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Benedetti G, Boisen N, Prada JM. Editorial: One Health surveillance in practice: experiences of integration among human health, animal health, environmental health, and food safety sectors. Front Public Health 2024; 12:1384988. [PMID: 38496385 PMCID: PMC10940499 DOI: 10.3389/fpubh.2024.1384988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Guido Benedetti
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Nadia Boisen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Joaquin M. Prada
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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2
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Massinga AJ, Garrine M, Messa A, Nobela NA, Boisen N, Massora S, Cossa A, Varo R, Sitoe A, Hurtado JC, Ordi J, Mucavele H, Nhampossa T, Breiman RF, Whitney CG, Blau DM, Bassat Q, Mandomando I. Klebsiella spp. cause severe and fatal disease in Mozambican children: antimicrobial resistance profile and molecular characterization. BMC Infect Dis 2021; 21:526. [PMID: 34090384 PMCID: PMC8178901 DOI: 10.1186/s12879-021-06245-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/20/2021] [Indexed: 12/31/2022] Open
Abstract
Background Klebsiella spp. are important pathogens associated with bacteremia among admitted children and is among the leading cause of death in children < 5 years in postmortem studies, supporting a larger role than previously considered in childhood mortality. Herein, we compared the antimicrobial susceptibility, mechanisms of resistance, and the virulence profile of Klebsiella spp. from admitted and postmortem children. Methods Antimicrobial susceptibility and virulence factors of Klebsiella spp. recovered from blood samples collected upon admission to the hospital (n = 88) and postmortem blood (n = 23) from children < 5 years were assessed by disk diffusion and multiplex PCR. Results Klebsiella isolates from postmortem blood were likely to be ceftriaxone resistant (69.6%, 16/23 vs. 48.9%, 43/88, p = 0.045) or extended-spectrum β-lactamase (ESBL) producers (60.9%, 14/23 vs. 25%, 22/88, p = 0.001) compared to those from admitted children. blaCTX-M-15 was the most frequent ESBL gene: 65.3%, 9/14 in postmortem isolates and 22.7% (5/22) from admitted children. We found higher frequency of genes associated with hypermucoviscosity phenotype and invasin in postmortem isolates than those from admitted children: rmpA (30.4%; 7/23 vs. 9.1%, 8/88, p = 0.011), wzi-K1 (34.7%; 8/23 vs. 8%; 7/88, p = 0.002) and traT (60.8%; 14/23 vs. 10.2%; 9/88, p < 0.0001), respectively. Additionally, serine protease auto-transporters of Enterobacteriaceae were detected from 1.8% (pic) to 12.6% (pet) among all isolates. Klebsiella case fatality rate was 30.7% (23/75). Conclusion Multidrug resistant Klebsiella spp. harboring genes associated with hypermucoviscosity phenotype has emerged in Mozambique causing invasive fatal disease in children; highlighting the urgent need for prompt diagnosis, appropriate treatment and effective preventive measures for infection control. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06245-x.
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Affiliation(s)
| | - Marcelino Garrine
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), Lisbon, Portugal
| | - Augusto Messa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Nélio A Nobela
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Nadia Boisen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Sergio Massora
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Anélsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Rosauro Varo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - António Sitoe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Jaume Ordi
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Hélio Mucavele
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Mozambique
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | | | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique. .,Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Mozambique.
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3
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Leonard MF, Rodriguez-Villalobos H, Boisen N, Scheutz F, Laterre PF, Hantson P. The causal relationship between O2:K7:H6 extra-intestinal pathogenic Escherichia coli (ExPEC) and native valve endocarditis: a case report. BMC Infect Dis 2021; 21:370. [PMID: 33879083 PMCID: PMC8056695 DOI: 10.1186/s12879-021-06066-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background Native valves infective endocarditis due to Escherichia coli is still a rare disease and a particular virulence of some E.coli isolate may be suspected. Case presentation A 79-year-old woman presented during the post-operative period of an orthopedic surgery a urinary tract infection following obstructive ureteral lithiasis. E. coli was isolated from a pure culture of urine and blood sampled simultaneously. After evidence of sustained E.coli septicemia, further investigations revealed acute cholecystitis with the same micro-organism in biliary drainage and a native valve mitral endocarditis. E.coli was identified as O2:K7:H6, phylogenetic group B2, ST141, and presented several putative and proven virulence genes. The present isolate can be classified as both extra-intestinal pathogenic E.coli (ExPECJJ) and uropathogenic E. coli (UPECHM). Conclusions The relationship between the virulent factors present in ExPEC strains and some serotypes of E. coli that could facilitate the adherence to cardiac valves warrants further investigation.
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Affiliation(s)
| | - Hector Rodriguez-Villalobos
- Department of Microbiology, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Nadia Boisen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, The International Centre for Reference and Research on Escherichia and Klebsiella, Copenhagen, Denmark
| | - Flemming Scheutz
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, The International Centre for Reference and Research on Escherichia and Klebsiella, Copenhagen, Denmark
| | - Pierre-François Laterre
- Department of Intensive Care, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Philippe Hantson
- Department of Intensive Care, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium.
