Outbreak of Non‐O157 Shiga Toxin–ProducingEscherichia coliInfection from Consumption of Beef Sausage (original) (raw)
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International Journal of Food Microbiology, 2009
During the spring of 2006, a national disease outbreak caused by Shiga toxin-producing Escherichia coli (STEC) O103:H25 was investigated in Norway. At the time of the outbreak the Norwegian School of Veterinary Science was the national reference laboratory for E. coli O157 in food, and the microbiological investigations to identify the food source were performed there. Food-and environmental samples (n = 931) were collected by the Norwegian Food Safety Authorities following two different hypotheses i) that minced meat was the source of STEC, and ii) that fermented sausage was the source of STEC. Twenty seven food samples, all collected following the latter hypothesis contained eae-positive E. coli O103:H25, but none of these were stx-positive. By PFGE it was shown that isolates from one particular type of fermented sausage "morr sausage 1" were identical to the isolates from patients. Samples of sheep meat that were linked epidemiologically to meat used for sausage production also contained isolates identical or closely related to patient strains. The presented study underpins epidemiological indications that fermented sausage was the source of the outbreak, but points specifically to one particular brand of sausage as the source.
Clinical Microbiology and Infection, 2008
Detection of Shiga toxin-producing Escherichia coli (STEC) in The Netherlands is traditionally limited to serogroup O157. To assess the relative importance of STEC, including non-O157 serogroups, stool samples submitted nationwide for investigation of enteric pathogens or diarrhoea were screened with real-time PCR for the presence of the Shiga toxin genes. Patients were selected if their stool contained blood upon macroscopic examination, if they had a history of bloody diarrhoea, were diagnosed with haemolytic uraemic syndrome, or were aged <6 years (irrespective of the bloody aspect of the stool). PCR-positive stools were forwarded to a central laboratory for STEC isolation and typing. In total, 4069 stools were examined, with 68 (1.7%) positive PCR results. The highest prevalence was for stools containing macroscopic blood (3.5%), followed by stools from patients with a history of bloody diarrhoea (2.4%). Among young children, the prevalence (1.0%) was not significantly higher than among random, non-bloody, stool samples from diarrhoeal patients (1.4%). STEC strains were isolated from 25 (38%) PCR-positive stools. Eleven O-serogroups were detected, including five STEC O157 strains. As serogroup O157 represented only 20% of the STEC isolates, laboratories should be encouraged to use techniques enabling them to detect non-O157 serogroups, in parallel with culture, for isolation and subsequent characterisation of STEC strains for public health surveillance and detection of outbreaks.
Emerging Infectious Diseases, 2017
During a large outbreak of Shiga toxin−producing Escherichia coli illness associated with an agricultural show in Australia, we used whole-genome sequencing to detect an IS1203v insertion in the Shiga toxin 2c subunit A gene of Shiga toxin−producing E. coli. Our study showed that clinical illness was mild, and hemolytic uremic syndrome was not detected. S higa toxin−producing Escherichia coli (STEC) is a major cause of serious human gastrointestinal illness and has the potential to cause life-threatening complications, such as hemolytic uremic syndrome (HUS) (1). An average of 0.4 cases of STEC illness per 100,000 persons per year are reported to public health authorities in Australia (2). Disease severity can range from asymptomatic infection to serious and sometimes fatal illness, particularly in young children and the elderly (3,4). Healthy ruminants, particularly cattle, are the reservoir for STEC (5). Human infection with STEC usually occurs as a result of inadvertent ingestion of fecal matter after consumption of contaminated food, water, or unpasteurized milk; contact with animals or their environments; or secondarily, through contact with infected humans (4,5). In the largest previously reported outbreak of STEC illness in Australia in 1995, which was associated with consumption of mettwurst (uncooked, semidry, fermented sausages), HUS developed in 23 of the 51 case-patients identified, and there was 1 death (6). The Study A multidisciplinary incident management team was established to investigate an outbreak of STEC illness associated with an annual agricultural show in Brisbane, Queensland, Australia, in August 2013 (online Technical Appendix, https://wwwnc.cdc.gov/EID/article/23/10/16-1836-Techapp1.pdf). The incident management team defined primary and secondary outbreak cases (online Technical Appendix). Persons with laboratory-confirmed STEC infection associated with the outbreak and their household contacts were followed up until the point of microbiological evidence of clearance, which was defined as 2 consecutive negative stool samples collected >24 h apart (7). Case-patients and contacts with a high risk for transmission (persons <5 years of age; persons unable to maintain good hygiene; or childcare, healthcare, aged care, or food preparation workers) were advised to avoid childcare and work settings in accordance with Queensland Health Guidelines (7). Enhanced surveillance measures were implemented to assist with case finding (online Technical Appendix). Medical practitioners were requested to avoid use of antimicrobial drugs for suspected case-patients with STEC infections because of previously reported associations between antimicrobial drug use and HUS (online Technical Appendix). We developed a case−control study to obtain additional information related to animal contact, hand hygiene, and food consumption at the agricultural show (online Technical Appendix). We analyzed data by using Epi Info 7 (Centers for Disease Control and Prevention, Atlanta, GA, USA) (online Technical Appendix). STEC identified from human, environmental, and animal samples were serotyped for O and H antigens (online Technical Appendix). Expression of Shiga toxin 1 (stx1) and stx2 genes was determined for selected isolates (online Technical Appendix). Shiga toxin gene subtyping and whole-genome sequencing (WGS) analysis was performed (online Technical Appendix). During August 21−September 27, 2013, we identified 57 outbreak-associated laboratory-confirmed case-patients with STEC infection: 54 confirmed primary case-patients, 1 probable primary case-patient, and 2 secondary case-patients (Figure 1). Of the 57 case-patients, 32 (56%) were
