Annual monitoring euwide data on the presence of e. A case of haemolytic uremic syndrome caused by escherichia coli o104. We present microbiological data from the outbreak of bloody diarrhoea and haemolyticuraemic syndrome associated with consumption of sprouts that occurred in junejuly, 2011, in the bordeaux area, southwest. However, it severely diminished the colonization and bio.
We concluded that, although the german outbreak was larger, the german isolates represent a clade within the greater diversity of the french outbreak. H7 is a gram negative oxidasenegative bacterial species that does not ferment sorbitol serotype of the bacterial species escherichia coli and is one of the like shiga toxinproducing types of e. Serotyping showed that the strains belonged to the o104. In the summer of 2011 germany experienced one of the largest outbreaks of a foodborne infection caused by enterohaemorrhagic escherichia coli ehec with the serotype o104. From may to july 2011, primarily in northern germany, there was a large outbreak of illnesses characterized by haemolyticuremic syndrome hus and bloody diarrhoea caused by enterohemorrhagic escherichia coli ehec of the serotype o104.
We report a molecular epidemiological analysis using multiplatform wholegenome sequencing and analysis of multiple isolates from the german and. In this article, we present epidemiological characteristics of the hamburg notification data. H4 infections that ultimately involved more than 4,000 persons in 16 countries. H4 strains were detected in cattle feces collected in the outbreak area, while classical stec was found in onequarter of the animals. Enterohemorrhagic escherichia coli with particular attention. However, experimentally infected cattle can shed this organism, at least transiently. In may 2011, public health authorities in europe began investigating an outbreak of shiga toxinproducing escherichia coli stec o104.
The outbreak strain was typed as an enteroaggregative shigatoxinproducing e. Based on the date of onset, the outbreak started in germany at the beginning of may and reached a peak on 22 may 2011. H4 isolates were obtained from a patient with hus and her. The illness was characterized by bloody diarrhea, with a high frequency of serious complications, including hemolyticuremic syndrome hus, a condition that requires urgent treatment. The first available draft sequence was reported by the beijing genomics institute bgi, which received the strain from researchers at the university of hamburg and finished the sequencing of the genome within 3 days by using their thirdgeneration sequencing platform from. H4 emerged as an important pathogen when it caused a. Hostspecific differences in the contribution of an extended spectrum.
Introduction a major pathogenic escherichia coli o104. Enterohemorrhagic escherichia coli with particular attention to the german outbreak strain o104. H4 strains that produce shiga toxins eaecstec caused an outbreak of hemorrhagic disease affecting nearly 4,000 patients in europe 1. H4 in germany from may to july, 2011 1 threw the public health agencies into an embarrassing situation. For example, in 2009 in the republic of georgia, culture of specimens from two patients who were part of a cluster of diarrheal illness yielded an e. H4 isolates were obtained from a patient with hus and her friend showing only gastrointestinal complaints.
Pdf in recent years, iraq has been imported quantities of meat and chicken from poor origins. H4 outbreak in germany in our paper 1, we analyzed isolates from theescherichia coli o104. H7 is one of many strains of the bacterium escherichia coli most strains of e. Genomes of ten outbreak isolates and a historical o104. From an initial case control study, the outbreak was associated with the consumption of fresh salad vegetables. H7 strains, the primary reservoir is the intestines of ruminants, particularly cattle. Epidemic profile of shigatoxinproducing escherichia coli o104. H4 outbreak article pdf available in journal of the formosan medical association 11010. Hostspecific differences in the contribution of an. What was the source of the 2011 outbreak of escherichia.
Enterohemorrhagic escherichia coli ehec is a subset of pathogenic e. In 2011, germany was hit by one of its largest outbreaks of acute gastroenteritis and haemolytic uraemic syndrome caused by a new emerging enterohaemorrhagic escherichia coli o104. H4 strain caused a large outbreak of haemolytic uraemic syndrome and bloody diarrhoea in 2011 in europe. H4 outbreak occurred in central europe during late spring of 2011, infecting nearly 4000 persons mainly in germany, it produced more than 900 cases of haemolytic uremic syndrome hus resulting in 54 deaths.