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4
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Boisen N, Østerlund MT, Joensen KG, Santiago AE, Mandomando I, Cravioto A, Chattaway MA, Gonyar LA, Overballe-Petersen S, Stine OC, Rasko DA, Scheutz F, Nataro JP. Redefining enteroaggregative Escherichia coli (EAEC): Genomic characterization of epidemiological EAEC strains. PLoS Negl Trop Dis 2020; 14:e0008613. [PMID: 32898134 PMCID: PMC7500659 DOI: 10.1371/journal.pntd.0008613] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/18/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022] Open
Abstract
Although enteroaggregative E. coli (EAEC) has been implicated as a common cause of diarrhea in multiple settings, neither its essential genomic nature nor its role as an enteric pathogen are fully understood. The current definition of this pathotype requires demonstration of cellular adherence; a working molecular definition encompasses E. coli which do not harbor the heat-stable or heat-labile toxins of enterotoxigenic E. coli (ETEC) and harbor the genes aaiC, aggR, and/or aatA. In an effort to improve the definition of this pathotype, we report the most definitive characterization of the pan-genome of EAEC to date, applying comparative genomics and functional characterization on a collection of 97 EAEC strains isolated in the course of a multicenter case-control diarrhea study (Global Enteric Multi-Center Study, GEMS). Genomic analysis revealed that the EAEC strains mapped to all phylogenomic groups of E. coli. Circa 70% of strains harbored one of the five described AAF variants; there were no additional AAF variants identified, and strains that lacked an identifiable AAF generally did not have an otherwise complete AggR regulon. An exception was strains that harbored an ETEC colonization factor (CF) CS22, like AAF a member of the chaperone-usher family of adhesins, but not phylogenetically related to the AAF family. Of all genes scored, sepA yielded the strongest association with diarrhea (P = 0.002) followed by the increased serum survival gene, iss (p = 0.026), and the outer membrane protease gene ompT (p = 0.046). Notably, the EAEC genomes harbored several genes characteristically associated with other E. coli pathotypes. Our data suggest that a molecular definition of EAEC could comprise E. coli strains harboring AggR and a complete AAF(I-V) or CS22 gene cluster. Further, it is possible that strains meeting this definition could be both enteric bacteria and urinary/systemic pathogens.
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Affiliation(s)
- Nadia Boisen
- Statens Serum Institut, Department of Bacteria, Parasites and Fungi, Copenhagen, Denmark
| | - Mark T. Østerlund
- Statens Serum Institut, Department of Bacteria, Parasites and Fungi, Copenhagen, Denmark
| | - Katrine G. Joensen
- Statens Serum Institut, Department of Bacteria, Parasites and Fungi, Copenhagen, Denmark
| | - Araceli E. Santiago
- University of Virginia School of Medicine, Department of Pediatrics, Charlottesville, Virginia, United States of America
| | - Inacio Mandomando
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Alejandro Cravioto
- Universidad Nacional Autónoma de México, Faculty of Medicine, Mexico City, Mexico
| | - Marie A. Chattaway
- Public Health England, Gastrointestinal Bacteria Reference Unit (GBRU), Colindale, United Kingdom
| | - Laura A. Gonyar
- University of Virginia School of Medicine, Department of Pediatrics, Charlottesville, Virginia, United States of America
| | | | - O. Colin Stine
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland, United States of America
| | - David A. Rasko
- University of Maryland School of Medicine, Institute for Genome Sciences, Department of Microbiology and Immunology, Baltimore, Maryland, United States of America
| | - Flemming Scheutz
- Statens Serum Institut, Department of Bacteria, Parasites and Fungi, Copenhagen, Denmark
| | - James P. Nataro
- University of Virginia School of Medicine, Department of Pediatrics, Charlottesville, Virginia, United States of America
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5
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Petro CD, Duncan JK, Seldina YI, Allué-Guardia A, Eppinger M, Riddle MS, Tribble DR, Johnson RC, Dalgard CL, Sukumar G, Connor P, Boisen N, Melton-Celsa AR. Genetic and Virulence Profiles of Enteroaggregative Escherichia coli (EAEC) Isolated From Deployed Military Personnel (DMP) With Travelers' Diarrhea. Front Cell Infect Microbiol 2020; 10:200. [PMID: 32509590 PMCID: PMC7251025 DOI: 10.3389/fcimb.2020.00200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/16/2020] [Indexed: 02/01/2023] Open
Abstract
To discern if there was a particular genotype associated with clinical enteroaggregative Escherichia coli (EAEC) strains isolated from deployed military personnel (DMP) with travelers' diarrhea (TD), we characterized a collection of EAEC from DMP deployed to Afghanistan, Djibouti, Kenya, or Honduras. Although we did not identify a specific EAEC genotype associated with TD in DMP, we found that EAEC isolated at the first clinic visit were more likely to encode the dispersin gene aap than EAEC collected at follow-up visits. A majority of the EAEC isolates were typical EAEC that adhered to HEp-2 cells, formed biofilms, and harbored genes for aggregative adherence fimbriae (AAF), AggR, and serine protease autotransporters of Enterobacteriaceae (SPATEs). A separate subset of the EAEC had aggR and genes for SPATEs but encoded a gene highly homologous to that for CS22, a fimbriae more commonly found in enterotoxigenic E. coli. None of these CS22-encoding EAEC formed biofilms in vitro or adhered to HEp-2 cells. Whole genome sequence and single nucleotide polymorphism analyses demonstrated that most of the strains were genetically diverse, but that a few were closely related. Isolation of these related strains occurred within days to more than a year apart, a finding that suggests a persistent source and genomic stability. In an ampicillin-treated mouse model we found that an agg4A+ aar- isolate formed a biofilm in the intestine and caused reduced weight gain in mice, whereas a strain that did not form an in vivo biofilm caused no morbidity. Our diverse strain collection from DMP displays the heterogeneity of EAEC strains isolated from human patients, and our mouse model of infection indicated the genotype agg4A+ aar– and/or capacity to form biofilm in vivo may correlate to disease severity.
