Escherichia coli O104:H4

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Escherichia coli O104:H4
Other names: Shiga toxin-producing E. coli O104:H4[1]
  • Top:Electron micrograph of O104:H4[2]
  • Bottom: a,b)Comparison of Escherichia coli O104:H4 isolates from Ontario[3]
SpecialtyInfectious disease
SymptomsNausea, abdominal cramps, diarrhea[4]
Risk factorsImmunocompromised[4]
Diagnostic methodStool culture , PCR[5]
TreatmentSymptomatic management (antibiotics are not recommended as first-line treatment)[6]

Escherichia coli O104:H4 is an enteroaggregative Escherichia coli strain of the bacterium Escherichia coli, and the cause of the 2011 Escherichia coli O104:H4 outbreak.[7] Among the possible symptoms for an individual with Escherichia coli O104:H4 are vomiting, nausea, as well as bloody diarrhea[4]

Following the 2011 outbreak, O104:H4 clones with the same virulence factors have been identified in France, thus the pathogen may have become endemic in Europe.[8]

Signs and symptoms

The clinical presentation of E coli O104:H4 is as follows:[9][4]

  • Vomiting
  • Bloody diarrhea
  • Nausea

Transmission

A common mode of E. coli O104:H4 infection involves ingestion of fecally contaminated food; the disease can thus be considered a foodborne illness. Most recently in 2011, an outbreak of the O104:H4 strain in Germany caused the deaths of several people, and hundreds were hospitalised.[10][11][9] German authorities traced the infection back to fenugreek sprouts grown from contaminated seeds imported from Egypt, but these results are debated.[12]

Pathophysiology

Virulence-associated genes in the genome of O104:H4 (outbreak) strain[13]

E. coli O104 is a Shiga toxin–producing E. coli (STEC). The toxins cause illness and the associated symptoms by sticking to the intestinal cells and aggravating the cells along the intestinal wall.[14][9] This, in turn, can cause bloody stools to occur. Another effect from this bacterial infection is hemolytic uremic syndrome (HUS), which is a condition characterized by destruction of red blood cells, that over a long period of time can cause kidney failure.[15]

Analysis of genomic sequences obtained by BGI Shenzhen shows that the O104:H4 outbreak strain is an enteroaggregative E. coli (EAEC or EAggEC) type that has acquired Shiga toxin genes, presumably by horizontal gene transfer.[16][17][18]Genome assembly and copy-number analysis both confirmed that two copies of the Shiga toxin stx2 prophage gene cluster are a distinctive characteristic of the genome of the O104:H4 outbreak strain.[19][20] The O104:H4 strain is characterized by these genetic markers:[20][21]

  • Shiga toxin stx2 positive
  • Tellurite resistance gene cluster positive
  • Intimin adherence gene negative
  • β-lactamases ampC, ampD, ampE, ampG, ampH are present.

The European Commission (EC) integrated approach to food safety[22] defines a case of Shiga-like toxin-producing E. coli (STEC) diarrhea caused by O104:H4 by an acute onset of diarrhea or bloody diarrhea together with the detection of the Shiga toxin 2 (Stx2) or the Shiga gene stx2.[23]Prior to the 2011 outbreak, only one case identified as O104:H4 had been observed, in a woman in South Korea in 2005.[24]

Diagnosis

Aggregative adherence pattern of E. coli O104:H4 outbreak strain to cultured HCT-8 intestinal epithelial cells

To diagnose infection with STEC, a patient's stool (feces) can be tested in a laboratory for the presence of Shiga toxin. Testing methods used include direct detection of the toxin by immunoassay, or detection of the stx2 gene or other virulence-factor genes by PCR. If infection with STEC is confirmed, the E. coli strain may be serotyped to determine whether O104:H4 is present.[14]

Prevention

Spread of E. coli is prevented simply by thorough hand-washing with soap, washing and hygienically preparing food, and properly heating/cooking food, so the bacteria are destroyed.Also being aware when traveling, if said destination might be an area where E. coli infections are more common.[5][25]

Treatment

As for management hydration is very important, especially with severe diarrhea. Oral rehydration solutions or intravenous fluids might be necessary.E. coli O104:H4 is difficult to treat as it is resistant to many antibiotics, although it is susceptible to carbapenems.[10][26]

Epidemiology

Escherichia coli O104H4 bacterial outbreak

In terms of epidemiology we find that in 2011 the global impact of an outbreak affected over 4,000 individuals across 16 countries. Germany alone saw more than 1,500 cases[25]

We find there have been sporadic cases since the 2011 outbreak. Specifically, there have been sporadic cases of E. coli O104:H4 infections, linked to travel to certain regions such as the country of Turkey and/or the region of North Africa.[27]

