Non-O157 Vero cytotoxin producing Escherichia coli: aetiological agents of diarrhoea in children in Dunedin, New Zealand

Prevalence of Shiga toxin-producing and enteropathogenic Escherichia coli marker genes in diarrhoeic stools in a New Zealand catchment area

BACKGROUND

Shiga toxin-producing (STEC) and enteropathogenic (EPEC) Escherichia coli are gastrointestinal pathogens causing diarrhoeal and extraintestinal disease. Due to lack of EPEC screening and use of Sorbitol-MacConkey (SMAC) agar in faecal screening, the true prevalence of EPEC and non-O157 STEC in New Zealand diarrhoeal cases is unknown.

METHODS

Diarrhoeic stools sourced from Dunedin hospital were pre-enriched, DNA extracted with Chelex-100 resin and screened using a multiplex TaqMan quantitative PCR assay amplifying stx1, sxt2 and EPEC (eae) gene markers.

RESULTS

Of the 522 diarrhoeic samples surveyed, 8 (1.53%) were PCR positive for stx1/stx2 and 23 (4.41%) were positive for eae. Six (75%) of the stx⁺ samples were uncommon non-O157 serotypes, and the remainder were found to be positive for both O103 and O157 STEC somatic antigens.

CONCLUSIONS

Results revealed shortcomings in current screening protocols for pathogenic E. coli; SMAC is not sufficiently discriminatory to detect emergent STEC serotypes and EPEC likely has an unappreciated role in cases of diarrhoea in New Zealand.

Multiplex real-time PCR and culture methods for detection of Shiga toxin-producing Escherichia coli and Salmonella Thompson in strawberries, a lettuce mix and basil

An appropriate approach of high throughput multi-screening was verified for Shiga toxin-producing Escherichia coli (STEC) and Salmonella spp. in strawberries, lettuce and basil. Sample replicates were inoculated with STEC O157 or O26 and Salmonella Thompson (ca. 10-70, 100-700 and 1000-7000 cfu/25 g) and analysed after 1 and 5 days of storage (strawberries and lettuce at 7 °C and basil at 10 °C). After 18-24 h of enrichment at 37 °C in buffered peptone water, detection was performed using the GeneDisc multiplex PCR (stx1, stx2, eae and iroB genes) and selective culture media for isolation of STEC (with immunomagnetic separation (IMS)) and Salmonella spp. in parallel. After 1 day, the pathogenic strains were recovered from all samples for all inoculum levels, whereas reduced detection rates of STEC O157 and S. Thompson were observed after 5 days of storage in case of strawberries, in particular for the lowest inoculums level, suggesting superior survival potential for STEC O26. Overall, this study indicates the ability of PCR based screening methods for reproducible multi-detection of low numbers (10-70 cfu/25 g) of STEC and Salmonella in this type of foods. However, for the basil samples, PCR needed twofold dilution of the DNA extract to overcome inhibition. It was noted that on several occasions growth of competitive microbiota obstructed finding presumptive colonies on the selective agar media, whereas the use of an additional agar medium such as CHROMagar STEC (without IMS) improved recovery rate of STEC.

Loss of vtx genes after the first subcultivation step of verocytotoxigenic Escherichia coli O157 and Non-O157 during isolation from naturally contaminated fecal samples

Verocytotoxins VT1 and VT2,produced by Verocytotoxigenic Escherichia coli (VTEC), are encoded on temperate bacteriophages. Several studies reported the loss of the vtx genes after multiple subcultivation steps or long preservation. The objective of this study was to determine if the loss of the verocytotoxin genes can already occur during the first subcultivation step. Consequently, the stability of the vtx genes were tested in 40 isolates originating from 40 vtx-positive fecal samples after the first subcultivation step following the isolation procedure. The loss occurred in 12 out of 40 strains tested and was rather rare among the O157 strains compared to the non-O157 strains. This is the first study demonstrating that the loss of the verocytotoxin genes can already occur after the first subcultivation step. This may lead to an underestimation of VTEC positive samples.