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Affiliation(s)
- Courtney D Petro
- Department of Microbiology and Immunolgy, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Jeffrey K Duncan
- Department of Microbiology and Immunolgy, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Yuliya I Seldina
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Anna Allué-Guardia
- Department of Biology, The University of Texas at San Antonio, San Antonio, TX, United States.,South Texas Center for Emerging Infectious Diseases, San Antonio, TX, United States
| | - Mark Eppinger
- Department of Biology, The University of Texas at San Antonio, San Antonio, TX, United States.,South Texas Center for Emerging Infectious Diseases, San Antonio, TX, United States
| | - Mark S Riddle
- Department of Preventative Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - David R Tribble
- Department of Preventative Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Ryan C Johnson
- Department of Preventative Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Clifton L Dalgard
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.,The American Genome Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Gauthaman Sukumar
- The American Genome Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.,Collaborative Health Initiative Research Program, Henry Jackson Foundation, Bethesda, MD, United States
| | - Patrick Connor
- Military Enteric Disease Group, Academic Department of Military Medicine, Birmingham, United Kingdom
| | - Nadia Boisen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Angela R Melton-Celsa
- Department of Microbiology and Immunolgy, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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6
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Boisen N, Melton-Celsa AR, Hansen AM, Zangari T, Smith MA, Russo LM, Scheutz F, O'Brien AD, Nataro JP. The Role of the AggR Regulon in the Virulence of the Shiga Toxin-Producing Enteroaggregative Escherichia coli Epidemic O104:H4 Strain in Mice. Front Microbiol 2019; 10:1824. [PMID: 31456767 PMCID: PMC6700298 DOI: 10.3389/fmicb.2019.01824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/24/2019] [Indexed: 12/04/2022] Open
Abstract
An O104:H4 Shiga toxin (Stx)-producing enteroaggregative Escherichia coli (EAEC) strain caused a large outbreak of bloody diarrhea and the hemolytic uremic syndrome in 2011. We previously developed an ampicillin (Amp)-treated C57BL/6 mouse model to measure morbidity (weight loss) and mortality of mice orally infected with the prototype Stx-EAEC strain C227-11. Here, we hypothesized that mice fed C227-11 cured of the pAA plasmid or deleted for individual genes on that plasmid would display reduced virulence compared to animals given the wild-type (wt) strain. C227-11 cured of the pAA plasmid or deleted for the known pAA-encoded virulence genes aggR, aggA, sepA, or aar were fed to Amp-treated C57BL/6 mice at doses of 1010–1011CFU. Infected animals were then either monitored for morbidity and lethality for 28 days or euthanized to determine intestinal pathology and colonization levels at selected times. The pAA-cured, aggR, and aggA mutants of strain C227-11 all showed reduced colonization at various intestinal sites. However, the aggR mutant was the only mutant attenuated for virulence as it showed both reduced morbidity and mortality. The aar mutant showed increased expression of the aggregative adherence fimbriae (AAF) and caused greater systemic effects in infected mice when compared to the C227-11 wt strain. However, unexpectedly, both the aggA and aar mutants displayed increased weight loss compared to wt. The sepA mutant did not exhibit altered morbidity or mortality in the Amp-treated mouse model compared to wt. Our data suggest that the increased morbidity due to the aar mutant could possibly be via an effect on expression of an as yet unknown virulence-associated factor under AggR control.
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Affiliation(s)
- Nadia Boisen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.,Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Angela R Melton-Celsa
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Anne-Marie Hansen
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Tonia Zangari
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Mark A Smith
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Lisa M Russo
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Flemming Scheutz
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Alison D O'Brien
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - James P Nataro
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States.,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
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7
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Ikumapayi UN, Boisen N, Hossain MJ, Betts M, Lamin M, Saha D, Kwambana-Adams B, Dione M, Adegbola RA, Roca A, Nataro JP, Antonio M. Identification of Subsets of Enteroaggregative Escherichia coli Associated with Diarrheal Disease among Under 5 Years of Age Children from Rural Gambia. Am J Trop Med Hyg 2017; 97:997-1004. [PMID: 28820687 PMCID: PMC5637583 DOI: 10.4269/ajtmh.16-0705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Enteroaggregative Escherichia coli (EAEC) cause acute and persistent diarrhea, mostly in children worldwide. Outbreaks of diarrhea caused by EAEC have been described, including a large outbreak caused by a Shiga toxin expressing strain. This study investigated the association of EAEC virulence factors with diarrhea in children less than 5 years. We characterized 428 EAEC strains isolated from stool samples obtained from moderate-to-severe diarrhea cases (157) and healthy controls (217) children aged 0–59 months recruited over 3 years as part of the Global Enteric Multicenter Study (GEMS) in The Gambia. Four sets of multiplex polymerase chain reaction were applied to detect 21 EAEC-virulence genes from confirmed EAEC strains that target pCVD432 (aatA) and AAIC (aaiC). In addition, Kirby-Bauer disc diffusion antimicrobial susceptibility testing was performed on 88 EAEC strains following Clinical Laboratory Standard Institute guidelines. We observed that the plasmid-encoded enterotoxin [odds ratio (OR): 6.9, 95% confidence interval (CI): 2.06–29.20, P < 0.001], aggregative adherence fimbriae/I fimbriae (aggA) [OR: 2.2, 95% CI: 1.16–4.29, P = 0.008], and hexosyltransferase (capU) [OR: 1.9, 95% CI 1.02–3.51, P = 0.028] were associated with moderate-to-severe diarrhea among children < 12 months old but not in the older age strata (> 12 months). Our data suggest that some EAEC-virulent factors have age-specific associations with moderate-to-severe diarrhea in infants. Furthermore, our study showed that 85% and 72% of EAEC strains tested were resistant to sulphamethoxazole-trimethoprim and ampicillin, respectively. Sulphamethoxazole-trimethoprim and ampicillin are among the first-line antibiotics used for the treatment of diarrhea in The Gambia.
