isolates, i.e., enteropathogenic E. coli (EPEC) belonging to the classical EPEC serotypes, non-EPEC attaching and effacing E. coli (A/EEC) and verocytotoxin-producing E. coli (VTEC), isolated in a case-control study of Danish children aged <5 years. Among 424 children with diarrhoea and 866 healthy controls, EPEC and VTEC were more prevalent in cases (2.4% and 2.6%, respectively) than in controls (0.7% and 0.7%, respectively). There was a high frequency of A/EEC isolates (n = 121), but these were equally prevalent in cases (11.3%) and controls (12.5%), and comprised a heterogeneous distribution of O:H serotypes. The intimin (eae) subtypes in A/EEC isolates showed an even distribution; the eae-gamma subtype predominated in classical EPEC cases. The virulence genes encoding the bundle-forming pilus (bfpA) and enteroaggregative heat-stable enterotoxin (astA) were rare among all isolates, and seemed to be of limited pathogenic importance in this population. Virulence characterisation of A/EEC isolates did not reveal any significant differences between cases and controls. Colonisation of children with A/EEC was associated with contact with sheep or goats (OR 2.2). The role of A/EEC, not being VTEC or belonging to the classical EPEC serotypes, requires further clarification, but serotyping is useful in discriminating between EPEC and A/EEC strains.
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Affiliation(s)
- C Jensen
- Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark
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Hien BTT, Trang DT, Scheutz F, Cam PD, Mølbak K, Dalsgaard A. Diarrhoeagenic Escherichia coli and other causes of childhood diarrhoea: a case-control study in children living in a wastewater-use area in Hanoi, Vietnam. J Med Microbiol 2007; 56:1086-1096. [PMID: 17644717 DOI: 10.1099/jmm.0.47093-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A case-control study was conducted to identify the aetiology of diarrhoeal diseases in pre-school children in a suburban area of Hanoi where the use of untreated wastewater in agriculture and aquaculture is a common practice. Stool specimens and clinical information were collected from 111 pairs of children with diarrhoea and healthy controls. A total of 73 cases (66 %) and 41 controls (36 %) had an enteric pathogen. The pathogens most often associated with diarrhoea were rotavirus (17 % of cases) and Entamoeba histolytica (15 %), followed by Shigella (5 %). Diarrhoeagenic Escherichia coli (DEC) was found in 23 % of both patients and controls. Characterization of DEC by serotyping, antimicrobial susceptibility test and PFGE showed that DEC represented by different pathotypes belonged to various serotypes. Except for three enterotoxigenic E. coli strains, typing by PFGE revealed no correlation between pathotype and serotype of DEC strains. This suggests a high prevalence of a variety of DEC subtypes in this area. For this particular region, vaccine development strategies targeting rotavirus and Shigella are likely to be of public health benefit, whereas the role of DEC and preventive measures need to be further elaborated.
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Affiliation(s)
- Bui Thi Thu Hien
- Department of Veterinary Pathobiology, Faculty of Life Science, Copenhagen University, Frederiksberg, Denmark
- Department of Microbiology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Do Thuy Trang
- Department of Microbiology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Flemming Scheutz
- International Escherichia and Klebsiella Centre (WHO), Department of Bacteriology, Mycology, and Parasitology, Statens Serum Institut, Copenhagen, Denmark
| | - Phung Dac Cam
- Department of Microbiology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Kåre Mølbak
- Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - Anders Dalsgaard
- Department of Veterinary Pathobiology, Faculty of Life Science, Copenhagen University, Frederiksberg, Denmark
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Abstract
In case-control studies the frequency of the exposure of interest is compared between a group of diseased subjects and a group of controls to determine whether an association exists between disease and exposure. Case-control studies are useful, but can be subject to several sources of bias if poorly conducted. Selection bias, which results in a lack of comparability between the groups being studied, is one of the most harmful types of bias. The aim of this study was to assess the information reported on case-control studies of periodontitis to identify sources of selection bias. We conducted an electronic search in PubMed, EMBASE, and Web of Science and evaluated the occurrence of sources of selection bias in case-control studies published in English during the year 2004. In relatively few studies did the authors provided information on recruitment periods for cases and controls (31.1% and 20%, respectively), sampling methods (26.7% and 31.1%, respectively), or participation rates (8.9% and 6.7%, respectively). The source of control subjects was appropriate in 15.6% of the studies, and the strategy used to select the controls was adequate in only 8.9% of the studies. It may be concluded that case-control studies on periodontitis are frequently inadequately conducted and reported.
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Affiliation(s)
- Rodrigo Lopez
- Department of Community Oral Health and Pediatric Dentistry, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denmark.