The non-O157 shiga-toxigenic (verocytotoxigenic) Escherichia coli; under-rated pathogens

Following a brief review of the ecology of Escherichia coli in general, the role of Shiga-Toxigenic (Verocytotoxigenic) E. coli (STEC) as pathogens is addressed. While STEC belonging to the serogroup O157 have been extensively studied and shown to be involved in many cases and outbreaks of human disease, the importance of STEC belonging to other serogroups has not been recognized as much. This review addresses the problems associated with these pathogens, demonstrating that increasing the awareness of them is a major part of the problem. This review then demonstrates how widespread isolations especially from food animals and human disease have been, discussing in particular STEC belonging to serogroups O8, O26, O103, O111, O113 and O128. The animal host-specificity of these STEC is also reviewed. In conclusion some methods of improving isolation of these pathogens is addressed.

Microbiological characterization of imported and domestic boneless beef trim used for ground beef

The United States imports lean boneless beef trim from Australia (AUS), New Zealand (NZL), and Uruguay (URY) to meet demand for ground beef production. The reported incidence of and etiological agents responsible for foodborne diseases differ between these countries and the United States. Our objective was to determine whether current U.S. microbiological profiling adequately addresses the potential differences between foreign and domestic beef trim. We compared the hygienic status of imported and domestic (USA) beef trim by enumeration of aerobic bacteria, Enterobacteriaceae, coliforms, Escherichia coli, and Staphylococcus aureus. We also compared the prevalence of pathogens between imported and domestic samples by screening for the presence of Salmonella, Campylobacter spp., Listeria spp., and non-O157 Shiga toxin-producing E. coli (STEC). A total of 1,186 samples (487 USA, 220 AUS, 223 NZL, and 256 URY) of boneless beef trim were analyzed. Results of enumeration revealed significant differences between samples from all countries, with the lowest pathogen numbers in samples from AUS and the highest in samples from URY. Six Salmonella isolates (1 NZL, 1 URY, and 4 USA), 79 L. monocytogenes isolates (4 AUS, 5 NZL, 53 URY, and 17 USA), and 7 Campylobacter isolates (1 NZL, 1 URY, 5 USA) were found among the trim samples tested. Non-O157 STEC prevalence was 10% in NZL samples and about 30% in all of the other samples; 99 STEC strains were isolated. Serotyping of these isolates revealed that serotypes associated with hemolytic uremic syndrome were not different in prevalence between imported and domestic beef trim. Although it may be tempting to do so, these data cannot be used to compare the microbiological quality of beef trim between the countries examined. However, these results indicate that the current pathogen monitoring procedures in the United States are adequate for evaluation of imported beef trim.

Screening of bacteria from the cattle gastrointestinal tract for inhibitory activity against enterohemorrhagic Escherichia coli O157:H7, O111:H-, and O26:H11

A quick and reproducible microgel plate assay was adapted to screen bacteria from cattle gastrointestinal tracts for production of compounds inhibitory to the growth of three enterohemorrhagic Escherichia coli (EHEC) serotypes: O157:H7, O111:H-, and O26:H11. The inhibitory activity of 309 bacteria, isolated on several agar media, was assessed by a microgel assay performed in 96-well microtiter plates. Fifty-three isolates secreted inhibitory compounds with a molecular weight of less than 1,000. In 12 isolates, the inhibitory activity was attributable to compounds other than lactic or acetic acid. These compounds were highly heat tolerant, with varying sensitivity to digestion by proteolytic enzymes. The inhibitory isolates were identified as lactic acid-producing bacteria on the basis of a combination of analyses, including 16S-rDNA restriction fragment length polymorphisms, 16S-rDNA gene sequences, and fermentation end products. The lactic acid bacteria of ruminants may contain antibacterial compounds not yet described. Naturally occurring populations of lactic acid bacteria may have potential as probiotics, to reduce the carriage of EHEC in the gastrointestinal tract of ruminants.

