Shiga toxin-producing Escherichia coli O171:H25 strain isolated from a patient with haemolytic uraemic syndrome

Shiga toxin-producing Escherichia coli (STEC) strains of O157:H7 serotype are a predominant cause of haemolytic uraemic syndrome (HUS) worldwide, but strains of non-O157 serotypes can also be associated with serious disease. Some of them are associated with outbreaks of HUS, others with sporadic cases of HUS, and some with diarrhoea but not with outbreaks or HUS. A large number of STEC serotypes isolated from ruminants and foods have never been associated with human disease. In this study we characterize a STEC strain belonging to serotype O171:H25 that is responsible for a case of HUS. This strain has a single Shiga toxin gene encoding Stx2 toxin, and hlyA gene, but is eae-negative.     

肠出血性大肠杆菌O157感染防治研究进展

肠出血性大肠杆菌 (EHEC)感染是一种重要的新发传染病 ,O15 7是EHEC的一个主要菌型 ,感染该菌可使人患腹泻、出血性结肠炎 (HC)、溶血性尿毒综合征 (HUS)等 ,死亡率较高。EHECO15 7感染在许多国家包括我国都有暴发流行。EHECO15 7产生的粘附因子Intimin可引起粘附擦拭 (A/E)损伤 ,并可产生致死性的毒素Stx。抗生素治疗可使患者并发HUS危险性增加 ,临床上无特效的治疗药物 ,疫苗研究将对EHECO15 7的控制起重要作用。     

EHEC的新型粘附因子研究进展

肠出血性大肠杆菌（enterohemorrhage E-coli,EHEC）是一种重要的人畜共患病,世界各地包括中国都有不同规模的暴发流行。EHEC有多种血清型,其中毒力最强血清型是0157：H7。EHEC0157：H7感染除可使人发生常规腹泻外,还可在5％-10％的病例中引发严重并发症,甚至死亡。该菌是重要的食源性致病菌,危害严重,缺乏有效的防治手段,而抗生素治疗可能会加剧溶血性尿毒症（haemoluticuraemicsyndrome,HUS）。由于以上特点EHEC0157：H7成为世界公共卫生问题,引起微生物学家和公共卫生工作者的广泛关注。目前,临床针对EHEC感染只是对症治疗和适当的抗茵治疗。粘附是EHEC感染宿主细胞的第一步,没有这一步,细菌和宿主肠道细胞之间不会发生任何的相互作用,而且对于许多病原菌来说,粘附具有宿主特异性。本文概述了EHEC的流行病学及粘附机理,并对近年在EHEC研究中的发现一些新型粘附因子和一些假设的定植因子的研究背詈及作用机理作一综述。     

Inducible stx2 phages are lysogenized in the enteroaggregative and other phenotypic Escherichia coli O86:HNM isolated from patients

We characterized two Shiga toxin-producing Escherichia coli (STEC) O86:HNM isolates from a patient with hemolytic uremic syndrome (HUS) or bloody diarrhea. Both of them did not possess the eaeA gene. However, the isolate from a HUS patient carried genetic markers of enteroaggregative E. coli (EAEC) and showed aggregative adherence pattern to HEp-2 cells. The other isolate from bloody diarrhea, which was negative with EAEC markers, was diffusely adhered to HEp-2 cells. The stx2 gene in both E. coli O86:HNM strains was encoded in each infectious phage, which was partially homologous to that of strain EDL933, a STEC O157:H7. These results will help to explain the genotypic divergences of STEC.     

Cattle,weather and water: mapping Escherichia coli O157:H7 infections in humans in England and Scotland

Entero‐haemorrhagic Escherichia coli O157:H7 is a zoonotic pathogen, responsible for a relatively small number of food poisoning and illness outbreaks each year, when compared with other food‐borne bacteria capable of causing infections in the population. Nevertheless, E. coli O157:H7 is a bacterial pathogen associated with severe human illnesses including bloody diarrhoea and haemolytic uremic syndrome occurring in both outbreak and sporadic settings. In England and Wales approximately 1% of all laboratory‐confirmed cases of food poisoning are the result of E. coli O157:H7; however, in Scotland this figure increases to 3%. When the size of the population is taken into account and the rate of E. coli O157:H7 confirmed cases per 100 000 population is examined, the rate of E. coli 0157:H7 infections in Scotland is much greater than England and Wales. The routes of transmission have changed over time, with new routes of transmission such as farm visits emerging. The prevalence of E. coli O157:H7 has a seasonal dependency, with greater faecal shedding of the organism in the warmer months; this is directly mirrored in the increased reporting of E. coli O157:H7 infection among hospitalized patients. This review attempts to suggest why this phenomenon occurs, paying particular attention to weather, animal movement and private water supplies.     