H4 outbreaks in germany and france in may to july 2011. These outbreaks further heightened public health concerns over the safety of sprouts. Apr 15, 2014 it differs essentially from typical ehec o104. H4 infections associated with sprout consumption europe and north america, mayjuly 2011. It is a cause of disease, typically foodborne illness, through consumption of contaminated and raw food, including raw milk and undercooked ground beef. H4 outbreak in germany in 2011 german ec as the likeli hood of a deliberate act has not been excluded in previous analyses. The outbreak was originally thought to have been caused by. Escherichia coli vtec, shiga toxin producing escherichia coli stec, genes escherichia coli o157. Laboratory preparedness for detection and monitoring of. Since early may 2011, there has been an increased incidence of hemolyticuremic syndrome hus and bloody diarrhoea associated with infections by enterohemorrhagic escherichia coli ehec of the serotype o104. H4 strain that was similar to the current outbreak strain. H4 isolates from 80 patients in the large outbreak in germany. H4 outbreak occurred in germany from may to july 2011.
H4 strain caused a serious outbreak of acute gastroenteritis and hemolyticuremic syndrome hus in germany. H4 from the outbreak centered in germany in mayjuly 2011, and the much smaller outbreak in southwest france in june 2011, were indistinguishable by standard tests. Epidemic profile of shigatoxinproducing escherichia coli. H4 emerged as an important pathogen when it caused a large outbreak in germany in 2011. It has been shown that detection of the 4 target genes with this kit provides a unique genetic signature that can correctly identify strains of li o104.
Never before was such a high rate of hus cases observed in an outbreak caused by a foodborne pathogen. H4 strains because it comprises a hybrid virulence profile that combines typical molecular and phenotypic characteristics of shiga toxin e. H4 with clusters in the north of germany and in the bordeaux region in france. Comprehensive characterization of escherichia coli o104. H4 genomes is designed for the in vitro quantification of li o104. Lessons learned from the 2011 outbreak of shiga toxinproducing. Reply to guy et al support for a bottleneck in the 2011. Bacteriophages in enteroaggregative escherichia coli o104. A large number of cases with bloody diarrhea and haemolytic uraemic syndrome hus occurred. Two surveys were performed in the european union eu and european economic area eea countries to assess their laboratory.
H4, respectively, including 371 proteins common to both strains. In 2011, enteroaggregative escherichia coli eaec o104. H4, a hybrid pathotype reported in a large 2011 foodborne outbreak in germany, has not been detected in cattle feces. The city of hamburg was the first focus of the epidemic and had the highest incidences among all 16 federal states of germany. Phylogenetic analyses were performed using various approaches which either are not. Shiga toxinproducing escherichia coli stec are important agents of foodborne disease worldwide. That strain produced shiga toxin, but had a different molecular.
H7 infections and is the most common cause of childhood acute renal failure. Emerging multidrugresistant hybrid pathotype shiga toxin. H4 bacteria caused a serious outbreak of foodborne illness focused in northern germany in may through june 2011. H4 isolated from patients in the netherlands mithila ferdous 1,kaizhou 1,2,3,boer 4, alexander w. While nono157 serotypes account for the majority of stec infections, frontline microbiology laboratories may only. November individual animal2016 importance enterohemorrhagic escherichia coli ehec is a subset of pathogenic e. Technical report stecvtec in humans, food and animals in the eueea 1 1 introduction this report aims to give a short summary of reported shiga toxinverotoxin producing escherichia coli stecvtec prevalence and incidence in humans, food and animals. A special reference is given to the strain stec o104. H4 genomes from the 2011 outbreak and other nonoutbreakrelated isolates.
H4 outbreak in germany clarification of the origin of the epidemic article pdf available in the european journal of public health 251 april 2014 with 183 reads. However, cattle harbor and shed in the feces other o104 serotypes, particularly o104. H7 is recognized as causing many outbreaks of foodborne disease, more than 400 other serotypes of stec, called nono157 stec, have been isolated from human patients scheutz and strockbine 2005. The deletion of agga did not affect the adherence of e. Apr 12, 2016 shiga toxinproducing escherichia coli stec are responsible for gastrointestinal diseases reported in numerous outbreaks around the world.
Given the public health importance of stec, effective detection, characterization and typing is critical to any medical laboratory system. Hostspecific differences in the contribution of an extended. On 22 june 2012, an increase of haemolyticuremic syndrome hus and bloody. Taxonomy navigation escherichia coli all lower taxonomy nodes 66 common name isynonym. We use an original and the most detailed scoring method so far, with 33 parameters pertaining to the source of. H4 strain isolated in 2001 were sequenced using different new generation sequencing platforms. Early in the outbreak, it became evident that international surveillance would be necessary to determine the scope of the outbreak, characterize the disease, and identify the source.