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Affiliation(s)
- Usman N Ikumapayi
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia.,Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Nadia Boisen
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Mohammad J Hossain
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Modupeh Betts
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Modou Lamin
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Debasish Saha
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Brenda Kwambana-Adams
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Michel Dione
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Richard A Adegbola
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Anna Roca
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - James P Nataro
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia.,Centre for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland
| | - Martin Antonio
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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8
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Hebbelstrup Jensen B, Poulsen A, Hebbelstrup Rye Rasmussen S, Struve C, Engberg JH, Friis-Møller A, Boisen N, Jønsson R, Petersen RF, Petersen AM, Krogfelt KA. Genetic Virulence Profile of Enteroaggregative Escherichia coli Strains Isolated from Danish Children with Either Acute or Persistent Diarrhea. Front Cell Infect Microbiol 2017; 7:230. [PMID: 28611957 PMCID: PMC5447714 DOI: 10.3389/fcimb.2017.00230] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 05/17/2017] [Indexed: 11/13/2022] Open
Abstract
Enteroaggregative Escherichia coli (EAEC) is frequently found in diarrheal stools worldwide. It has been associated with persistent diarrhea, weight loss, and failure to thrive in children living in developing countries. A number of important EAEC virulence genes are identified; however, their roles in acute and persistent diarrhea have not been previously investigated. The aim of this study was to identify specific EAEC virulence genes associated with duration and type of diarrhea in Danish children. We aimed to improve the current diagnostics of EAEC and enable targeting of strains with an expected severe disease course. Questionnaires answered by parents provided information regarding duration of diarrhea and presence of blood or mucus. A total of 295 EAEC strains were collected from children with acute (≤7 days) and persistent diarrhea (≥14 days) and were compared by using multiplex PCR targeting the genes sat, sepA, pic, sigA, pet, astA, aatA, aggR, aaiC, aap, agg3/4C, ORF3, aafA, aggA, agg3A, agg4A, and agg5A. Furthermore, the distribution of EAEC genes in strains collected from cases of bloody, mucoid, and watery diarrhea was investigated. The classification and regression tree analysis (CART) was applied to investigate the relationship between EAEC virulence genes and diarrheal duration and type. Persistent diarrhea was associated with strains lacking the pic gene (p = 0.002) and with the combination of the genes pic, sat, and absence of the aggA gene (p = 0.05). Prolonged diarrhea was associated with the combination of the genes aatA and astA (p = 0.03). Non-mucoid diarrhea was associated with strains lacking the aatA gene (p = 0.004). Acute diarrhea was associated with the genes aggR, aap, and aggA by individual odds ratios. Resistance toward gentamicin and ciprofloxacin was observed in 7.5 and 3% of strains, respectively. Multi-drug resistance was observed in 38% of strains. Genetic host factors have been associated with an increased risk of EAEC-associated disease. Therefore, we investigated a panel of risk factors in two groups of children—EAEC-positive and EAEC-negative—to identify additional factors predisposing to disease. The duration of breastfeeding was positively correlated with the likelihood of belonging to the EAEC-negative group of children.
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Affiliation(s)
| | - Anja Poulsen
- Department of Gastroenterology, Copenhagen University Hospital HvidovreCopenhagen, Denmark
| | | | - Carsten Struve
- Department of Bacteria, Parasites and Fungi, Statens Serum InstitutCopenhagen, Denmark
| | - Jørgen H Engberg
- Department of Clinical Microbiology, Slagelse HospitalSlagelse, Denmark
| | - Alice Friis-Møller
- Department of Clinical Microbiology, Copenhagen University Hospital HvidovreCopenhagen, Denmark
| | - Nadia Boisen
- Department of Bacteria, Parasites and Fungi, Statens Serum InstitutCopenhagen, Denmark
| | - Rie Jønsson
- Department of Bacteria, Parasites and Fungi, Statens Serum InstitutCopenhagen, Denmark
| | - Randi F Petersen
- Department of Bacteria, Parasites and Fungi, Statens Serum InstitutCopenhagen, Denmark
| | - Andreas M Petersen
- Department of Bacteria, Parasites and Fungi, Statens Serum InstitutCopenhagen, Denmark.,Department of Gastroenterology, Copenhagen University Hospital HvidovreCopenhagen, Denmark.,Department of Clinical Microbiology, Copenhagen University Hospital HvidovreCopenhagen, Denmark
| | - Karen A Krogfelt
- Department of Bacteria, Parasites and Fungi, Statens Serum InstitutCopenhagen, Denmark
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9
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Jønsson R, Struve C, Boll EJ, Boisen N, Joensen KG, Sørensen CA, Jensen BH, Scheutz F, Jenssen H, Krogfelt KA. A Novel pAA Virulence Plasmid Encoding Toxins and Two Distinct Variants of the Fimbriae of Enteroaggregative Escherichia coli. Front Microbiol 2017; 8:263. [PMID: 28275371 PMCID: PMC5320562 DOI: 10.3389/fmicb.2017.00263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/07/2017] [Indexed: 11/29/2022] Open
Abstract
Enteroaggregative Escherichia coli (EAEC) is an increasingly recognized pathogen associated with acute and persistent diarrhea worldwide. While EAEC strains are considered highly heterogeneous, aggregative adherence fimbriae (AAFs) are thought to play a pivotal role in pathogenicity by facilitating adherence to the intestinal mucosa. In this study, we optimized an existing multiplex PCR to target all known AAF variants, which are distinguished by differences in their pilin subunits. We applied the assay on a collection of 162 clinical Danish EAEC strains and interestingly found six, by SNP analysis phylogenetically distinct, strains harboring the major pilin subunits from both AAF/III and AAF/V. Whole-genome and plasmid sequencing revealed that in these six strains the agg3A and agg5A genes were located on a novel pAA plasmid variant. Moreover, the plasmid also encoded several other virulence genes including some not previously found on pAA plasmids. Thus, this plasmid endows the host strains with a remarkably high number of EAEC associated virulence genes hereby likely promoting strain pathogenicity.