Introduction to the food safety concerns of verotoxin-producing Escherichia coli

Verotoxin-producing Escherichia coli (VTEC) have emerged in the past two decades as food-borne pathogens that can cause major outbreaks of human illnesses worldwide. The number of outbreaks has increased in recent years due to changes in food production and processing systems, eating habits, microbial adaptation, and methods of VTEC transmission. The human illnesses range from mild diarrhea to hemolytic uremic syndrome (HUS) that can lead to death. The VTEC outbreaks have been attributed to O157:H7 and non-O157:H7 serotypes of E. coli. These E. coli serotypes include motile (e.g., O26:H11 and O104:H21) and nonmotile (e.g., O111:H-, O145:H-, and O157:H-) strains. In the United States, E. coli O157:H7 has been the major cause of VTEC outbreaks. Worldwide, however, non-O157:H7 VTEC (e.g., members of the O26, O103, O111, O118, O145, and O166 serogroups) have caused approximately 30% of the HUS cases in the past decade. Because large numbers of the VTEC outbreaks have been attributed to consumption of ruminant products (e.g., ground beef), cattle and sheep are considered reservoirs of these food-borne pathogens. Because of the food safety concern of VTEC, a global perspective on this problem is addressed (Exp Biol Med Vol. 228, No. 4). The first objective was to evaluate the known non-O157:H7 VTEC strains and the limitations associated with their detection and characterization. The second objective was to identify the VTEC serotypes associated with outbreaks of human illnesses and to provide critical evaluation of their virulence. The third objective was to determine the rumen effect on survival of E. coli O157:H7 as a VTEC model. The fourth objective was to explore the role of intimins in promoting attaching and effacing lesions in humans. Finally, the ability of VTEC to cause persistent infections in cattle was evaluated.     

Modulation of chemokine gene expression by Shiga-toxin producing Escherichia coli belonging to various origins and serotypes

Infection with Shiga-toxin producing Escherichia coli (STEC) may result in the development of the haemolytic-uremic syndrome (HUS), the main cause of acute renal failure in children. While O157:H7 STEC are associated with large outbreaks of HUS, it is difficult to predict whether a non-O157:H7 isolate can be pathogenic for humans. The mucosal innate immune response plays a central role in the pathogenesis of HUS; therefore, we compared the induction of IL-8 and CCL20 in human colon epithelial cells infected with strains belonging to different serotypes, isolated from cattle or from HUS patients. No correlation was observed between strain virulence and chemokine gene expression. Rather, the genetic background of the strains seems to determine the chemokine gene expression profile. Investigating the contribution of different bacterial factors in this process, we show that the type III secretion system of O157:H7 bacteria, but not the intimate adhesion, is required to stimulate the cells. In addition, H7, H10, and H21 flagellins are potent inducers of chemokine gene expression when synthesized in large amount.     

Clinical significance of Verocytotoxin-producing Escherichia coli O157

In 1977, Konowalchuk and colleagues (Konowalchuk, J., Speirs, J.I. & Stavric, S. 1977 Infection and Immunity 18, 775–779) were the first to describe Verocytotoxin-producing strains of Escherichia coli or VTEC. The surveillance of infection caused by VTEC demonstrated strains of E. coli belonging to serogroup O157 as the main cause of human infection capable of causing haemorrhagic colitis (HC) and haemolytic uraemic syndrome (HUS). Infection with O157 VTEC results in a range of disease manifestations including abdominal cramps, vomiting and fever. This frequently leads to cases with bloody diarrhoea and HC, and approximately 10% of patients develop HUS. The symptoms of disease caused by VTEC O157 have been well documented and the pathogenic mechanisms expressed by VTEC have been the focus of considerable attention. However, the role of putative pathogenic mechanisms in the pathogenesis of disease is not fully understood. The aim of this review is to consider the clinical aspects of infection with strains of VT-producing E. coli O157 in terms of the putative pathogenic mechanisms expressed by these bacteria. This revised version was published online in November 2006 with corrections to the Cover Date.     

Can the high levels of human verocytotoxigenic Escherichia coli O157 infection in rural areas of NE Scotland be explained by consumption of contaminated meat?

