Enterohemorrhagic Escherichia coli as the cause of diarrhea in the Czech Republic, 1965–2013
Authors:
M. Marejková 1,2; P. Petráš 1
Authors place of work:
Státní zdravotní ústav Praha, Národní referenční laboratoř pro E. coli a shigely
1; Univerzita Karlova Praha, 3. lékařská fakulta
2
Published in the journal:
Epidemiol. Mikrobiol. Imunol. 63, 2014, č. 3, s. 173-183
Category:
Souhrnná sdělení, původní práce, kazuistiky
Summary
Aim:
Enterohemorrhagic Escherichia coli (EHEC) is the cause of diarrhea, bloody diarrhea, and haemolytic uremic syndrome (HUS) worldwide. The role of EHEC in the etiology of HUS in the Czech Republic has recently been described, but the prevalence, characteristics, and epidemiology of EHEC causing diarrhea have not been fully known. Therefore, this study analyzed the serotypes, stx genotypes, and virulence factors in EHEC strains isolated in 1965–2013 from patients with diarrhea or bloody diarrhea and their family contacts. In addition, we characterized diagnostically relevant phenotypes of EHEC strains, their antimicrobial susceptibility, seasonal trends, and distribution by administrative region.
Material and methods:
Serogrouped E. coli isolates from patients were referred to the National Reference Laboratory (NRL) for E. coli and Shigella for the detection of Stx. Specimens of both human and non-human origin were referred to the NRL for epidemiological investigation. Serotyping was performed by conventional and molecular methods, PCR was applied to stx genotyping and identification of non-stx virulence factors, and standard methods were used for phenotypic analysis and antimicrobial susceptibility testing. The epidemiological link between the human and animal isolates was confirmed using pulsed-field gel electrophoresis (PFGE).
Results:
Of 50 EHEC strains, 24 were recovered from patients with diarrhea without blood, 19 from patients with bloody diarrhea, six from family contacts, and one from an epidemiologically linked animal. EHEC cases were reported during the whole year, with peaks in May through October, most often in the Central Bohemian and Hradec Králové Regions. EHEC outbreaks occurred in three families: in one of them sheep-to-human transmission of EHEC was detected. The EHEC strains were assigned to five serotypes, with more than half of them being non-sorbitol fermenting (NSF) O157:H7/NM[fliCH7] and a third being strains O26:H11/NM[fliCH11]; serotypes O111:NM[fliCH8], O118:NM[fliCH25], and O104:H4, similarly to sorbitol-fermenting (SF) strains O157:NM[fliCH7], were rare. Of seven stx genotypes identified, all were present in NSF EHEC O157, two in each of EHEC O26 and O111, and one in each of EHEC O118, O104, and SF O157. All but one strain were Stx producers. Genes encoding other virulence factors including toxins (EHEC-hlyA, cdt-V, and espP) and adhesins (eae, efa1, iha, lpf, and sfpA) were detected in all strains and their occurrence was serotype specific. The most common of these genes were eae encoding adhesin intimin and EHEC-hlyA encoding EHEC hemolysin. All EHEC strains but SF O157 harboured terE encoding tellurite resistance. All strains except NSF EHEC O157 and EHEC O118 fermented sorbitol and produced ß-D-glucuronidase. Most (89.8%) EHEC strains were susceptible to all 12 antimicrobials tested.
Conclusion:
EHEC strains cause diarrhea and bloody diarrhea in the Czech Republic. Nevertheless, only a systematic screening of the stool from patients with diarrhea can make it possible to elucidate their actual role in the etiology of diarrheal diseases (as well as HUS) in the Czech Republic and to consider the data in the European context. EHEC cases are reported to the European Centre for Disease Prevention and Control (ECDC) within the Food and Waterborne Diseases Surveillance Network.
Key words:
Enterohaemorrhagic Escherichia coli – Shiga toxin – genotype – diarrhea – Czech Republic
Zdroje
1. Alexa P, Konstantinova L, Zajacova-Sramkova Z. Faecal shedding of verotoxigenic Escherichia coli in cattle in the Czech Republic. Veterinární Medicina, 2011;56:149–155.
2. Ambrožová H, Marejková M. Enterohaemorrhagic Escherichia coli - dangerous new pathogens. Cas Lek Cesk, 2012;151(11):514–518.
3. Bielaszewska M, Janda J. Mikrobiologické aspekty infekce kmeny E. coli produkujícími verotoxin u dětí s hemolyticko-uremickým syndromem. Cesk Epidemiol Mikrobiol Imunol, 1989;38:237–244.
4. Bielaszewska M, Mellmann A, Bletz S, et al. Enterohemorrhagic Escherichia coli O26:H11/H- : A new virulent clone emerges in Europe. Clin Infect Dis, 2013;56:1373–1381.