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Affiliation(s)
- Rie Jønsson
- Department of Science and Environment, Roskilde UniversityRoskilde, Denmark; Department of Microbiology and Infection Control, Statens Serum InstitutCopenhagen, Denmark
| | - Carsten Struve
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
| | - Erik J Boll
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
| | - Nadia Boisen
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
| | - Katrine G Joensen
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
| | - Camilla A Sørensen
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
| | - Betina H Jensen
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
| | - Flemming Scheutz
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
| | - Håvard Jenssen
- Department of Science and Environment, Roskilde University Roskilde, Denmark
| | - Karen A Krogfelt
- Department of Microbiology and Infection Control, Statens Serum Institut Copenhagen, Denmark
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10
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Hebbelstrup Jensen B, Stensvold CR, Struve C, Olsen KEP, Scheutz F, Boisen N, Röser D, Andreassen BU, Nielsen HV, Schønning K, Petersen AM, Krogfelt KA. Enteroaggregative Escherichia coli in Daycare-A 1-Year Dynamic Cohort Study. Front Cell Infect Microbiol 2016; 6:75. [PMID: 27468409 PMCID: PMC4942469 DOI: 10.3389/fcimb.2016.00075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 06/29/2016] [Indexed: 12/24/2022] Open
Abstract
Enteroaggregative Escherichia coli (EAEC) has been associated with persistent diarrhea, reduced growth acceleration, and failure to thrive in children living in developing countries and with childhood diarrhea in general in industrialized countries. The clinical implications of an EAEC carrier-status in children in industrialized countries warrants clarification. To investigate the pathological significance of an EAEC carrier-state in the industrialized countries, we designed a 1-year dynamic cohort study and performed follow-up every second month, where the study participants submitted a stool sample and answered a questionnaire regarding gastrointestinal symptoms and exposures. Exposures included foreign travel, consumption of antibiotics, and contact with a diseased animal. In the capital area of Denmark, a total of 179 children aged 0–6 years were followed in a cohort study, in the period between 2009 and 2013. This is the first investigation of the incidence and pathological significance of EAEC in Danish children attending daycare facilities. Conventional microbiological detection of enteric pathogens was performed at Statens Serum Institute, Copenhagen, Denmark, and at Hvidovre Hospital, Copenhagen, Denmark. Parents completed questionnaires regarding gastrointestinal symptoms. The EAEC strains were further characterized by serotyping, phylogenetic analysis, and susceptibility testing. EAEC was detected in 25 (14%) of the children during the observational period of 1 year. One or more gastrointestinal symptoms were reported from 56% of the EAEC-positive children. Diarrhea was reported in six (24%) of the EAEC positive children, but no cases of weight loss, and general failure to thrive were observed. The EAEC strains detected comprised a large number of different serotypes, confirming the genetic heterogeneity of this pathotype. EAEC was highly prevalent (n = 25, 14%) in Danish children in daycare centers and was accompanied by gastrointestinal symptoms in 56% of the infected children. No serotype or phylogenetic group was specifically linked to children with disease.
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Affiliation(s)
| | - Christen R Stensvold
- Department of Microbiology and Infection Control, Statens Serum Institute Copenhagen, Denmark
| | - Carsten Struve
- Department of Microbiology and Infection Control, Statens Serum Institute Copenhagen, Denmark
| | - Katharina E P Olsen
- Department of Microbiology and Infection Control, Statens Serum Institute Copenhagen, Denmark
| | - Flemming Scheutz
- Department of Microbiology and Infection Control, Statens Serum Institute Copenhagen, Denmark
| | - Nadia Boisen
- Department of Microbiology and Infection Control, Statens Serum Institute Copenhagen, Denmark
| | - Dennis Röser
- Department of Microbiology and Infection Control, Statens Serum InstituteCopenhagen, Denmark; Department of Pediatrics, Copenhagen University Hospital HvidovreCopenhagen, Denmark
| | - Bente U Andreassen
- Department of Pediatrics, H.C. Andersen's Hospital, University of Odense Odense, Denmark
| | - Henrik V Nielsen
- Department of Microbiology and Infection Control, Statens Serum Institute Copenhagen, Denmark
| | - Kristian Schønning
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre Copenhagen, Denmark
| | - Andreas M Petersen
- Department of Microbiology and Infection Control, Statens Serum InstituteCopenhagen, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital HvidovreCopenhagen, Denmark; Department of Gastroenterology, Copenhagen University Hospital HvidovreCopenhagen, Denmark
| | - Karen A Krogfelt
- Department of Microbiology and Infection Control, Statens Serum Institute Copenhagen, Denmark
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11
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Abstract
In 2011, a Shiga toxin (Stx) type 2a-producing enteroaggregative E. coli (EAEC) strain of serotype O104:H4 caused a large lethal outbreak in Northern Europe. Until recently, the pathogenic mechanisms explaining the high virulence of the strain have remained unclear. Our laboratories have shown that EAEC genes encoded on the pAA virulence plasmid, particularly the AggR-regulated AAF/I fimbriae, enhance inflammation and enable the outbreak strain to both adhere to epithelial cells and translocate Stx2a across the intestinal epithelium, possibly explaining the high incidence of the life threatening post-diarrheal sequelae of hemolytic uremic syndrome. Epidemiologic evidence supports a model of EAEC pathogenesis comprising the concerted action of multiple virulence factors along with induction of inflammation. Here, we suggest a model for the pathogenesis of the O104:H4 outbreak strain that includes contributions from EAEC alone, but incorporating additional injury induced by Stx2a.