AIMS: To determine if contamination levels of Escherichia coli O157 and generic E. coli in retail-minced meat products are greater in rural shops compared with urban shops in Grampian, NE Scotland. We also investigated whether meat from supermarkets and meat from local butcher shops had a similar bacteriological quality. METHODS AND RESULTS: Minced beef and minced lamb were tested from November 2004 to August 2006. Escheichia coli O157 was found at low levels in four samples out of 530 tested samples (0.75%). Generic E. coli were present in 11% of the samples tested, of which 67% came from supermarkets. We observed no significant difference in the prevalence of generic E. coli between rural and urban areas. CONCLUSIONS: Low levels of contamination with E. coli O157 and generic E. coli in retail meat suggest that meat is not a major route of infection in NE Scotland. SIGNIFICANCE AND IMPACT OF THE STUDY: The study does not suggest that the high incidence of E. coli O157 human infection in the rural areas of Grampian is because of meat consumption--this provides further evidence of contact with animals or water being the routes of infection. Hence, risk mitigation should be focussed more on environmental pathways of infection.     

The serological response to Verocytotoxigenic Escherichia coli in patients with haemolytic uraemic syndrome

AIMS: To screen sera from 80 patients with clinical haemolytic uraemic syndrome (HUS) and serum antibodies to the lipopolysaccharide (LPS) of Escherichia coli O157, for antibodies to Verocytotoxin-producing Escherichia coli (VTEC) belonging to serogroups O5, O26, O104, O111, O128, O145, O153 and O165. METHODS AND RESULTS: Sera were screened by an LPS-based ELISA and SDS-PAGE/immunoblotting. None of the 80 sera contained antibodies binding to long-chain LPS of any of the LPS types employed; however, nine sera contained antibodies binding to R3 LPS-core epitopes. CONCLUSIONS: The presence of patients' serum antibodies to the LPS of E. coli O157, in the absence of antibodies to the LPS of a range of other VTEC, demonstrated that cases of HUS may be caused by strains of O157 VTEC alone and that concurrent infection with multiple strains of VTEC is not a prerequisite for cases of HUS. SIGNIFICANCE AND IMPACT OF THE STUDY: Antibodies to long-chain LPS of VTEC other than O157 were not detected, and so there was no evidence of infection with VTEC belonging to more than one serogroup. The results of immunoassays such as ELISAs and micro-agglutinations must take into consideration antibodies binding to R3 epitopes located on LPS-core.     

EHEC 的新型粘附因子研究进展*

摘要：肠出血性大肠杆菌（enterohemorrhage ，EHEC）是一种重要的人畜共患病，世界各地包括中国都有不同规模的暴发流 行。EHEC有多种血清型，其中毒力最强血清型是O157：H7。EHEC O157：H7 感染除可使人发生常规腹泻外，还可在5%-10%的病 例中引发严重并发症，甚至死亡。该菌是重要的食源性致病菌，危害严重，缺乏有效的防治手段，而抗生素治疗可能会加剧溶血性 尿毒症（haemolutic uraemic syndrome，HUS）。由于以上特点EHEC O157：H7 成为世界公共卫生问题，引起微生物学家和公共卫生 工作者的广泛关注。目前，临床针对EHEC 感染只是对症治疗和适当的抗菌治疗。粘附是EHEC感染宿主细胞的第一步，没有这 一步，细菌和宿主肠道细胞之间不会发生任何的相互作用，而且对于许多病原菌来说，粘附具有宿主特异性。本文概述了EHEC 的流行病学及粘附机理，并对近年在EHEC 研究中的发现一些新型粘附因子和一些假设的定植因子的研究背景及作用机理作一 综述。     

Molecular analysis as an aid to assess the public health risk of non-O157 Shiga toxin-producing Escherichia coli strains

Shiga toxin-producing Escherichia coli (STEC) strains are commensal bacteria in cattle with high potential for environmental and zoonotic transmission to humans. Although O157:H7 is the most common STEC serotype, there is growing concern over the emergence of more than 200 highly virulent non-O157 STEC serotypes that are globally distributed, several of which are associated with outbreaks and/or severe human illness such as hemolytic-uremic syndrome (HUS) and hemorrhagic colitis. At present, the underlying genetic basis of virulence potential in non-O157 STEC is unknown, although horizontal gene transfer and the acquisition of new pathogenicity islands are an expected origin. We used seropathotype classification as a framework to identify genetic elements that distinguish non-O157 STEC strains posing a serious risk to humans from STEC strains that are not associated with severe and epidemic disease. We report the identification of three genomic islands encoding non-LEE effector (nle) genes and 14 individual nle genes in non-O157 STEC strains that correlate independently with outbreak and HUS potential in humans. The implications for transmissible zoonotic spread and public health are discussed. These results and methods offer a molecular risk assessment strategy to rapidly recognize and respond to non-O157 STEC strains from environmental and animal sources that might pose serious public health risks to humans.     

