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

The non-O157 Shiga toxin–producing Escherichia coli (STEC) contamination in carcasses and feces of 811 bovines in nine beef abattoirs from Argentina was analyzed during a period of 17 months. The feces of 181 (22.3%) bovines were positive for non-O157 STEC, while 73 (9.0%) of the carcasses showed non-O157 STEC contamination. Non-O157 STEC strains isolated from feces (227) and carcasses (80) were characterized. The main serotypes identified were O178:H19, O8:H19, O130:H11, and O113:H21, all of which have produced sporadic cases of hemolytic-uremic syndrome in Argentina and worldwide. Twenty-two (7.2%) strains carried a fully virulent stx/eae/ehxA genotype. Among them, strains of serotypes O103:[H2], O145:NM, and O111:NM represented 4.8% of the isolates. XbaI pulsed-field gel electrophoresis pattern analysis showed 234 different patterns, with 76 strains grouped in 30 clusters. Nine of the clusters grouped strains isolated from feces and from carcasses of the same or different bovines in a lot, while three clusters were comprised of strains distributed in more than one abattoir. Patterns AREXSX01.0157, AREXBX01.0015, and AREXPX01.0013 were identified as 100% compatible with the patterns of one strain isolated from a hemolytic-uremic syndrome case and two strains previously isolated from beef medallions, included in the Argentine PulseNet Database. In this survey, 4.8% (39 of 811) of the bovine carcasses appeared to be contaminated with non-O157 STEC strains potentially capable of producing sporadic human disease, and a lower proportion (0.25%) with strains able to produce outbreaks of severe disease.

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Isolation and Characterization of Sorbitol-Fermenting Shiga Toxin (Verocytotoxin)-Producing Escherichia coli O157:Hßtrains in the Czech Republic

Journal of Clinical Microbiology ◽

10.1128/jcm.36.7.2135-2137.1998 ◽

1998 ◽

Vol 36 (7) ◽

pp. 2135-2137 ◽

Cited By ~ 43

Author(s):

Martina Bielaszewska ◽

Herbert Schmidt ◽

Mohamed A. Karmali ◽

Rasik Khakhria ◽

Jan Janda ◽

...

Keyword(s):

Escherichia Coli ◽

Czech Republic ◽

Shiga Toxin ◽

Escherichia Coli O157 ◽

The Czech Republic ◽

Isolation And Characterization ◽

First Finding ◽

Uremic Syndrome ◽

Genotypic Characteristics

Two sorbitol-fermenting (SF) Shiga toxin-producingEscherichia coli (STEC) O157:H− strains were isolated from patients with hemolytic-uremic syndrome in the Czech Republic in 1995. Their phenotypic and genotypic characteristics and genomic DNA fingerprints were identical or closely related to those of SF STEC O157:H− strains isolated in Germany in 1988 to 1997. This indicates that the Czech isolates belong to the SF STEC O157 clone which is widespread in Germany. It is the first finding of the clone outside Germany.

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Hemolytic uremic syndrome caused by Shiga toxin–producing Escherichia coli in children: incidence, risk factors, and clinical outcome

Pediatric Nephrology ◽

10.1007/s00467-020-04560-0 ◽

2020 ◽

Vol 35 (9) ◽

pp. 1749-1759 ◽

Cited By ~ 1

Author(s):

Elisa Ylinen ◽

Saara Salmenlinna ◽

Jani Halkilahti ◽

Timo Jahnukainen ◽

Linda Korhonen ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Clinical Outcome ◽

Hemolytic Uremic Syndrome ◽

Shiga Toxin ◽

Incidence Risk ◽

Uremic Syndrome

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Prevalence and Characterization of Shiga Toxin-Producing Escherichia coli Isolated from Cattle, Food, and Children during a One-Year Prospective Study in France

Journal of Clinical Microbiology ◽

10.1128/jcm.38.3.1023-1031.2000 ◽

2000 ◽

Vol 38 (3) ◽

pp. 1023-1031 ◽

Cited By ~ 186

Author(s):

Nathalie Pradel ◽

Valérie Livrelli ◽

Christophe De Champs ◽

Jean-Bernard Palcoux ◽

Alain Reynaud ◽

...