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Affiliation(s)
- Nadia Boisen
- Statens Serum Institut; Department of Microbiology and Clinical Control; Copenhagen, Denmark,Correspondence to: Nadia Boisen;
| | - Angela R Melton-Celsa
- Statens Serum Institut; Department of Microbiology and Clinical Control; Copenhagen, Denmark
| | - Flemming Scheutz
- Statens Serum Institut; Department of Microbiology and Clinical Control; Copenhagen, Denmark
| | - Alison D O'Brien
- Department of Microbiology and Immunology; Uniformed Services University of the Health Sciences; Bethesda, MD USA
| | - James P Nataro
- Department of Pediatrics; University of Virginia School of Medicine; Charlottesville, VA USA
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12
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Abstract
Diarrhea causes substantial morbidity and mortality in children in low-income countries. Although numerous pathogens cause diarrhea, the etiology of many episodes remains unknown. Serratia marcescens is incriminated in hospital-associated infections, and HIV/AIDS associated diarrhea. We have recently found that Serratia spp. may be found more commonly in the stools of patients with diarrhea than in asymptomatic control children. We therefore investigated the possible enteric pathogenicity of S. marcescens in vitro employing a polarized human colonic epithelial cell (T84) monolayer. Infected monolayers were assayed for bacterial invasion, transepithelial electrical resistance (TEER), cytotoxicity, interleukin-8 (IL-8) release and morphological changes by scanning electron microscopy. We observed significantly greater epithelial cell invasion by S. marcescens compared to Escherichia coli strain HS (p = 0.0038 respectively). Cell invasion was accompanied by reduction in TEER and secretion of IL-8. Lactate dehydrogenase (LDH) extracellular concentration rapidly increased within a few hours of exposure of the monolayer to S. marcescens. Scanning electron microscopy of S. marcescens-infected monolayers demonstrated destruction of microvilli and vacuolization. Our results suggest that S. marcescens interacts with intestinal epithelial cells in culture and induces dramatic alterations similar to those produced by known enteric pathogens.
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Affiliation(s)
- John B Ochieng
- Department of Pediatrics; University of Virginia School of Medicine; Charlottesville, VA USA,Kenya Medical Research Institute/Centers for Disease Control and Prevention (KEMRI/CDC); Kisumu, Kenya,Department of Biomedical Science and Technology; Maseno University; Maseno, Kenya
| | - Nadia Boisen
- Department of Pediatrics; University of Virginia School of Medicine; Charlottesville, VA USA
| | - Brianna Lindsay
- Department of Epidemiology and Public Health; University of Maryland School of Medicine; Baltimore, MD USA
| | - Araceli Santiago
- Department of Pediatrics; University of Virginia School of Medicine; Charlottesville, VA USA
| | - Collins Ouma
- Department of Biomedical Science and Technology; Maseno University; Maseno, Kenya
| | - Maurice Ombok
- Kenya Medical Research Institute/Centers for Disease Control and Prevention (KEMRI/CDC); Kisumu, Kenya
| | - Barry Fields
- Global Disease Detection Division; Centers for Disease Control and Prevention; Nairobi, Kenya
| | - O Colin Stine
- Department of Epidemiology and Public Health; University of Maryland School of Medicine; Baltimore, MD USA
| | - James P Nataro
- Department of Pediatrics; University of Virginia School of Medicine; Charlottesville, VA USA,Correspondence to: James P Nataro;
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13
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Boisen N, Hansen AM, Melton-Celsa AR, Zangari T, Mortensen NP, Kaper JB, O'Brien AD, Nataro JP. The presence of the pAA plasmid in the German O104:H4 Shiga toxin type 2a (Stx2a)-producing enteroaggregative Escherichia coli strain promotes the translocation of Stx2a across an epithelial cell monolayer. J Infect Dis 2014; 210:1909-19. [PMID: 25038258 DOI: 10.1093/infdis/jiu399] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A Shiga toxin type 2a (Stx2a)-producing enteroaggregative Escherichia coli (EAEC) strain of serotype O104:H4 caused a large outbreak in 2011 in northern Europe. Pathogenic mechanisms for this strain are unclear. We hypothesized that EAEC genes encoded on the pAA virulence plasmid promoted the translocation of Stx2a across the intestinal mucosa. METHODS We investigated the potential contribution of pAA by using mutants of Stx-EAEC strain C227-11, either cured of the pAA plasmid or deleted for individual known pAA-encoded virulence genes (ie, aggR, aggA, and sepA). The resulting mutants were tested for their ability to induce interleukin 8 (IL-8) secretion and translocation of Stx2a across a polarized colonic epithelial (T84 cell) monolayer. RESULTS We found that deletion of aggR or aggA significantly reduced bacterial adherence and (independently) translocation of Stx2a across the T84-cell monolayer. Moreover, deletion of aggR, aggA, sepA, or the Stx2a-encoding phage from C227-11 resulted in reduced secretion of IL-8 from the infected monolayer. CONCLUSIONS Our data suggest that the AggR-regulated aggregative adherence fimbriae I enhance inflammation and enable the outbreak strain to both adhere to epithelial cells and translocate Stx2a across the intestinal epithelium.
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Affiliation(s)
- Nadia Boisen
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | - Anne-Marie Hansen
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore
| | - Angela R Melton-Celsa
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Tonia Zangari
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Ninell Pollas Mortensen
- Technology for Industry and the Environment, Discovery-Science-Technology, RTI International, Research Triangle Park, North Carolina Biological and Nanoscale Systems, BioSciences Division, Oak Ridge National Laboratory, Tennessee
| | - James B Kaper
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore
| | - Alison D O'Brien
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - James P Nataro
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
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14
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In J, Lukyanenko V, Foulke-Abel J, Hubbard AL, Delannoy M, Hansen AM, Kaper JB, Boisen N, Nataro JP, Zhu C, Boedeker EC, Girón JA, Kovbasnjuk O. Serine protease EspP from enterohemorrhagic Escherichia coli is sufficient to induce shiga toxin macropinocytosis in intestinal epithelium. PLoS One 2013; 8:e69196. [PMID: 23874912 PMCID: PMC3715455 DOI: 10.1371/journal.pone.0069196] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 06/05/2013] [Indexed: 12/14/2022] Open
Abstract
Life-threatening intestinal and systemic effects of the Shiga toxins produced by enterohemorrhagic Escherichia coli (EHEC) require toxin uptake and transcytosis across intestinal epithelial cells. We have recently demonstrated that EHEC infection of intestinal epithelial cells stimulates toxin macropinocytosis, an actin-dependent endocytic pathway. Host actin rearrangement necessary for EHEC attachment to enterocytes is mediated by the type 3 secretion system which functions as a molecular syringe to translocate bacterial effector proteins directly into host cells. Actin-dependent EHEC attachment also requires the outer membrane protein intimin, a major EHEC adhesin. Here, we investigate the role of type 3 secretion in actin turnover occurring during toxin macropinocytosis. Toxin macropinocytosis is independent of EHEC type 3 secretion and intimin attachment. EHEC soluble factors are sufficient to stimulate macropinocytosis and deliver toxin into enterocytes in vitro and in vivo; intact bacteria are not required. Intimin-negative enteroaggregative Escherichia coli (EAEC) O104:H4 robustly stimulate Shiga toxin macropinocytosis into intestinal epithelial cells. The apical macropinosomes formed in intestinal epithelial cells move through the cells and release their cargo at these cells' basolateral sides. Further analysis of EHEC secreted proteins shows that a serine protease EspP alone is able to stimulate host actin remodeling and toxin macropinocytosis. The observation that soluble factors, possibly serine proteases including EspP, from each of two genetically distinct toxin-producing strains, can stimulate Shiga toxin macropinocytosis and transcellular transcytosis alters current ideas concerning mechanisms whereby Shiga toxin interacts with human enterocytes. Mechanisms important for this macropinocytic pathway could suggest new potential therapeutic targets for Shiga toxin-induced disease.