Fenotypic and genotypic characterization of Shiga toxin-producing Escherichia coli O111 strain isolated from patient with hemolytic-uremic syndrome

Shiga toxin-producing E. coli O157 and non-O157 are important emergance pathogens that can cause diarrhea and hemorrhagic colitis with life-threatening complications, such as hemolytic uremic syndrome (HUS). A few cases of EHEC infections are documented per year in Poland. Among them only one patient with EHEC O157 infection developed HUS. We characterized the first VTEC non-O157 strain isolated from child with HUS in Poland. The VTEC O111 strain produced Stx2 which was cytotoxic for Vero cell. Using DNA microarray analysis we have found set of virulence genes in VTEC O111 strain as: stx2A, stx2B, ehly, eae, tir tccP espA, espJ, cif nleA, nleB, lpfA, iha, efa1, cba. The strain was fenotypic resistant to streptomycin, tetracyclin and sulphonamides (strA, tetA, sul2 genes were detected).     

The serodiagnosis of infections caused by Verocytotoxin-producing Escherichia coli

Patients with haemolytic uraemic syndrome (HUS) and haemorrhagic colitis (HC) produce serum antibodies to the lipopolysaccharides (LPS) of Escherichia coli O157 and certain other E. coli serogroups. Patients may also make salivary antibodies to the LPS of E. coli O157. Serological tests based on these antibodies can be used to provide evidence of infection in the absence of culturable VTEC or the toxins they produce. Serum antibodies to LPS persist for several months following onset of disease, enabling both current and retrospective serological testing. The LPS of E. coli O157 shares epitopes with strains of Brucella abortus, Yersinia enterocolitica O9, Vibrio cholerae O1 Inaba, group N Salmonella and certain strains of Citrobacter freundii and E. hermanni. Serological tests for serum antibodies to E. coli O157 should be evaluated in the light of these cross-reactions. Serological tests to supply evidence of infection with E. coli O157 have been shown to provide a valuable adjunct to bacteriological procedures for detecting culturable VTEC and VT. The use of well characterized LPS antigens in association with the techniques of ELISA and immunoblotting provide valuable procedures for detecting evidence of infection with E. coli O157 and possibly other VTEC.     

Waterborne Escherichia coli O157

The waterborne route of Vero cytotoxin-producing E. coli (VTEC) O157 infection was first suggested in two unconnected human cases in 1985. Since then, waterborne VTEC O157 has been identified in sporadic cases and in outbreaks of illness. Recreational waters, private and municipal supplies have been implicated from microbiological, environmental and epidemiological studies of cases. In addition, a research cohort study of farm workers identified exposure to private water supplies as a risk factor for having antibodies to E. coli O157. Sources of contamination are thought to be animal and human faeces or sewage. The presence of low numbers of target organisms in water makes microbiological confirmation difficult, therefore epidemiological evidence has been essential in outbreak investigations. Despite the potential for contamination of water with VTEC O157, waterborne infection is relatively rare largely due to the susceptibility of the organism to water treatment processes. This paper presents the evidence for waterborne VTEC O157 infection, considering current microbiological, environmental and particularly epidemiological information.     

Acute diarrhoeal disease in rabbit: bacteriological diagnosis and efficacy of oral rehydration in combination with loperamide hydrochloride

Acute outbreaks of diarrhoea with high mortality rates are frequently observed in rabbits. Amongst various aetiological factors Escherichia coli or its toxins have been found to be commonly incriminated. Sulphonamides or antibiotics are used to treat rabbits with bacterial diarrhoea. The result of the antibiotic treatment is moderately successful. We had good results using oral rehydration treatment in combination with loperamide hydrochloride (Immodium) in a colony of rabbits with E. coli diarrhoea.     

