Risk determinants for the development of typical haemolytic uremic syndrome in Belgium and proposition of a new virulence typing algorithm for Shiga toxin-producing Escherichia coli

Abstract In Belgium, it is mandatory to report Shiga toxin-producing Escherichia coli (STEC) infections to the health inspection authorities. To facilitate the decision making regarding infection control measures, information about the risk factors for the development of the haemolytic uremic syndrome (HUS) can be helpful. We performed statistical analyses on a dataset of 411 Belgian STEC strains. Demographic and clinical patient characteristics as well as phenotypical and genotypical STEC strain characteristics were taken into account. Multivariate logistic regression models indicated that age categories ⩽5, 6–12 and ⩾75; the stx2 gene; and the eae gene were significant HUS development risk determinants. The stx2a subtype had the highest risk (OR 29.6, 95% CI 7.0–125.1), while all stx1 subtypes encompassed a significant lower risk (OR 0.3, 95% CI 0.1–0.5). Presence of the stx1 gene without stx2 encompassed a lower risk than the combined presence of stx1 and stx2, or stx2 solely. Based on these results, we propose a new virulence typing algorithm that will enable the National Reference Centre to provide the physicians and health inspection authorities with a risk classification for the development of HUS. We believe this will contribute to a more efficient STEC infection control management in Belgium.

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An outbreak of diarrhoea due to multiple antimicrobial-resistant Shiga toxin-producing Escherichia coli O26[ratio ]H11 in a nursery

Epidemiology and Infection ◽

10.1017/s0950268801006069 ◽

2001 ◽

Vol 127 (2) ◽

pp. 221-227 ◽

Cited By ~ 30

Author(s):

N. HIRUTA ◽

T. MURASE ◽

N. OKAMURA

Keyword(s):

Escherichia Coli ◽

Shiga Toxin ◽

Food Samples ◽

The Other ◽

Haemolytic Uremic Syndrome ◽

Pulsed Field ◽

Electrophoretic Patterns ◽

Transmissible Plasmid ◽

Contaminated Food ◽

Uremic Syndrome

An outbreak due to Shiga toxin-producing Escherichia coli O26[ratio ]H11 (STEC) occurred at a nursery in southeastern Japan in 1997. Thirty-two children had watery or bloody diarrhoea but none of them suffered from haemolytic-uremic syndrome. All of the STEC O26 were isolated during the period from 23 July to 22 August from 24 children, 3 nurses, and 2 food samples. These organisms had stx1 and eae genes but none of the other genes for which we tested (stx2, bfp, and EAF plasmid). They also possessed multiple antimicrobial resistances, which were encoded by a transmissible plasmid, and showed mostly identical genomic pulsed-field gel electrophoretic patterns. The results of this investigation suggested that contaminated food was the main contributing factor to this multiple antimicrobial-resistant STEC O26 infection, and person-to-person transmission also contributed to the spread of this outbreak.

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Shiga toxin-producing escherichia coli infections in Norway, 1992–2012: characterization of isolates and identification of risk factors for haemolytic uremic syndrome

BMC Infectious Diseases ◽

10.1186/s12879-015-1017-6 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 46

Author(s):

Lin T. Brandal ◽

Astrid L. Wester ◽

Heidi Lange ◽

Inger Løbersli ◽

Bjørn-Arne Lindstedt ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Shiga Toxin ◽

Haemolytic Uremic Syndrome ◽

Uremic Syndrome

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DiarrhoeagenicEscherichia coliandEscherichia albertiiin Brazil: pathotypes and serotypes over a 6-year period of surveillance

Epidemiology and Infection ◽

10.1017/s0950268818002595 ◽

2018 ◽

Vol 147 ◽

Cited By ~ 14

Author(s):

E. L. Ori ◽

E. H. Takagi ◽

T. S. Andrade ◽

B. T. Miguel ◽

M. C. Cergole-Novella ◽

...