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Affiliation(s)
- Julie In
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Valeriy Lukyanenko
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jennifer Foulke-Abel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Ann L. Hubbard
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Michael Delannoy
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Anne-Marie Hansen
- Department of Microbiology & Immunology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - James B. Kaper
- Department of Microbiology & Immunology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Nadia Boisen
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - James P. Nataro
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Chengru Zhu
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Edgar C. Boedeker
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Jorge A. Girón
- Department of Molecular Genetics and Microbiology, Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Olga Kovbasnjuk
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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15
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Lima IFN, Boisen N, Silva JDQ, Havt A, de Carvalho EB, Soares AM, Lima NL, Mota RMS, Nataro JP, Guerrant RL, Lima AÂM. Prevalence of enteroaggregative Escherichia coli and its virulence-related genes in a case-control study among children from north-eastern Brazil. J Med Microbiol 2013; 62:683-693. [PMID: 23429698 DOI: 10.1099/jmm.0.054262-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Enteroaggregative Escherichia coli (EAEC) is an important agent that causes endemic and epidemic diarrhoeal diseases worldwide. Several EAEC virulence-related genes (VRGs) have been described but their role in the clinical outcome of infection is not completely defined. This study investigated the prevalence of EAEC and potential associations of its VRGs with risk of or protection from diarrhoeal diseases in children from urban communities in north-eastern Brazil. The case-control study included 166 children, who had their stools evaluated for the EAEC diagnostic genes (aaiC and aatA) using PCR. Positive samples were further analysed by multiplex PCR and identified 18 VRGs. EAEC was found in the same proportion in both groups (41%). The plasmid-borne gene encoding a hexosyltransferase homologue (capU) was the most frequently detected (89.6%), followed by dispersin protein (aap, 58.2%) and EAEC HilA homologue (eilA, 57.8%). The AAF/III fimbrial subunit (agg3A) gene was observed at lower frequency (1.5%). Plasmid-encoded toxin (pet) or AAF/II fimbrial subunit (aafA) was associated significantly with disease. AAF/IV fimbrial subunit (agg4A) or hypothetical plasmid-encoded haemolysin (orf61) was detected significantly more in controls than in children with diarrhoea. In addition, one set of genes in combination, aaiC and agg3/4C but lacking agg4A and orf61, was associated with diarrhoea cases; and another one, orf61 in the absence of pet and aafA, was correlated with control children. These data confirm a high prevalence, endemicity and heterogeneity of EAEC strains in the developing urban areas of north-eastern Brazil. Statistical correlation between cases and controls was seen with either isolated or combined sets of genes, suggesting that the pathophysiology of EAEC infection involves a complex and dynamic modulation of several VRGs.
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Affiliation(s)
- Ila Fernanda Nunes Lima
- Institute of Biomedicine for Brazilian Semi-Arid and Clinical Research Unit/Center for Global Health, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Nadia Boisen
- Center for Global Health, Division of Infectious Diseases and International Health, Departments of Medicine and Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | | | - Alexandre Havt
- Institute of Biomedicine for Brazilian Semi-Arid and Clinical Research Unit/Center for Global Health, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Eunice Bobo de Carvalho
- Institute of Biomedicine for Brazilian Semi-Arid and Clinical Research Unit/Center for Global Health, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Alberto Melo Soares
- Institute of Biomedicine for Brazilian Semi-Arid and Clinical Research Unit/Center for Global Health, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Noélia Leal Lima
- Institute of Biomedicine for Brazilian Semi-Arid and Clinical Research Unit/Center for Global Health, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Rosa Maria Salani Mota
- Departament of Statistics and Applied Mathematics, Science Center, Federal University of Ceara, Fortaleza, CE, Brazil
| | - James P Nataro
- Center for Global Health, Division of Infectious Diseases and International Health, Departments of Medicine and Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Richard Littleton Guerrant
- Center for Global Health, Division of Infectious Diseases and International Health, Departments of Medicine and Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA.,Institute of Biomedicine for Brazilian Semi-Arid and Clinical Research Unit/Center for Global Health, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Aldo Ângelo Moreira Lima
- Center for Global Health, Division of Infectious Diseases and International Health, Departments of Medicine and Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA.,Institute of Biomedicine for Brazilian Semi-Arid and Clinical Research Unit/Center for Global Health, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
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16
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Boisen N, Scheutz F, Rasko DA, Redman JC, Persson S, Simon J, Kotloff KL, Levine MM, Sow S, Tamboura B, Toure A, Malle D, Panchalingam S, Krogfelt KA, Nataro JP. Genomic characterization of enteroaggregative Escherichia coli from children in Mali. J Infect Dis 2011; 205:431-44. [PMID: 22184729 PMCID: PMC3256949 DOI: 10.1093/infdis/jir757] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background. Enteroaggregative Escherichia coli (EAEC) is a cause of epidemic and sporadic diarrhea, yet its role as an enteric pathogen is not fully understood. Methods. We characterized 121 EAEC strains isolated in 2008 as part of a case-control study of moderate to severe acute diarrhea among children 0–59 months of age in Bamako, Mali. We applied multiplex polymerase chain reaction and comparative genome hybridization to identify potential virulence factors among the EAEC strains, coupled with classification and regression tree modeling to reveal combinations of factors most strongly associated with illness. Results. The gene encoding the autotransporter protease SepA, originally described in Shigella species, was most strongly associated with diarrhea among the EAEC strains tested (odds ratio, 5.6 [95% confidence interval, 1.92–16.17]; P = .0006). In addition, we identified 3 gene combinations correlated with diarrhea: (1) a clonal group positive for sepA and a putative hemolysin; (2) a group harboring the EAST-1 enterotoxin and the flagellar type H33 but no other previously identified EAEC virulence factor; and (3) a group carrying several of the typical EAEC virulence genes. Conclusion. Our data suggest that only a subset of EAEC strains are pathogenic in Mali and suggest that sepA may serve as a valuable marker for the most virulent isolates.