The emerging clinical importance of non-O157 Shiga toxin-producing Escherichia coli

In 1982, hemorrhagic colitis and hemolytic-uremic syndrome were linked to infection with Escherichia coli O157:H7, a serotype now classified as Shiga toxin-producing E. coli (STEC). Thereafter, hemorrhagic colitis and hemolytic-uremic syndrome associated with non-O157 STEC serogroups were reported, with the frequency of non-O157 STEC illness rivaling that of O157:H7 in certain geographic regions. In the United States, non-O157 E. coli may account for up to 20%-50% of all STEC infections. A high index of suspicion, paired with options to test for non-O157 STEC infection, are necessary for early recognition and appropriate treatment of these infections. Supportive care without the use of antibiotics is currently considered to be optimal treatment for all STEC infections. This commentary provides a perspective on the non-O157 STEC as human pathogens, how and when the clinician should approach the diagnosis of these organisms, and the challenges ahead.

Physiologic and molecular markers for detection of shiga toxin-producing Escherichia coli serotype O26 strains

Knowledge of physiologic/phenotypic and genetic variation of Escherichia coli O157 and its tight clonality was the basis for development of successful detection protocols for Shiga toxin-producing E. coli (STEC) O157:H7/H. Phenotypic and genetic characteristics of diarrheagenic E. coli O26 isolates from different geographical regions may differ as indicated by representative reports from all continents. In this review, we summarize current knowledge on STEC O26, a pathogen whose emergence predates that of other STEC, including O157:H7/H-. The overall objectives are to integrate information available from peer-reviewed literature on the clinical and public health significance of STEC O26 worldwide, and to highlight phenotypic and genetic markers that could be used for routine detection of this pathogen. Our ultimate goal is to render information that will allow quick, accurate, and specific detection of STEC O26 genotypic variants worldwide, so as to aid with control of this pathogen. The information herein will be invaluable to a variety of scientists that include epidemiologists and microbiologists (medical, veterinary, food, and environmental) with interest in STEC O26--a zoonotic and emerging foodborne pathogen.

The prevalence of Shiga toxin-producingEscherichia coliin cattle and sheep in the lower North Island, New Zealand

AIM

To genotype Escherichia coli cultured from the faeces of healthy cattle and sheep in the lower North Island, in order to investigate the possible role of ruminants as a reservoir for Shiga toxin-producing E. coli (STEC) in New Zealand.

METHODS

A total of 952 strains of E. coli were isolated on selective media, from faecal swabs from 319 animals (187 cattle and 132 sheep) from four sites in the Manawatu and Rangitikei regions of New Zealand. A multiplex polymerase chain reaction (PCR) was used to genotype the E. coli isolates, using amplification of Shiga toxin genes (stx1 and stx2) and the E. coli attaching and effacing gene (eae).

RESULTS

Isolates of E. coli were cultured from swabs from 178/187 (95.2%) cattle and all 132 (100%) sheep. Ninety-nine (10.4%) of the isolates were stx1 only, 83 (8.7%) stx2 only, 33 (3.5%) stx1 and stx2, 23 (2.4%) stx1 and eae, one (0.1%) stx2 and eae, and 115 (12.1%) were eae only. Overall, 51 (27.3%) cattle and 87 (65.9%) sheep were stx-positive, whereas 69 (36.9%) cattle and 36 (27.3%) sheep were eae-positive.

CONCLUSIONS

Both healthy cattle and sheep are asymptomatic reservoirs of STEC in New Zealand. Direct contact with cattle and sheep or consumption of water or foodstuffs contaminated with cattle of sheep faeces may represent a significant source of infection for humans.

Phenotypic and Genetic Markers for Serotype-Specific Detection of Shiga Toxin-ProducingEscherichia coliO26 Strains from North America