Keyword(s):

Escherichia Coli ◽

Active Surveillance ◽

Shiga Toxin ◽

Control Strategies ◽

Clinical Samples ◽

Haemolytic Uremic Syndrome ◽

E Coli ◽

Enteric Diseases ◽

Uremic Syndrome ◽

And Control

AbstractDiarrhoeagenicEscherichia coli(DEC) is a leading cause of infectious diarrhoea worldwide. In recent years,Escherichia albertiihas also been implicated as a cause of human enteric diseases. This study describes the occurrence ofE. colipathotypes and serotypes associated with enteric illness and haemolytic uremic syndrome (HUS) isolated in Brazil from 2011 to 2016. Pathotypes isolated included enteropathogenicE. coli(EPEC), enteroaggregativeE. coli(EAEC), enterotoxigenicE. coli(ETEC), enteroinvasiveE. coli(EIEC) and Shiga toxin-producingE. coli(STEC). PCR of stool enrichments for DEC pathotypes was employed, andE. albertiiwas also sought. O:H serotyping was performed on all DEC isolates. A total of 683 DEC and 10E. albertiistrains were isolated from 5047 clinical samples. The frequencies of DEC pathotypes were 52.6% (359/683) for EPEC, 32.5% for EAEC, 6.3% for ETEC, 4.4% for EIEC and 4.2% for STEC. DEC strains occurred in patients from 3 months to 96 years old, but EPEC, EAEC and STEC were most prevalent among children. Both typical and atypical isolates of EPEC and EAEC were recovered and presented great serotype heterogeneity. HUS cases were only associated with STEC serotype O157:H7. TwoE. albertiiisolates belonged to serogroup O113 and one had thestx2f gene. The higher prevalence of atypical EPEC in relation to EAEC in community-acquired diarrhoea in Brazil suggests a shift in the trend of DEC pathotypes circulation as previously EAEC predominated. This is the first report ofE. albertiiisolation from active surveillance. These results highlight the need of continuing DEC andE. albertiisurveillance, as a mean to detect changes in the pattern of pathotypes and serotypes circulation and provide useful information for intervention and control strategies.

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Highlights from the clinical symposium on Shiga toxin-producing Escherichia coli / haemolytic uremic syndrome, Berlin, September 2011

Eurosurveillance ◽

10.2807/ese.16.39.19977-en ◽

2011 ◽

Vol 16 (39) ◽

Cited By ~ 3

Author(s):

A Jansen

Keyword(s):

Escherichia Coli ◽

Shiga Toxin ◽

Basic Science ◽

Antibody Therapy ◽

German Society ◽

Haemolytic Uremic Syndrome ◽

Convention Center ◽

Uremic Syndrome

On 9 September 2011, the Estrel Convention Center in Berlin was the venue for a first clinical symposium on Shiga toxin-producing Escherichia coli / haemolytic uremic syndrome (STEC/HUS) reflecting on the large STEC outbreak in Germany earlier this year. The German Society of Nephrology (DGfN) invited internationally renowned clinical experts and microbiologists to discuss the basic science and diagnostics of STEC infections and the different options for treating an EHEC-associated HUS, including plasmapheresis, antibody therapy with Eculizumab, and extracorporeal immune adsorption.

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Comparative Genomics to Delineate Pathogenic Potential in Non-O157 Shiga Toxin-Producing Escherichia coli (STEC) from Patients with and without Haemolytic Uremic Syndrome (HUS) in Norway

PLoS ONE ◽

10.1371/journal.pone.0111788 ◽

2014 ◽

Vol 9 (10) ◽

pp. e111788 ◽

Cited By ~ 21

Author(s):

Kjersti Haugum ◽

Jostein Johansen ◽

Christina Gabrielsen ◽

Lin T. Brandal ◽

Kåre Bergh ◽

...

Keyword(s):

Escherichia Coli ◽

Comparative Genomics ◽

Shiga Toxin ◽

Pathogenic Potential ◽

Haemolytic Uremic Syndrome ◽

Uremic Syndrome

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The Czech Experience with Eculizumab in Severe Paediatric Shiga Toxin-Producing Escherichia coli-Associated Haemolytic Uremic Syndrome Patients

Klinische Pädiatrie ◽

10.1055/a-1288-3597 ◽

2020 ◽

Author(s):

Patrik Konopasek ◽

Jan David ◽

Monika Marejkova ◽

Nadezda Simankova ◽

Karel Vondrak ◽

...