A 2014 review indicated that much after the 2011 outbreak, the country of France detected similar O104:H4 clones exhibiting the same virulence factors which indicates, per the author, that it had " become endemically established in Europe" after the outbreak ended[8]

See also

References

  1. ↑ Muniesa, Maite; Hammerl, Jens A.; Hertwig, Stefan; Appel, Bernd; Brüssow, Harald (15 June 2012). "Shiga Toxin-Producing Escherichia coli O104:H4: a New Challenge for Microbiology". Applied and Environmental Microbiology. 78 (12): 4065–4073. doi:10.1128/AEM.00217-12. PMC 3370534. PMID 22504816.
  2. ↑ Burger, Reinhard (2012). "EHEC O104:H4 IN GERMANY 2011: LARGE OUTBREAK OF BLOODY DIARRHEA AND HAEMOLYTIC URAEMIC SYNDROME BY SHIGA TOXIN–PRODUCING E. COLI VIA CONTAMINATED FOOD". Improving Food Safety Through a One Health Approach: Workshop Summary. National Academies Press (US). Archived from the original on 2024-06-23. Retrieved 2024-10-31.
  3. ↑ Alexander, David C.; Hao, Weilong; Gilmour, Matthew W.; Zittermann, Sandra; Sarabia, Alicia; Melano, Roberto G.; Peralta, Analyn; Lombos, Marina; Warren, Keisha; Amatnieks, Yuri; Virey, Evangeline; Ma, Jennifer H.; Jamieson, Frances B.; Low, Donald E.; Allen, Vanessa G. (March 2012). "Escherichia coli O104:H4 Infections and International Travel". Emerging Infectious Diseases. 18 (3): 473–476. doi:10.3201/eid1803.111281. PMC 3309582. PMID 22377016.
  4. ↑ 4.0 4.1 4.2 4.3 "Technical Information". E. coli Infection (Escherichia coli). 14 May 2024. Archived from the original on 27 September 2024. Retrieved 5 November 2024.
  5. ↑ 5.0 5.1 "Escherichia coli, Diarrheagenic | CDC Yellow Book 2024". wwwnc.cdc.gov. Retrieved 31 October 2024.
  6. ↑ Mueller, Matthew; Tainter, Christopher R. (2024). "Escherichia coli Infection". StatPearls. StatPearls Publishing. PMID 33231968. Archived from the original on 2024-08-22. Retrieved 2024-10-31.
  7. ↑ Mellman, Alexander; Harmsen, D; Cummings, CA; et al. (July 20, 2011). "Prospective genomic characterization of the German enterohemorrhagic Escherichia coli O104:H4 outbreak by rapid next generation sequencing technology". PLoS One. 6 (7): e22751. doi:10.1371/journal.pone.0022751. PMC 3140518. PMID 21799941.
  8. ↑ 8.0 8.1 Navarro-Garcia, Fernando (December 2014). "Escherichia coli O104:H4 Pathogenesis: an Enteroaggregative E. coli/Shiga Toxin-Producing E. coli Explosive Cocktail of High Virulence". Microbiology Spectrum. 2 (6). doi:10.1128/microbiolspec.EHEC-0008-2013. ISSN 2165-0497. PMID 26104460. Archived from the original on 2023-02-13. Retrieved 2024-10-31.
  9. ↑ 9.0 9.1 9.2 Reinberg, Steven. "German E. Coli Strain Especially Lethal - Infectious Diseases: Causes, Types, Prevention, Treatment and Facts on MedicineNet.com." Medicinenet.com. MedicineNet Inc, 22 June 2011. Web. 08 Nov. 2011.http://www.medicinenet.com/script/main/art.asp?articlekey=146119 Archived 2012-01-18 at the Wayback Machine.
  10. ↑ 10.0 10.1 "E. coli on the March - Scientific American". 12 November 2022. Archived from the original on 2022-11-12. Retrieved 4 November 2024. {{cite journal}}: Cite journal requires |journal= (help)
  11. ↑ "July 8, 2011: Outbreak of Shiga Toxin-producing E. Coli O104 (STEC O104:H4) Infections Associated with Travel to Germany | E. Coli." Centers for Disease Control and Prevention. Center for Disease Control and Prevention, 8 July 2011. Web. 08 Nov. 2011.https://www.cdc.gov/ecoli/2011/ecolio104/
  12. ↑ "EHEC O104:H4 outbreak event in Germany clarified: sprouts of fenugreek seeds imported from Egypt as underlying cause - BfR". www.bfr.bund.de. Retrieved 2 November 2024.