Phenotypic and genetic markers of Shiga toxin-producing Escherichia coli (STEC) O26 from North America were used to develop serotype-specific protocols for detection of this pathogen. Carbohydrate fermentation profiles and prevalence of gene sequences associated with STEC O26 (n = 20) were examined. Non-STEC O26 (n = 17), E. coli O157 (n = 20), E. coli O111 (n = 22), and generic E. coli (n = 21) were used as comparison strains. Effects of supplements: cefixime-tellurite, 4-methylumbelliferyl-beta-D-glucuronide (MUG) and chromogenic additives (5-bromo4-chloro-3-indolyl-beta-D-galactopyranoside (X-Gal), 5-bromo-4-chloro-3-indolyl-beta-D-glucuronide (X-GlcA) and o-nitrophenyl-beta-D-galactopyranoside (ONPG), added to isolation agar media were examined. Tests for presence of gene sequences encoding beta intimin (eae beta), Shiga toxin 1 and 2 (stx1 and stx2), H7 flagella (flicCh7), enterohemolysin (ehlyA), O26 somatic antigen (wzx), and high pathogenicity island genes (irp2 and fyuA) were conducted using multiplex polymerase chain reaction. Pulsed-field gel electrophoresis (PFGE) of XbaI restriction endonuclease genomic DNA digests was used to establish clonality among E. coli O26 strains. Of the 26 carbohydrates tested, only rhamnose had diagnostic value. Rhamnose non-fermenters included STEC O26 (100%), non-STEC O26 (40%), generic E. coli (29%), E. coli O111 (23%), and E. coli O157 (0%). Rhamnose non-fermenting colonies growing on Rhamnose-McConkey agar supplemented with X-GlcA, X-Gal, or ONPG, respectively, were blue, white, or faint yellow, whereas rhamnose-fermenters were red. Blue colonies from X-GlcA-containing media were the most well-defined and easiest to pick for further tests. All STEC O26 were MUG-fluorescent, while STEC O157 (n = 18) were non-fluorescent. E. coli O111 and generic E. coli strains were either MUG-positive or-negative. Serotype-specific detection of STEC O26 was achieved by selecting cefixime-tellurite-resistant, MUG-fluorescent, rhamnose-nonfermenting colonies, which carried stx1, eae beta, irp2, and wzx gene sequences. STEC O26 prevalence in dairy farm environmental samples determined using the developed isolation and genetic detection protocols was 4%. PFGE indicated the presence of one major cluster of E. coli O26 with 72-100% DNA fragment-length digest similarity among test strains. The serotype-specific detection methods described herein have potential for routine application in STEC O26 diagnosis.

Non-O157 verotoxin-producing Escherichia coli: a problem, paradox, and paradigm

The problems associated with identification and characterization of non-O157 verotoxin-producing Escherichia coli (VTEC) are discussed. The paradox of VTEC is that most reports of human illnesses are associated with serotypes such as O157:H7, O111:H- (nonmotile), O26:H11, and O113:H21, which are rarely found in domestic animals. However, those VTEC serotypes commonly found in domestic animals, especially ruminants, rarely cause human illnesses. When they cause human illnesses, the symptoms are similar to those caused by the serotypes E. coli O157:H7, O111:H-, O26:H11, and O113:H21. The impact of VTEC on human and animal health is also addressed. The VTEC and their toxicity are considered as a paradigm for emerging pathogens. The question on how such pathogens could arise from a basic commensal population is also addressed.

Serotypes of non-O157 verocytotoxigenic Escherichia coli isolated from meat in New Zealand

Verocytotoxigenic Escherichia coli (VTEC) were isolated from meat in New Zealand. They were tested for the presence of virulence factors associated with VTEC and serotyped. Some of the serotypes found were identical to ones reported from other parts of the world, but some serotypes were also found which had not been reported elsewhere. This study confirms the world-wide distribution of these emerging food-borne pathogens.

Role of non-O157 VTEC

Non-O157 VTEC are typical Escherichia coli that differ only in their ability to produce verocytotoxins (VT). The transmission of VTEC is discussed in relation to the transmission of commensal E. coli. The emergence over the last few decades of a great variety of VTEC serotypes from healthy and diseased humans and animals is described. Particular attention is given to the distribution of the more important serogroups pathogenic for humans that have been described from around the world, particularly serogroups O26, O111, O128 and O103. The possible role of ruminants as reservoirs is discussed. The problems of laboratory diagnosis of non-O157 VTEC are considered and various laboratory methods are assessed. Evidence is presented that the particular E. coli serotypes now known to be VTEC were present in humans and animals many years ago, but have acquired the ability to produce VT and probably other virulence factors. Finally, predictions are made of the possible increase in problems associated with these emerging pathogens.