Keyword(s):

Escherichia Coli ◽

Shiga Toxin ◽

Haemolytic Uremic Syndrome ◽

Uremic Syndrome

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Shiga Toxin–Producing Escherichia coli: Pre- and Postharvest Control Measures To Ensure Safety of Dairy Cattle Products

Journal of Food Protection ◽

10.4315/0362-028x-68.1.199 ◽

2005 ◽

Vol 68 (1) ◽

pp. 199-207 ◽

Cited By ~ 27

Author(s):

HUSSEIN S. HUSSEIN ◽

TOSHIE SAKUMA

Keyword(s):

Escherichia Coli ◽

Dairy Cattle ◽

Foodborne Pathogens ◽

Shiga Toxin ◽

Dairy Products ◽

Management Practices ◽

Dairy Herd ◽

Control Measures ◽

Safety Concerns ◽

Uremic Syndrome

The large number of cases of human illness caused by Shiga toxin–producing Escherichia coli (STEC) worldwide has raised safety concerns for foods of bovine origin. These human illnesses include diarrhea, hemorrhagic colitis, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura. Severe cases end with chronic renal failure, chronic nervous system deficiencies, and death. Over 100 STEC serotypes, including E. coli O157:H7, are known to cause these illnesses and to be shed in cattle feces. Thus, cattle are considered reservoirs of these foodborne pathogens. Because beef and dairy products were responsible for a large number of STEC outbreaks, efforts have been devoted to developing and implementing control measures that assure safety of foods derived from dairy cattle. These efforts should reduce consumers' safety concerns and support a competitive dairy industry at the production and processing levels. The efficacy of control measures both before harvest (i.e., on-farm management practices) and after harvest (i.e., milk processing and meat packing) for decreasing the risk of STEC contamination of dairy products was evaluated. The preharvest measures included sanitation during milking and management practices designed to decrease STEC prevalence in the dairy herd (i.e., animal factors, manure handling, drinking water, and both feeds and feeding). The postharvest measures included the practices or treatments that could be implemented during processing of milk, beef, or their products to eliminate or minimize STEC contamination.

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Molecular characterisation of human Shiga toxin-producing Escherichia coli O26 strains: results of an outbreak investigation, Romania, February to August 2016

Eurosurveillance ◽

10.2807/1560-7917.es.2017.22.47.17-00148 ◽

2017 ◽

Vol 22 (47) ◽

Cited By ~ 8

Author(s):

Codruţa-Romaniţa Usein ◽

Adriana Simona Ciontea ◽

Cornelia Mãdãlina Militaru ◽

Maria Condei ◽

Sorin Dinu ◽

...

Keyword(s):

Escherichia Coli ◽

Shiga Toxin ◽

Genetic Relatedness ◽

Diverse Population ◽

National Surveillance ◽

Severe Diarrhoea ◽

Surveillance Strategy ◽

Haemolytic Uremic Syndrome ◽

Virulence Markers ◽

Uremic Syndrome

Introduction At the beginning of 2016, an increase in paediatric haemolytic uremic syndrome (HUS) cases was observed in Romania. The microbiological investigations allowed isolation of Shiga toxin-producing Escherichia coli (STEC) O26 as the causative agent from most cases. Methods: An enhanced national surveillance of HUS and severe diarrhoea was established across the country following the identification of the first cases and was carried out until August 2016. A total of 15 strains were isolated from 10 HUS and five diarrhoea cases. Strains were characterised by virulence markers (i.e. stx type/subtype, eae, ehxA genes), phylogroup, genetic relatedness and clonality using PCR-based assays, PFGE and multilocus sequence typing (MLST). The first six strains were further characterised by whole genome sequencing (WGS). Results: Five PCR-defined genotypes were distinguished. All strains from HUS cases harboured stx2a and eae, with or without stx1a, while strains from diarrhoea cases carried exclusively stx1a and eae genes. PFGE resolved strains into multiple pulsotypes, compatible with a certain geographic segregation of the cases, and strains were assigned to phylogroup B1 and sequence type (ST) 21. WGS confirmed the results of conventional molecular methods, brought evidence of O26:H11 serotype, and complemented the virulence profiles. Discussion/conclusion: This first description of STEC O26 strains from cases in Romania showed that the isolates belonged to a diverse population. The virulence content of most strains highlighted a high risk for severe outcome in infected patients. Improving the national surveillance strategy for STEC infections in Romania needs to be further considered.

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