The influence of melatonin on growth of E. coli O157:H7 in pure culture and exogenous melatonin on faecal shedding of E. coli O157:H7 in experimentally infected wethers

AIMS: To determine if exogenous melatonin (MEL) influences growth of Escherichia coli O157:H7 in pure culture and if MEL affects faecal shedding patterns of E. coli O157:H7 or total leucocyte counts in sheep. METHODS AND RESULTS: Two strains of E. coli O157:H7 were cultured in the presence of varying concentrations of MEL. Maximal specific growth rates of E.coli O157:H7 strains were not affected by MEL addition in pure culture. Wethers (n = 16) received either 0 (CONT) or 25 mg MEL hd(-1) day(-1) for 21 days. Daily shedding patterns of E. coli O157:H7 were not different (P > 0.10) between groups with faecal populations of E. coli O157:H7 decreasing daily (P < 0.01) in both groups. However, shedding tended to differ between the control and treated group by the end of the experiment. Total WBC and differential leucocyte counts were not affected by treatment. CONCLUSIONS: Melatonin had no affect on specific growth rates in pure culture nor did the administration of exogenous MEL alter bacterial shedding patterns or immune response indicators in experimentally infected wethers exposed to a long photoperiod. SIGNIFICANCE AND IMPACT OF THE STUDY: Although MEL did not affect shedding patterns or gastrointestinal populations of E. coli O157:H7, the tendency for MEL-treated sheep to shed less E. coli O157:H7 towards the end of the experiment warrants further research. Providing MEL for a longer period of time, or at greater concentrations, may elucidate a potential role that MEL plays in the seasonal shedding patterns of E. coli O157:H7 in livestock.     

Acid tolerance of Escherichia coli O157:H7 and its survival in apple juice

Outbreaks of diarrhoea and haemolytic uraemic syndrome have been associated with the consumption of apple cider and apple juice. The organism implicated in these outbreaks has been Escherichia coli O157:H7, indicating the resistance of the serotype to acidic pH. On comparing the growth of this serotype with a control strain of E. coli, it was found that strain O157:H7 grew well in trypticase soy broth at pH levels ranging from 2.0 to 9.0, while control strains failed to grow at pH levels below 4.0 and above 9.0. The growth of both strains were inhibited by adding 0.05% of either benzoic acid or sorbic acid. Similarly, O157:H7 grew well in both natural (unpasteurized) as well as in pasteurized apple juice and the growth was inhibited by adding 0.1% of either benzoic acid or sorbic acid. Control strains of E. coli failed to grow in either types of apple juice. The possible sources of contamination of natural apple juice with O157:H7 serotype are discussed.     

Non-O157:H7 Shiga toxin (verocytotoxin)-producing Escherichia coli strains: epidemiological significance and microbiological diagnosis

Shiga toxin (Stx)-producing Escherichia coli (STEC) are important causes of diarrhoea and the haemolytic uremic syndrome (HUS). The most common STEC serotype implicated worldwide is E. coli O157:H7 that is diagnosed using procedures based on its typical phenotypic feature, the lack of sorbitol fermentation. In addition to E. coli O157:H7, a variety of non-O157:H7 STEC strains that usually ferment sorbitol and are thus missed by using the diagnostic protocol for E.coli O157:H7 have been isolated from patients. Among these sorbitol-fermenting (SF) non-O157:H7 STEC, SF E. coli O157:H⁻ and non-O157 STEC strains of serogroups O26, O103, O111 and O145 have emerged as significant causes of HUS and diarrhoea in continental Europe and have been associated with human disease in other parts of the world. Microbiological diagnosis of non-O157:H7 STEC strains is difficult due to their serotype diversity and the absence of a simple biochemical property that distinguishes such strains from the physiological intestinal microflora. Screening for non-O157:H7 STEC and their isolation from stools is presently based on the detection of Stx production or stx genes that are common characteristics of such strains. Molecular subtyping of the most frequent non-O157 STEC demonstrated that strains of serogroups O26, O103 and O111 belong to their own clonal lineages and show unique virulence profiles. SF STEC O157:H⁻ strains that have been isolated mostly in Central Europe represent a new clone within E. coli O157 serogroup which has its own typical combination of virulence factors. This revised version was published online in November 2006 with corrections to the Cover Date.     

Characterization of Escherichia coli strains O157:H7, isolated on the territories of the Central Federal District

The characterization of E.coli strains O157:H7, isolated from humans and animals on some territories of the Central Federal District, is presented. Among the isolates from human outbreaks, related and, probably, related cultures prevailed, while among the isolates obtained from different animals mainly unrelated cultures have been detected. A conclusion has been made concerning the existence of several independent zoonotic reservoirs of E. coli O157:H7 infection on this territory. The advantages and drawbacks of the use of pulse electrophoresis in the characterization of E. coli O157:H7 are discussed. Grounds are given for the necessity of the patients examination with hemorrhagic enetrocolitis for the presence of E. coli O157:H7, as well as for the expediency of having a special item for the registration of this E. coli infection in relevant statistical forms.