Keyword(s):

Escherichia Coli ◽

Shiga Toxin ◽

Diarrheal Disease ◽

Geographical Area ◽

Vero Cells ◽

Healthy Cattle ◽

Uremic Syndrome ◽

Stool Specimens ◽

One Year

During a 1-year survey of Shiga toxin-producing Escherichia coli (STEC) prevalence in central France, 2,143 samples were investigated by PCR for Shiga toxin-encoding genes. A total of 330 (70%) of 471 fecal samples collected from healthy cattle at the Clermont-Ferrand slaughterhouse, 47 (11%) of 411 beef samples, 60 (10%) of 603 cheese samples, and 19 (3%) of 658 stool specimens from hospitalized children with and without diarrhea were positive for thestx gene(s). A STEC strain was isolated from 34% (162 of 471) of bovine feces, 4% (16 of 411) of beef samples, 1% (5 of 603) of cheese samples, and 1.5% (10 of 658) of stool specimens. Of the 220 STEC strains isolated, 34 (15%) harbored thestx 1 gene, 116 (53%) harbored thestx 2 gene, and 70 (32%) carried both thestx 1 and stx 2 genes. However, 32 (14.5%) were not cytotoxic for Vero cells. Theeae gene, found in 12 (5%) of the 220 strains, was significantly associated with the stx 1 gene and with isolates from children. Sequences homologous to ehxAwere found in 102 (46%) of the 220 strains. Thirteen serotypes, OX3:H2, O113:H21, O113:H4, OX3:H21, O6:H10, OX178:H19, O171:H2, O46:H38, O172:H21, O22:H16, O91:H10, O91:H21, and O22:H8, accounted for 102 (55%) of 186 typeable isolates, and only one strain (0.5% of the 186 STEC isolates from cattle), belonged to the O157:H7 serotype. We showed that the majority of the STEC isolates from cattle, beef, and cheese were not likely to be pathogenic for humans and that the STEC strains isolated from children in this study were probably not responsible for diarrheal disease. Finally, the strains associated with hemolytic-uremic syndrome in the same geographical area were shown to belong to particular subsets of the STEC population found in the bovine reservoir.

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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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Predicting Hemolytic Uremic Syndrome and Renal Replacement Therapy in Shiga Toxin–producing Escherichia coli–infected Children

Clinical Infectious Diseases ◽

10.1093/cid/ciz432 ◽

2019 ◽

Vol 70 (8) ◽

pp. 1643-1651 ◽

Cited By ~ 4

Author(s):

Ryan S McKee ◽

David Schnadower ◽

Phillip I Tarr ◽

Jianling Xie ◽

Yaron Finkelstein ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Renal Replacement Therapy ◽

Serum Sodium ◽

Shiga Toxin ◽

Leukocyte Count ◽

Lower Serum ◽

Younger Age ◽

Intravenous Fluid Administration ◽

Uremic Syndrome

Abstract Background Shiga toxin–producing Escherichia coli (STEC) infections are leading causes of pediatric acute renal failure. Identifying hemolytic uremic syndrome (HUS) risk factors is needed to guide care. Methods We conducted a multicenter, historical cohort study to identify features associated with development of HUS (primary outcome) and need for renal replacement therapy (RRT) (secondary outcome) in STEC-infected children without HUS at initial presentation. Children aged <18 years who submitted STEC-positive specimens between January 2011 and December 2015 at a participating study institution were eligible. Results Of 927 STEC-infected children, 41 (4.4%) had HUS at presentation; of the remaining 886, 126 (14.2%) developed HUS. Predictors (all shown as odds ratio [OR] with 95% confidence interval [CI]) of HUS included younger age (0.77 [.69–.85] per year), leukocyte count ≥13.0 × 103/μL (2.54 [1.42–4.54]), higher hematocrit (1.83 [1.21–2.77] per 5% increase) and serum creatinine (10.82 [1.49–78.69] per 1 mg/dL increase), platelet count <250 × 103/μL (1.92 [1.02–3.60]), lower serum sodium (1.12 [1.02–1.23 per 1 mmol/L decrease), and intravenous fluid administration initiated ≥4 days following diarrhea onset (2.50 [1.14–5.46]). A longer interval from diarrhea onset to index visit was associated with reduced HUS risk (OR, 0.70 [95% CI, .54–.90]). RRT predictors (all shown as OR [95% CI]) included female sex (2.27 [1.14–4.50]), younger age (0.83 [.74–.92] per year), lower serum sodium (1.15 [1.04–1.27] per mmol/L decrease), higher leukocyte count ≥13.0 × 103/μL (2.35 [1.17–4.72]) and creatinine (7.75 [1.20–50.16] per 1 mg/dL increase) concentrations, and initial intravenous fluid administration ≥4 days following diarrhea onset (2.71 [1.18–6.21]). Conclusions The complex nature of STEC infection renders predicting its course a challenge. Risk factors we identified highlight the importance of avoiding dehydration and performing close clinical and laboratory monitoring.

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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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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

Epidemiology and Infection ◽

10.1017/s0950268818002546 ◽

2018 ◽

Vol 147 ◽

Cited By ~ 10

Author(s):

K. De Rauw ◽

R. Buyl ◽

S. Jacquinet ◽

D. Piérard

Keyword(s):

Escherichia Coli ◽

Infection Control ◽

Shiga Toxin ◽

Lower Risk ◽

Control Measures ◽

Haemolytic Uremic Syndrome ◽

Health Inspection ◽

Uremic Syndrome ◽

Virulence Typing ◽

Risk Determinants

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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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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