<i>Escherichia coli</i>O104 Associated with Human Diarrhea, South Africa, 2004–2011

Tau, Nomsa P.; Meidany, Parastu; Smith, Anthony M.; Sooka, Arvinda; Keddy, Karen H.

doi:10.3201/eid1808.111616

Cited by 19 publications

(18 citation statements)

References 12 publications

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“…STEC O104:H4 caused a case of HUS in South Korea (2004), but this strain was not enteroaggregative [13]. EAggEC O104:H4 has been associated with human diarrhoea in South Africa (2007, 2009 and 2010) and Canada (2010) [14,15]. Agg-STEC O104:H4 have been isolated from patients with HUS in Germany (2001), France (2009) and Italy (2009); from two patients with bloody diarrhoea in the Republic of Georgia (2009); from a patient with haemorrhagic colitis in France (2004); and from patients in Norway (2006) and Sweden (2010) [16][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Enteroaggregative Shiga toxin-producing Escherichia coli of serotype O104:H4 in Belgium and Luxembourg

Rauw

Vincken

Garabedian

et al. 2014

New Microbes and New Infections

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In 2011, a large outbreak of infections caused by Shiga toxin-producing Escherichia coli (STEC) O104:H4 occurred in Germany. This exceptionally virulent strain combined virulence factors of enteroaggregative E. coli (EAggEC) and STEC. After the outbreak only a few sporadic cases of infection with this rare serotype were reported, most of which were related to travel to the Middle East or North Africa. Here we describe two cases of enteroaggregative STEC (Agg-STEC) O104:H4 infection that occurred in Belgium in 2012 and 2013 respectively. In both cases travel in a Mediterranean country preceded the infection. The first strain was isolated from the stool of a 42-year-old woman presenting bloody diarrhoea, who had travelled to Tunisia the week before. The second case involves a 14-year-old girl who, upon her return from Turkey to Belgium, suffered from an episode of bloody diarrhoea and haemolytic uraemic syndrome. Extended typing of the isolates with pulsed field gel electrophoresis revealed that the strains were closely related, though not exactly the same as the 2011 outbreak strain. This report supports the previously made hypothesis that Agg-STEC has a human reservoir and might be imported by travellers coming from an area where the pathogen is endemic. Furthermore, it emphasizes the concern that these bacteria may cause future outbreaks as evenly virulent O104:H4 isolates seem to be widespread.

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Section: Discussionmentioning

confidence: 99%

Enteroaggregative Shiga toxin-producing Escherichia coli of serotype O104:H4 in Belgium and Luxembourg

Rauw

Vincken

Garabedian

et al. 2014

New Microbes and New Infections

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“…The 55989 strain, which has never been typed but which might be of serotype O104:H4 according to unpublished in silico serotyping, was isolated in the Central African Republic and 5 strains of VT2-negative O104:H4 E. coli were identified in South Africa (2004-2011) [26]. The strain described here, E112/10 was isolated from a patient who had travelled to Tunisia, and out of the three other travel-related cases of patients infected with O104 strains for which the country of travel was identified, one had travelled to Turkey in 2009 and another to Egypt in 2010 [27].…”

Section: Discussionmentioning

confidence: 99%

Adaptive Mutations and Replacements of Virulence Traits in the Escherichia coli O104:H4 Outbreak Population

et al. 2013

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The sequencing of highly virulent Escherichia coli O104:H4 strains isolated during the outbreak of bloody diarrhea and hemolytic uremic syndrome in Europe in 2011 revealed a genome that contained a Shiga toxin encoding prophage and a plasmid encoding enteroaggregative fimbriae. Here, we present the draft genome sequence of a strain isolated in Sweden from a patient who had travelled to Tunisia in 2010 (E112/10) and was found to differ from the outbreak strains by only 38 SNPs in non-repetitive regions, 16 of which were mapped to the branch to the outbreak strain. We identified putatively adaptive mutations in genes for transporters, outer surface proteins and enzymes involved in the metabolism of carbohydrates. A comparative analysis with other historical strains showed that E112/10 contained Shiga toxin prophage genes of the same genotype as the outbreak strain, while these genes have been replaced by a different genotype in two otherwise very closely related strains isolated in the Republic of Georgia in 2009. We also present the genome sequences of two enteroaggregative E. coli strains affiliated with phylogroup A (C43/90 and C48/93) that contain the agg genes for the AAF/I-type fimbriae characteristic of the outbreak population. Interestingly, C43/90 also contained a tet/mer antibiotic resistance island that was nearly identical in sequence to that of the outbreak strain, while the corresponding island in the Georgian strains was most similar to E. coli strains of other serotypes. We conclude that the pan-genome of the outbreak population is shared with strains of the A phylogroup and that its evolutionary history is littered with gene replacement events, including most recently independent acquisitions of antibiotic resistance genes in the outbreak strains and its nearest neighbors. The results are summarized in a refined evolutionary model for the emergence of the O104:H4 outbreak population.

