Outbreak of gastroenteritis highlighting the diagnostic and epidemiological challenges of enteroinvasive Escherichia coli, County of Halland, Sweden, November 2017

Abstract

An outbreak of gastroenteritis with 83 cases occurred at a conference venue in November 2017 in Halland County, Sweden. Stool samples from two venue visitors and a symptomatic secondary case attributed to household transmission were PCR-positive for the ipaH gene, a target found in both Shigella spp. and enteroinvasive Escherichia coli (EIEC). EIEC was isolated from stool samples and whole genome sequencing analysis confirmed EIEC O96:H19 to be the aetiological agent. A cohort study was conducted among venue attendees and employees and the findings implicated contaminated leafy greens as the vehicle of infection, however, no microbiological evidence could support the study results. Here, we report the investigation into the first recorded EIEC outbreak in Sweden and illustrate the challenges associated with the differential laboratory diagnostics of Shigella/EIEC in an outbreak setting.

Genomic Insights Into Clinical Shiga Toxin-Producing Escherichia coli Strains: A 15-Year Period Survey in Jönköping, Sweden

“…The DNA library preparation and purification were done using the AB Library Builder system and AMPure beads (Thermo Fisher Scientific, Waltham, MA, United States). The library was then sequenced using the Ion Torrent S5 XL platform (single-end reads; length 400 bp) at The Public Health Agency of Sweden as previously described (Lagerqvist et al, 2020). The quality of the raw reads was assessed with FastQC (version 0.11.8) 1 .…”

Virulence Factors of Enteric Pathogenic Escherichia coli: A Review

“…The SigA -encoded cytotoxin contributes to intestinal fluid accumulation in the EIEC or Shigella -infected hosts [ 86 ]. Recently, other virulence factors have also been detected and identified prevalently in EIEC and Shigella isolates, including iutA , iucB , EatA , VirF , VirB , IpaJ , and OspC3 implicated for aerobactin synthesis, complex siderophore iron receptor, SPATE toxin, the regulation of virulence factor gene expression, the control of virulence factor gene synthesis, the inhibition of the host cell trafficking membrane, and the inhibition of inflammasomes, respectively ( Table 1 ) [ 72 , 79 ].…”

“…Severe mucosal and bloody diarrhea with abdominal cramps and fever are typical clinical features of bacillary dysentery or shigellosis caused by different species of Shigella and EIEC as invasive foodborne pathogens [13,71]. Initially known as Bacillus dysenteriae, Shigella was previously characterized in 1897 by Kiyoshi Shiga in Japan after a severe epidemic causing more than 91,000 cases, with 20% mortality [72]. Fifty years later, EIEC was discovered and characterized with the same genetic, pathogenic, and biochemical properties as were observed for Shigella.…”

Virulence factors of Enteric Pathogenic Escherichia coli: A Review

“…Severe mucosal and bloody diarrhoea with abdominal cramps and fever are typical clinical features of bacillary dysentery or shigellosis caused by different species of Shigella and EIEC as invasive foodborne pathogens [13,71]. Initially known as Bacillus dysenteriae, Shigella was previously characterized in 1897 by Kiyoshi Shiga in Japan after a severe epidemic causing more than 91,000 cases with 20% mortality [72]. Fifty years later, EIEC was discovered and characterized with the same genetic, pathogenic, and biochemical properties as were observed for Shigella.…”

“…SigA encoded cytotoxin contributes to intestinal fluid accumulation in the EIEC or Shigella infected host [86]. There are also some other virulence factors recently been detected and identified prevalently in EIEC and Shigella isolates, including iutA, iucB, EatA, VirF, VirB, IpaJ and OspC3 implicated for aerobactin synthesis, complex siderophore iron receptor, SPATE toxin, regulation of virulence factor gene expression, control of virulence factor gene synthesis, inhibition of host cell trafficking membrane and inhibition of inflammasomes, respectively (Table) [72,79].…”