5. Bielaszewska M, Mellmann A, Zhang W, et al. Characterisation of the Escherichia coli strain associated with an outbreak of haemolytic uraemic syndrome in Germany, 2011: a microbiological study. Lancet Infect Dis, 2011;11:671–676.
6. Bielaszewska M, Rüter C, Kunsmann L, et al. Enterohemorrhagic Escherichia coli hemolysin employs outer membrane vesicles to target mitochondria and cause endothelial and epithelial apoptosis. PLoS Pathog, 2013;9(12):e1003797.
7. Bielaszewska M, Schmidt H, Liesegang A, et al. Cattle can be a reservoir of sorbitol-fermenting Shiga toxin-producing Escherichia coli O157:H- strains and a source of human diseases. J Clin Microbiol, 2000;38(9):3470–3473.
8. Buchholz U, Bernard H, Werber D, et al. German outbreak of Escherichia coli O104:H4 associated with sprouts. N Engl J Med, 2011;365(19):1763–1770.
9. Bunger JC, Melton-Celsa AR, O'Brien AD. Shiga toxin type 2dact displays increased binding to globotriaosylceramide in vitro and increased lethality in mice after activation by elastase. Toxins (Basel), 2013;5(11):2074–92. doi: 10.3390/toxins5112074.
10. Buvens G, Bogaerts P, Glupczynski Y, et al. Antimicrobial resistance testing of verocytotoxin-producing Escherichia coli and first description of TEM-52 extended-spectrum ß-lactamase in serogroup O26. Antimicrob Agents Chemother, 2010;54(11):4907–4909.
11. Buvens G, De Gheldre Y, Dediste A, et al. Incidence and virulence determinants of verocytotoxin-producing Escherichia coli infections in the Brussels-Capital Region, Belgium, in 2008-2010. J Clin Microbiol, 2012;50:1336–1345.
12. Centers for Disease Control and Prevention (CDC). Outbreak of Escherichia coli O104:H4 Infections Associated with Sprout Consumption - Europe and North America, May-July 2011. MMWR Morb Mortal Wkly Rep, 2013;62(50):1029–1031.
13. Čížek A, Dolejská M, Novotná R, et al. Survey of Shiga toxigenic Escherichia coli O157 and drug-resistant coliform bacteria from in-line milk filters on dairy farms in the Czech Republic. J Appl Microbiol, 2007;104:852–860.
14. Eklund M, Scheutz F, Siitonen A. Clinical isolates of non-O157 Shiga toxin-producing Escherichia coli: serotypes, virulence characteristics, and molecular profiles of strains of the same serotype. J Clin Microbiol, 2001;39:2829–2834.
15. EUCAST committees and subcommittees. European Committee on Antimicrobial Susceptibility Testing. EUCAST SOP 4.1, 2013. Dostupný na www: http://www.eucast.org.
16. Friedrich AW, Bielaszewska M, Zhang W, et al. Escherichia coli harboring Shiga toxin 2 gene variants: frequency and association with clinical symptoms. J Infect Dis, 2002;185:74–84.
17. Friedrich AW, Lu S, Bielaszewska M, et al. Cytolethal distending toxin in Escherichia coli O157:H7: spectrum of conservation, structure, and endothelial toxicity. J Clin Microbiol, 2006;44(5): 1844–1846.
18. Hiramatsu R, Matsumoto M, Miwa Y, et al. Characterization of Shiga toxin-producing Escherichia coli O26 strains and establishment of selective isolation media for these strains. J Clin Microbiol, 2002;40:922–925.
19. Karch H, Denamur E, Dobrindt U, et al. The enemy within us: lessons from the 2011 European Escherichia coli O104:H4 outbreak. EMBO Mol Med, 2012;4(9):841–848.
20. Karch H, Schubert S, Zhang D, et al. A genomic island, termed high-pathogenicity island, is present in certain non-O157 Shiga toxin-producing Escherichia coli clonal lineages. Infect Immun, 1999;67:5994–6001.
21. Karch H, Tarr PI, Bielaszewska M. Enterohaemorrhagic Escherichia coli in human medicine. Int J Med Microbiol, 2005;295(6-7):405–418.
22. Karmali MA, Petric M, Lim C, et al. The association between hemolytic uremic syndrome and infection by Verotoxin-producing Escherichia coli. J Infect Dis, 1985;151:775–782.
23. Lhotová H. Hemolyticko-uremický syndrom u dítěte vyvolaný verotoxigenním kmenem Escherichia coli O26. Zprávy CEM (SZÚ, Praha), 1999;8(11):426.
24. Lhotová H, Bielaszewska M, Kopalová E, et al. Haemolyticko-uremický syndrom – mikrobiologické šetření. Cesk Epid Mikrobiol Imunol, 1990;39(1):13–20.