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47
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Persson S, Olsen KEP, Scheutz F, Krogfelt KA, Gerner-Smidt P. A method for fast and simple detection of major diarrhoeagenic Escherichia coli in the routine diagnostic laboratory. Clin Microbiol Infect 2007; 13:516-24. [PMID: 17331124 DOI: 10.1111/j.1469-0691.2007.01692.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A multiplex PCR was developed for the detection of the following genes characteristic of diarrhoeagenic Escherichia coli (DEC): verocytotoxins 1 (vtx1) and 2 (vtx2), characteristic of verocytotoxin-producing E. coli (VTEC); intimin (eae), found in enteropathogenic E. coli (EPEC), attaching and effacing E. coli and VTEC; heat-stable enterotoxin (estA) and heat-labile enterotoxin (eltA), characteristic of enterotoxigenic E. coli (ETEC); and invasive plasmid antigen (ipaH), characteristic of enteroinvasive E. coli (EIEC) and Shigella spp. The method allowed the simultaneous identification of all six genes in one reaction, and included a 16S rDNA internal PCR control. When applied to pure cultures from a reference strain collection, all virulence genes in 124 different DEC strains and 15 Shigella spp. were identified correctly, and there were no cross-reactions with 13 non-E. coli species. The detection limit of the method was 10(2)-10(3) DEC CFU/PCR in the presence of 10(6) non-target cells. When the multiplex PCR was tested with colonies from plate cultures of clinical stool samples, it was a faster, more sensitive, less expensive and less laborious diagnostic procedure than DNA hybridisation. When used with DNA purified from spiked stool samples (by two different commercial kits), the method had a detection limit of 10(6) CFU/mL stool sample.
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Affiliation(s)
- S Persson
- Department of Bacteriology, Mycology and Parasitology, Unit of Gastrointestinal Infection, Statens Serum Institut, Copenhagen, Denmark.
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Persson S, Olsen KEP, Ethelberg S, Scheutz F. Subtyping method for Escherichia coli shiga toxin (verocytotoxin) 2 variants and correlations to clinical manifestations. J Clin Microbiol 2007; 45:2020-4. [PMID: 17446326 PMCID: PMC1933035 DOI: 10.1128/jcm.02591-06] [Citation(s) in RCA: 228] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Shiga toxin 2 (Stx2) from Shiga toxin-producing Escherichia coli (STEC) was subtyped by a method involving partial sequencing of the stxAB2 operon. Of 255 strains from the Danish STEC cohort, all 20 cases of hemolytic-uremic syndrome were associated with subtype Stx2 (11 cases), subtype Stx2c (1 case), or the two combined (8 cases).
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Affiliation(s)
- Søren Persson
- Department of Bacteriology, Mycology and Parasitology, The National Reference Laboratory for Enteropathogenic Bacteria, Unit of Gastrointestinal Infections, Statens Serum Institut, Artillerivej 5, Building 37B, 2300 Copenhagen S, Denmark.
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Olesen B, Nielsen E, Søgaard P, Scheutz F, Kolmos H, Bruun B. P946 Recurrent cases of Escherichia coli bacteraemia in the county of Funen, Denmark in 1996–2001. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70787-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Alfeeli MA, Syed GM, Fielding HW, Alenizi EK, Collier BD, Scheutz F. A comparison of myocardial perfusion gated SPECT studies obtained at rest and after stress. Med Princ Pract 2007; 16:34-9. [PMID: 17159362 DOI: 10.1159/000096138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Accepted: 04/04/2006] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To perform a comparison between post-stress and rest gated single-photon emission computer tomography (SPECT) myocardial perfusion imaging (MPI) studies to assess post-stress stunning and the variables underlying this phenomenon. SUBJECTS AND METHODS This was a prospective study of 318 consecutive adult patients undergoing stress and rest gated SPECT using a 2-day (99m)Tc-tetrofosmin protocol. Bruce protocol treadmill stress (n = 93) or i.v. dipyridamole pharmacologic stress (n = 225) were used as stressors. Ejection fractions (EF) and left ventricular (LV) end-diastolic (EDV) and end-systolic volumes (ESV) were calculated using the Cedars Sinai Quantitative Gated SPECT software. Perfusion defects were visually scored using a 20-segment model to obtain summed stress scores. Statistical analysis was performed by applying paired t test and multi-regression. Statistically significant (p < 0.05) paired differences between post-stress and rest EF and ESV and type of stressing were noted. RESULTS Analysis of patient groups based on the type of stress showed significantly low EF on post-stress studies for both treadmill and dipyridamole stressing and also significantly high ESV on post-stress studies for dipyridamole. Multi-regression analysis using differences in post-stress and rest EF, EDV and ESV as dependent and summed stress scores, type of stress, delay time, previous myocardial infarction and size of LV as independent variables showed statistically significant associations between high summed stress scores (>13) and size of post-stress LV for EDV and ESV differences. High volumes were noted on post-stress studies. The magnitudes of the observed differences were well within the reproducibility of LV volume calculations. CONCLUSIONS Patients showing stunning had significant ischemia or a dilated LV. The stunning manifested as high EDV and ESV differences. The magnitude of the differences observed in EF and LV volumes were not clinically significant.
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Affiliation(s)
- Mahmoud A Alfeeli
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Salmia, Kuwait.
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