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“…Previous studies in South Africa have also noted high prevalence of EAEC in food and environmental (Caine et al, 2014) as well as clinical sources (Adefisoye and Okoh, 2016;Bisi-johnson et al, 2011;Samie et al, 2007;Tau et al, 2012).…”

Section: Adherence Testsmentioning

confidence: 91%

“…Variation in epidemiology of diarrhoeal disease and associated pathotypes has been linked to geographical, temporal and climatic conditions complicating food safety and public health prevention and control initiatives especially in resource limited countries (Carlton et al, 2016). South Africa like many developing and Sub-Saharan African countries experiences a high incidence of diarrhoea (Tau et al, 2012) in infants and immune compromised adults, such as HIV-positive patients (Samie et al, 2007). Such illness would disproportionately affect the low income population, which makes up a large part of the urban and rural population (World Bank, 2014) due to inadequate waste disposal and sanitation facilities (Baker et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Such illness would disproportionately affect the low income population, which makes up a large part of the urban and rural population (World Bank, 2014) due to inadequate waste disposal and sanitation facilities (Baker et al, 2016). Within South Africa, The National Institute of Communicable Diseases (NICD) initiated a national surveillance program to monitor diarrheagenic pathotypes (Tau et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

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Enteroaggregative Escherichia coli is the predominant diarrheagenic E. coli pathotype among irrigation water and food sources in South Africa

Aijuka

Santiago

Girón

et al. 2018

International Journal of Food Microbiology

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Diarrheagenic E. coli (DEC) has been implicated in foodborne outbreaks worldwide and have been associated with childhood stunting in the absence of diarrhoea. Infection is extraordinarily common, but the routes of transmission have not been determined. Therefore, determining the most prevalent pathotypes in food and environmental sources may help provide better guidance to various stakeholders in ensuring food safety and public health and advancing understanding of the epidemiology of enteric disease. We characterized 205 E. coli strains previously isolated from producer distributor bulk milk (PDBM)(118), irrigation water (48), irrigated lettuce (29) and street vendor coleslaw (10) in South Africa. Enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC), enteroaggregative E. coli (EAEC) and diffusely adherent E. coli (DAEC) were sought. We used PCR and partial gene sequencing for all 205 strains while 46 out of 205 that showed poor resolution were subsequently characterized using cell adherence (HeLa cells). PCR and partial gene sequencing of aatA and/or aaiC genes confirmed EAEC (2%, 5 out of 205) as the only pathotype. Phylogenetic analysis of sequenced EAEC strains with E. coli strains in GenBank showing ≥80% nucleotide sequence similarity based on possession of aaiC and aatA generated distinct clusters of strains separated predominantly based on their source of isolation (food source or human stool) suggesting a potential role of virulence genes in source tracking. EAEC 24%, 11 out of 46 strains (PDBM = 15%, irrigation water = 7%, irrigated lettuce = 2%) was similarly the predominant pathotype followed by strains showing invasiveness to HeLa cells, 4%, 2 out of 46 (PDBM = 2%, irrigated lettuce = 2%), among stains characterized using cell adherence. Therefore, EAEC may be the leading cause of DEC associated food and water-borne enteric infection in South Africa. Additionally, solely using molecular based methods targeting virulence gene determinants may underestimate prevalence, especially among heterogeneous pathogens such as EAEC.

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Escherichia coliO104 Associated with Human Diarrhea, South Africa, 2004–2011

Cited by 19 publications

References 12 publications

Enteroaggregative Shiga toxin-producing Escherichia coli of serotype O104:H4 in Belgium and Luxembourg

Enteroaggregative Shiga toxin-producing Escherichia coli of serotype O104:H4 in Belgium and Luxembourg

Adaptive Mutations and Replacements of Virulence Traits in the Escherichia coli O104:H4 Outbreak Population

Enteroaggregative Escherichia coli is the predominant diarrheagenic E. coli pathotype among irrigation water and food sources in South Africa

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