Phenotypic and genotypic characterization of Escherichia coli verotoxin-producing isolates from humans and pigs

The aim of this study was to characterize verotoxin-producing Escherichia coli (VTEC) isolates obtained from humans and pigs in the same geographic areas and during the same period of time in order to determine whether porcine VTEC isolates could be related to human cases of diarrhea and also to detect the presence of virulence factors in these isolates. From 1,352 human and 620 porcine fecal samples, 11 human and 18 porcine verotoxin-positive isolates were obtained by the VT immunoblot or the individual colony testing technique. In addition, 52 porcine VTEC strains isolated from diseased pigs at the Faculté de médecine vétérinaire during the same period or from fecal samples collected previously isolated at slaughterhouses were characterized in this study. Antimicrobial resistance profiles were different between human and porcine isolates. In general, the serotypes observed in the two groups were different. No porcine isolate was of serotype O157:H7; however, one isolate was O91:NM, a serotype that has been associated with hemorrhagic colitis in humans. Also, one serotype (O8:H19) was found in isolates from both species; however, the O8:H19 isolates of the two groups were of different pathotypes. The pathotypes observed in the human and porcine isolates were different, with the exception of VT2vx-positive isolates; the serotypes of these isolates from the two groups were nevertheless different. Pulsed-field gel electrophoresis analysis indicated no relatedness between the human and porcine isolates. In conclusion, these results suggest that the porcine and human isolates of the present study were not genetically related. Most porcine VTEC isolates did not possess known virulence factors required to infect humans. However, certain non-O157:H7 porcine VTECs may potentially infect humans.

Simultaneous isolation of verotoxin-producing strains of Escherichia coli O128:H2 and viruses in gastroenteritis outbreaks

Three outbreaks of gastroenteritis from which the Verotoxin producing Escherichia coli serotype O128:H2 was isolated are reported. In addition Norwalk-like viruses were detected in patients from two of the outbreaks and astrovirus in the third outbreak. While it cannot be specifically determined which of these agents played the major role in these outbreaks, the findings suggest that the viral agents need to be considered in investigations of gastroenteritis outbreaks, regardless of whether bacterial enteropathogens have also been isolated. This study points to a strong need to investigate gastroenteritis outbreaks for both bacterial and viral agents and to review in detail the asymptomatic carriage rate of Verotoxin-producing bacteria and gastroenteritis-associated viral agents; these areas of public health significance have been largely neglected.

Occurrence and virulence factors of non-O157 Shiga toxin-producing Escherichia coli in retail meat in Dunedin, New Zealand

Retail raw meat was sampled for the presence of Shiga toxin-producing Escherichia coli (STEC) using enrichment culture and Vero cell assay. The STEC obtained were serotyped and tested for enterohaemolysin (Ehly) production and the eae gene. The presence of Shiga toxin genes (stx) was confirmed by polymerase chain reaction. A total of 18 STEC were isolated accounting for 12% of beef, 17% of lamb and 4% of pork samples. Five isolates produced Ehly but none possessed the eae gene. Five isolates were identified which possessed the stx2 gene and belonged to serotypes associated with severe infection.

Shiga Toxin-Producing Escherichia coli

Shiga toxin-producing Escherichia coli (STEC) are emerging as a significant source of foodborne infectious disease in the developed world. Multistate outbreaks of E. coli O157 and non-O157 serogroups in the United States are facilitated by the centralization of food processing and distribution. Our ability to recognize the clonality of these clusters has been advanced by developments in molecular detection techniques and in the establishment of active surveillance practices. These studies have helped identify important risk factors for both sporadic and outbreak STEC infection, allowing us to develop appropriate prevention strategies. Identification of these factors is of critical importance because of the lack of adequate treatments available. This brief review of the literature discusses major developments in the epidemiology, pathogenesis, diagnosis, treatment, and prevention of STEC disease published in the past few years.