25. Lhotová H, Ševčíková A. Závažný průběh hemolyticko-uremického syndromu u dítěte vyvolaný kmenem E. coli O157:H7 produkujícím verocytotoxin. Zprávy CEM (SZÚ, Praha), 2000;9(10):405–406.
26. Liu Y, Fratamico P, Debroy C, et al. DNA sequencing and identification of serogroup-specific genes in the Escherichia coli O118 O antigen gene cluster and demonstration of antigenic diversity but only minor variation in DNA sequence of the O antigen clusters of E. coli O118 and O151. Foodborne Pathog Dis, 2008;5(4):449–457.
27. Marejková M, Bláhová K, Janda J, et al. Enterohemorrhagic Escherichia coli as causes of hemolytic uremic syndrome in the Czech Republic. PLoS One, 2013;8(9):e73927.
28. Marejková M, Roháčová H, Reisingerová M, et al. An imported case of bloody diarrhea in the Czech Republic caused by a hybrid enteroaggregative hemorrhagic Escherichia coli (EAHEC) O104:H4 strain associated with the large outbreak in Germany, May 2011. Folia Microbiol (Praha), 2012;57(2):85–89.
29. Marejková M, Zieg J, Dušek J, et al. Smrtelný případ diareapozitivního hemolyticko-uremického syndromu vyvolaného enterohemoragickou E. coli O26. Zprávy EM (SZÚ, Praha) 2009;18(6):212–214.
30. Rangel JM, Sparling PH, et al. Epidemiology of Escherichia coli O157:H7 outbreaks, United States, 1982–2002. Emerg Infect Dis, 2005;11:603–609.
31. Ribot EM, Fair MA, Gautom R, et al. Standardization of pulsed-field gel electrophoresis protocols for the subtyping of Escherichia coli O157:H7, Salmonella, and Shigella for PulseNet. Foodborne Pathog Dis, 2006;3:59–67.
32. Rosales A, Hofer J, Zimmerhackl LB, et al. Need for long-term follow-up in enterohemorrhagic Escherichia coli - associated hemolytic uremic syndrome due to late-emerging sequelae. Clin Infect Dis, 2012;54:1413–1421.
33. Scheutz F, Teel LD, Beutin L, et al. Multicenter evaluation of a sequence-based protocol for subtyping Shiga toxins and standardizing Stx nomenclature. J Clin Microbiol, 2012;50:2951–2963.
34. Tarr PI, Gordon CA, Chandler WL. Shiga toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet, 2005;365:1073–1086.
35. Tarr PI, Neill MA, Clausen CR, et al. Escherichia coli O157:H7 and the hemolytic uremic syndrome: importance of early cultures in establishing the etiology. J Infect Dis, 1990;162:553–556.
36. Torres AG, Zhou X, Kaper JB. Adherence of diarrheagenic Escherichia coli strains to epithelial cells. Infect Immun, 2005; 73(1):18–29.
37. Wong CS, Jelacic S, Habeeb RL, et al. The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections. N Engl J Med, 2000;342:1930–1936.
38. Zhang W, Nadirk J, Kossow A, et al. Phylogeny and phenotypes of clinical and environmental Shiga toxin-producing Escherichia coli O174. Environ Microbiol, 2013; Aug 1. doi: 10.1111/1462-2920.12234. [Epub ahead of print]
39. Zieg J, Dusek J, Marejkova M, et al. Fatal case of diarrhea-associated hemolytic uremic syndrome with severe neurologic involvement. Pediatr Int, 2012;54:166–167.
Štítky
Hygiena a epidemiológia Infekčné lekárstvo MikrobiológiaČlánok vyšiel v časopise
Epidemiologie, mikrobiologie, imunologie
![Číslo 3](https://www.prelekara.sk/media/cache/resolve/journal_issue/media/image_pdf/aa789d2af2455edad8bdc498aa97f844.jpeg)
2014 Číslo 3
- Parazitičtí červi v terapii Crohnovy choroby a dalších zánětlivých autoimunitních onemocnění
- Očkování proti virové hemoragické horečce Ebola experimentální vakcínou rVSVDG-ZEBOV-GP
- Koronavirus hýbe světem: Víte jak se chránit a jak postupovat v případě podezření?
Najčítanejšie v tomto čísle
- Současný pohled na diagnostiku a léčbu amébózy ve světle vlastní kazuistické zkušenosti
- Infekce vyvoláné lidskými alfa herpetickými viry
- Enterohemoragické Escherichia coli jako původci průjmu v České republice (1965–2013)
- Výskyt a charakteristika termotolerantních kampylobakterů v potravinovém řetězci člověka