A severe foodborne outbreak of diarrhoea linked to a canteen in Italy caused by enteroinvasiveEscherichia coli, an uncommon agent

Abstract

We describe a foodborne outbreak in Italy caused by enteroinvasive Escherichia coli (EIEC), an enteric pathogen uncommon in industrialized countries. On 14 April 2012 a number of employees of the city of Milan Fire Brigade (FB) were admitted to hospital with severe diarrhoea after attending their canteen. Thirty-two patients were hospitalized and a total of 109 cases were identified. A case-control study conducted on 83 cases and 32 controls attending the canteen without having symptoms identified cooked vegetables to be significantly associated with the disease. Stool samples collected from 62 subjects were screened for enteric pathogens using PCR-based commercial kits: 17 cases and two asymptomatic kitchen-workers were positive for the Shigella marker gene ipaH; an ipaH-positive EIEC strain O96:H19 was isolated from six cases. EIEC may cause serious dysentery-like outbreaks even in Western European countries. Microbiologists should be aware of microbiological procedures to detect EIEC, to be applied especially when no common enteric pathogens are identified.

Diarrheagenic Escherichia coli

“…Currently, the investigation of the ipaH gene, a multi-copy gene (4–10) present in EIEC and Shigella , by PCR is recommended,442, 446 or studies of other DNA sequences are needed, such as the invasion-associated locus gene ( ial ) 447 . The presence of the iudA and lacY genes can differentiate EIEC from S. flexneri 446 .…”

A case of haemolytic uraemic syndrome (HUS) revealed an outbreak of Shiga toxin-2-producing Escherichia coli O26:H11 infection in a nursery, with long-lasting shedders and person-to-person transmission, Italy 2015

“…Attività analoghe a quelle descritte sono state condotte attarverso le reti Enter-Net Italia e il Registro SEU nel 2011, per l'allerta relativa ad un focolaio di infezione da S. Stratchona associata al consumo di pomodori pachino di produzione italiana che era stata oggetto anche di un'allerta RASFF (Rapid Alert System for Food and Feed) (Müller et al, 2013). Nel 2012 durante un focolaio di infezione di origine alimentare da E. coli enteroinvasivo che aveva colpito in modo importante la caserma dei vigili del fuoco di Milano (Escher et al, 2014). E ancora, nel 2013 in occasione del focolaio epidemico di SEU da STEC O26 in Puglia (Germinario et al, 2016) e dell'allerta per l'aumento di S. Mikawasima in UE (ECDC, 2013).…”

Uropathogenic Escherichia coli pathogenicity islands and other ExPEC virulence genes may contribute to the genome variability of enteroinvasive E. coli

“…Like the other DEC pathotypes EIEC infections occur by the fecal-oral route, and usually are more prominent in low-income regions due to poor sanitation [2–4]. Nevertheless, outbreaks associated with contaminated food and water can occur among high-income people groups as well [5–9]. …”

“…The recent occurrence of two important outbreaks in Europe due to an EIEC strain [9, 21] has motivated studies on the molecular characterization and comparative genomics of EIEC strains isolated in various geographic regions to better understand the evolution of this E. coli pathovar [12, 17]. However, a possible way of EIEC rearrangements driven by the acquisition of mobile genetic elements engaged in virulence of other E. coli pathovars has not been addressed yet.…”