  13. ↑ Karch, Helge; Denamur, Erick; Dobrindt, Ulrich; Finlay, B. Brett; Hengge, Regine; Johannes, Ludgers; Ron, Eliora Z.; Tønjum, Tone; Sansonetti, Philippe J.; Vicente, Miguel (September 2012). "The enemy within us: lessons from the 2011 European Escherichia coli O104:H4 outbreak". EMBO Molecular Medicine. 4 (9): 841–848. doi:10.1002/emmm.201201662. PMC 3491817. PMID 22927122.
  14. ↑ 14.0 14.1 Frank, C; Werber, D; Cramer, JP; et al. (October 26, 2011). "Epidemic profile of Shiga-toxin–producing Escherichia coli O104:H4 outbreak in Germany". New England Journal of Medicine. 365 (19): 1771–1780. doi:10.1056/NEJMoa1106483. PMID 21696328.<http://www.nejm.org/doi/full/10.1056/NEJMoa1106483 Archived 2022-11-12 at the Wayback Machine>
  15. ↑ European Food Safety Authority. "Shiga Toxin-producing E. Coli (STEC) O104:H4 2011 Outbreaks in Europe:." EFSA Journal. European Food Safety Authority, 3 Nov. 2011. Web. 08 Nov. 2011. <http://www.efsa.europa.eu/en/efsajournal/pub/2390 Archived 2022-11-12 at the Wayback Machine>.
  16. ↑ "BGI Sequences Genome of the Deadly E. coli in Germany and Reveals New Super-Toxic Strain". BGI. 2011-06-02. Archived from the original on 2011-06-06. Retrieved 2011-06-02.
  17. ↑ David Tribe (2011-06-02). "BGI Sequencing news: German EHEC strain is a chimera created by horizontal gene transfer". Biology Fortified. Archived from the original on 2012-05-27. Retrieved 2011-06-02.
  18. ↑ Maev Kennedy and agencies (2011-06-02). "E. coli outbreak: WHO says bacterium is a new strain". London: guardian.co.uk. Archived from the original on 2011-06-02. Retrieved 2011-06-04.
  19. ↑ "BGI releases the complete map of the Germany E. coli O104 genome and attributed the strain as a category of Shiga toxin-producing enteroaggregative Escherichia coli (STpEAEC)". BGI. 2011-06-16. Archived from the original on 2011-06-21. Retrieved 2011-06-20.
  20. ↑ 20.0 20.1 "Copy number analysis of German outbreak strain E. coli EHEC O104:H4". Johannes Kepler University of Linz. 2011-06-11. Archived from the original on 2011-09-10. Retrieved 2011-06-15.
  21. ↑ "Characterization of EHEC O104:H4" (PDF). Robert Koch Institute. 2011-06-03. Archived from the original (PDF) on 2012-03-25. Retrieved 2011-06-15.
  22. ↑ "The EU integrated approach to food safety". Archived from the original on 2011-03-19. Retrieved 2021-08-28.
  23. ↑ "Case Definition for diarrhoea and haemolytic uremic syndrome caused by O104:H4" (PDF). European Commission. 2011-06-03. Archived (PDF) from the original on 2011-06-17. Retrieved 2011-06-16.
  24. ↑ Bae, WK; Lee, YK; Cho, MS; et al. (June 30, 2006). "A case of haemolytic uremic syndrome caused by Escherichia coli O104:H4". Yonsei Medical Journal. 47 (3): 473–479. doi:10.3349/ymj.2006.47.3.437. PMC 2688167. PMID 16807997.
  25. ↑ 25.0 25.1 "Outbreak of Escherichia coli O104:H4 Infections Associated with Sprout Consumption — Europe and North America, May–July 2011". www.cdc.gov. Archived from the original on 18 January 2017. Retrieved 4 November 2024.
  26. ↑ Goldwater, Paul N.; Bettelheim, Karl A. (2 February 2012). "Treatment of enterohemorrhagic Escherichia coli (EHEC) infection and hemolytic uremic syndrome (HUS)". BMC Medicine. 10 (1): 12. doi:10.1186/1741-7015-10-12. ISSN 1741-7015.
  27. ↑ Coipan, Claudia E.; Friesema, Ingrid H.; Beld, Maaike J. C. van den; Bosch, Thijs; Schlager, Sabine; Voort, Menno van der; Frank, Christina; Lang, Christina; Fruth, Angelika; Franz, Eelco (2022). "Sporadic Occurrence of Enteroaggregative Shiga Toxin–Producing Escherichia coli O104:H4 Similar to 2011 Outbreak Strain - Volume 28, Number 9—September 2022 - Emerging Infectious Diseases journal - CDC". Emerging Infectious Diseases. 28 (9): 1890–1894. doi:10.3201/eid2809.220037. PMC 9423916. PMID 35997633. Archived from the original on 14 September 2024. Retrieved 3 November 2024.
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