H4 is a rare enterohemorrhagic strain of the bacterium escherichia coli, and the cause of the 2011 escherichia coli o104. H4 associated with fenugreek sprouts occurred in germany and france, resulting in more than 4,000 illnesses and 50 deaths 16. Pdf in 2011, germany was hit by one of its largest outbreaks of acute gastroenteritis and haemolytic uraemic syndrome caused by a new emerging. H4 outbreak, germany 2011 2 abstract from may to july 2011, primarily in northern germany, there was a large outbreak of ill. The o in the serological classification identifies the cell wall lipopolysaccharide antigen, and the h identifies the flagella antigen analysis of genomic sequences obtained by bgi shenzhen shows that the o104. Detection, characterization, and typing of shiga toxin. On 21 may 2011, germany reported an ongoing outbreak of shiga. We obtained circularized sequences of the o80 strain rdex444, responsible for hemolytic uremic syndrome with bacteremia, and noncircularized sequences of 35 o80 e. H4 strain in germany was spread mostly by contaminated sprouts, and in just a few cases, from close contact with a sick person. Bae wk, lee yk, cho ms, ma sk, kim sw, kim nh, et al.
Although shiga toxinproducing escherichia coli stec o157 is an often identified pathogen, illnesses involving nono157 serogroups are increasingly recognized. The mosaic genome structure and phylogeny of shiga toxin. Common name isynonym iother names i escherichia coli o104. To determine the origin of 4,000 suspected diarrheagenic escherichia coli strains isolated during 20042011 in south africa, we identified 7 isolates as serotype o104. H4 is an enteroaggregative escherichia coli strain of the bacterium escherichia coli, and the cause of the 2011 escherichia coli o104. Although it is likely that microgreens could also serve as vehicle of bacterial. During 200120, several countries reported infections caused. H4 grew rapidly during sprouting, reaching levels of 5. The german haemolytic uraemic syndromeenterohaemorrhagic e. Response to outbreaks a virulent and rare strain of vtec, o104. In this study, we examined the extracellular proteins from escherichia coli o157. H4 occurred in europe and north america that was associated with consumption of raw fenugreek sprouts. Different cellular origins and functions of extracellular. The aim of the study was to further clarify the origin of escherichia coli o104.
Analysis of genomic sequences obtained by bgi shenzhen shows that the o104. Hus, consisting of hemolytic anemia, thrombocytopenia, and acute renal insufficiency, complicates approximately 15% of childhood ehec o157. H4 strain from a child who developed bloody diarrhea, hus, and severe neurological. H4 infections associated with sprout consumption europe and north america, mayjuly 2011 in may 2011, public health authorities in europe began investigating an outbreak of shiga toxinproducing escherichia coli stec o104. Little is known about the evolutionary history and genomic diversity of the bacterium. Phylogenetic analyses were performed using various approaches. It appears that the escherichia coli abbreviated as e. Extracellular proteins play important roles in bacterial interactions with the environmental matrices. H4 outbreak, germany 2011 2 abstract from may to july 2011, primarily in northern germany, there was a large outbreak of illnesses characterized by haemolyticuremic syndrome hus and bloody diarrhoea assoc iated with infections by enterohemorrhagic escherichia coli ehec of the serotype o104.
H4 outbreak occurred in germany from may to july 2011, causing numerous cases of hemolyticuremic syndrome hus and deaths. Enterohemorrhagic escherichia coli with particular. Shiga toxinproducing escherichia coli stec are a pathogenic group of. H4 outbreak from sprouted seeds in germany gives a clear indication of the emerging relevance of the consumption of these products within food safety issues soon et. We present microbiological data from the outbreak of bloody diarrhoea and haemolyticuraemic syndrome associated with consumption of sprouts that occurred in junejuly, 2011, in the bordeaux area, south. Epidemiological and ecological characterization of the. Taxonomy navigation escherichia coli all lower taxonomy nodes 66 common name isynonym iother names i stec o104. The o in the serological classification identifies the cell wall lipopolysaccharide antigen, and the h identifies the flagella antigen.
The current communication describes a comprehensive analysis of stec o104. Shiga toxinproducing escherichia coli stec are responsible for gastrointestinal diseases reported in numerous outbreaks around the world. Enterohemorrhagic escherichia coli serogroup o80, involved in hemolytic uremic syndrome associated with extraintestinal infections, has emerged in france. A hybrid strain of enteroaggregative and shiga toxin 2producing escherichia coli eaecstec serotype o104. Enterohemorrhagic escherichia coli ehec causes diarrhea, bloody diarrhea, and the hemolytic uremic syndrome hus. Fenugreek sprouts were identified as most likely vehicle of. The sequencing of the german epidemic strain was achieved in record time by several groups. We identified 500 and 859 proteins from the growth media of e.
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