Journal of Clinical Microbiology, 2004
We have investigated 677 Shiga toxin-producing Escherichia coli (STEC) strains from humans to determine their serotypes, virulence genes, and clinical signs in patients. Six different Shiga toxin types (1, 1c, 2, 2c, 2d, and 2e) were distributed in the STEC strains. Intimin (eae) genes were present in 62.6% of the strains and subtyped into intimins ␣1, 1, ␥1, , , and . Shiga toxin types 1c and 2d were present only in eae-negative STEC strains, and type 2 was significantly (P < 0.001) more frequent in eae-positive STEC strains. Enterohemorrhagic E. coli hemolysin was associated with 96.2% of the eae-positive strains and with 65.2% of the eae-negative strains. Clinical signs in the patients were abdominal pain (8.7%), nonbloody diarrhea (59.2%), bloody diarrhea (14.3%), and hemolytic-uremic syndrome (HUS) (3.5%), and 14.3% of the patients had no signs of gastrointestinal disease or HUS. Infections with eae-positive STEC were significantly (P < 0.001) more frequent in children under 6 years of age than in other age groups, whereas eae-negative STEC infections dominated in adults. The STEC strains were grouped into 74 O:H types by serotyping and by PCR typing of the flagellar (fliC) genes in 221 nonmotile STEC strains. Eleven serotypes (accounted for 69% of all STEC strains. We identified 41 STEC strains belonging to 31 serotypes which had not previously been described as human STEC. Twenty-six of these were positive for intimins ␣1 (one serotype), 1 (eight serotypes), (two serotypes), and (three serotypes). Our study indicates that different types of STEC strains predominate in infant and adult patients and that new types of STEC strains are present among human isolates.
Shiga toxin-producing Escherichia coli (STEC) food-borne outbreaks
Journal of the Hellenic Veterinary Medical Society, 2017
Escherichia coli (E. coli) are Gram negativo, non-sporulating bacteria, which belong to the normal intestinal flora of humans and animals. Shiga toxin-producing E. coli (STFC) arc a group of if. coli that is defined by the capacity to produce toxins called Shiga toxins (Stx). hollowing ingestion of STEC, the significant risk of two serious and potentially life-threatening complications of infection, hemorrhagic colitis and hemolytic uremic syndrome (HUS), makes STHC food poisoning a serious public health problem. Besides Stx, human pathogenic STFC harbor additional virulence factors that are important for their pathogenicity. Although human infection may also be acquired by direct transmission from person to person or by direct contact of humans with animal carriers, the majority of STFC infections are food-borne in origin.The gastrointestinal tract of healthy ruminants seems to be the foremost important reservoir for STFC and ingestion of undercooked beef one of the most likely rou...
Prevalence and Genotypes of Shiga Toxin (Verotoxin) – Producing Escherichia coli in Romanian Food
Romanian Biotechnological Letters, 2020
In the background of the severe hemolytic-uremic syndrome outbreak occurred in Romania at the beginning of 2016, 1484 different milk and meat food units were investigated for Shiga-toxin producing Escherichia coli (STEC) contamination. Prevalence of the virulence genes was calculated and the isolated STEC strains were pheno-genotypic characterized by chromogenic media technique, PCR and DNA sequencing. Sixty-nine STEC isolates were recovered and, of the all food matrices, ovine carcass swabs were the most contaminated (37/1484; 2.49%), followed by minced meat and meat (22/1484; 1.48%) and milk products (7/1484; 0.047%). Most prevalent Shiga-toxin encoding gene was stx2 (53/69; 76.81%), followed by stx1 (44/69; 63.76%); the eae-intimin encoding gene represented 5.79% (4/69). Among these isolates, one O157 STEC and two non-O157 serotypes, O26 and O113 were identified. Sanger sequencing showed single nucleotide polymorphism for stx genes and more than 10% differences in nucleotide and amino acids structure were encountered on virulence genes and/or eae and serogroup-associated genes. Our findings underlines the importance of the phenogenotyping characterization of STECs in food relating to public safety and the continuous surveillance for non-O157 STEC emerging serotypes that represents a real support for the surveillance of new STEC infections in humans.
1996
Shiga-like toxin-producing Escherichia coli (SLTEC) strains are a diverse group of organisms which are known to cause diarrhea and hemorrhagic colitis in humans. This can lead to potentially fatal systemic sequelae, such as hemolytic-uremic syndrome (HUS). Strains belonging to more than 100 different O:H serotypes have been associated with severe SLTEC disease in humans, of which only O157 strains (which are uncommon in Australia) have a distinguishable cultural characteristic (sorbitol negative). During an outbreak of HUS in Adelaide, South Australia, a sensitive PCR assay specific for Shiga-like toxin genes (slt) was used to test cultures of feces and suspected foods. This enabled rapid confirmation of infection and identified a locally produced dry fermented sausage (mettwurst) as the source of infection. Cultures of feces from 19 of 21 HUS patients and 7 of 8 mettwurst samples collected from their homes were PCR positive for slt-I and slt-II genes. SLTEC isolates belonging to serotype O111:H ؊ was subsequently isolated from 16 patients and 4 mettwurst samples. Subsequent restriction fragment length polymorphism analysis of chromosomal DNA from these isolates with slt-specific probes indicated that at least three different O111:H ؊ genotypes were associated with the outbreak. Pulsed-field gel electrophoresis of genomic DNA restricted with XbaI showed that two of these restriction fragment length polymorphism types were closely related, but the third was quite distinct. However, SLTEC strains of other serotypes, including O157:H ؊ , were also isolated from some of the HUS patients.