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Affiliation(s)
- Nadia Boisen
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
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17
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Mortensen NP, Schiellerup P, Boisen N, Klein BM, Locht H, Abuoun M, Newell D, Krogfelt KA. The role of Campylobacter jejuni cytolethal distending toxin in gastroenteritis: toxin detection, antibody production, and clinical outcome. APMIS 2011; 119:626-34. [PMID: 21851421 DOI: 10.1111/j.1600-0463.2011.02781.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The role of Campylobacter jejuni cytolethal distending toxin (CDT) on clinical outcome after gastroenteritis was investigated. Clinical data, blood serum samples, and Campylobacter spp. isolated, from each of 30 patients were collected over a period of 6 months. The CDT encoding genes, cdtABC, characterized by PCR, revealed that all but one of the C. jejuni strains had the wild-type sequence. Sequencing of cdtABC from this strain showed two major deletions. From all of the strains, CDT titers were determined, and toxin neutralizing antibodies were documented using an in vitro assay. Three of the thirty clinical isolates, including the one with the mutant cdtABC coding genes, did not have a detectable CDT activity. Analyzing the relationship between CDT titer, serum neutralization of CDT, and the clinical outcome showed that campylobacteriosis caused by CDT-negative strains was clinically indistinguishable from that of patients infected with an isolate that produced high levels of CDT. These results suggest that CDT does not solely determine severity of infection and clinical outcome.
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Affiliation(s)
- Ninell P Mortensen
- Department of Microbial Research and Surveillance, Statens Serum Institut, Denmark
| | - Peter Schiellerup
- Department of Microbial Research and Surveillance, Statens Serum Institut, Denmark
| | - Nadia Boisen
- Department of Microbial Research and Surveillance, Statens Serum Institut, Denmark
| | | | - Henning Locht
- Department of Autoimmunology and Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Manal Abuoun
- Veterinary Laboratories Agency (Weybridge), New Haw, Addlestone, Surrey, UK
| | - Diane Newell
- Veterinary Laboratories Agency (Weybridge), New Haw, Addlestone, Surrey, UK
| | - Karen A Krogfelt
- Department of Microbial Research and Surveillance, Statens Serum Institut, Denmark
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18
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Rasko DA, Webster DR, Sahl JW, Bashir A, Boisen N, Scheutz F, Paxinos EE, Sebra R, Chin CS, Iliopoulos D, Klammer A, Peluso P, Lee L, Kislyuk AO, Bullard J, Kasarskis A, Wang S, Eid J, Rank D, Redman JC, Steyert SR, Frimodt-Møller J, Struve C, Petersen AM, Krogfelt KA, Nataro JP, Schadt EE, Waldor MK. Origins of the E. coli strain causing an outbreak of hemolytic-uremic syndrome in Germany. N Engl J Med 2011; 365:709-17. [PMID: 21793740 PMCID: PMC3168948 DOI: 10.1056/nejmoa1106920] [Citation(s) in RCA: 588] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND A large outbreak of diarrhea and the hemolytic-uremic syndrome caused by an unusual serotype of Shiga-toxin-producing Escherichia coli (O104:H4) began in Germany in May 2011. As of July 22, a large number of cases of diarrhea caused by Shiga-toxin-producing E. coli have been reported--3167 without the hemolytic-uremic syndrome (16 deaths) and 908 with the hemolytic-uremic syndrome (34 deaths)--indicating that this strain is notably more virulent than most of the Shiga-toxin-producing E. coli strains. Preliminary genetic characterization of the outbreak strain suggested that, unlike most of these strains, it should be classified within the enteroaggregative pathotype of E. coli. METHODS We used third-generation, single-molecule, real-time DNA sequencing to determine the complete genome sequence of the German outbreak strain, as well as the genome sequences of seven diarrhea-associated enteroaggregative E. coli serotype O104:H4 strains from Africa and four enteroaggregative E. coli reference strains belonging to other serotypes. Genomewide comparisons were performed with the use of these enteroaggregative E. coli genomes, as well as those of 40 previously sequenced E. coli isolates. RESULTS The enteroaggregative E. coli O104:H4 strains are closely related and form a distinct clade among E. coli and enteroaggregative E. coli strains. However, the genome of the German outbreak strain can be distinguished from those of other O104:H4 strains because it contains a prophage encoding Shiga toxin 2 and a distinct set of additional virulence and antibiotic-resistance factors. CONCLUSIONS Our findings suggest that horizontal genetic exchange allowed for the emergence of the highly virulent Shiga-toxin-producing enteroaggregative E. coli O104:H4 strain that caused the German outbreak. More broadly, these findings highlight the way in which the plasticity of bacterial genomes facilitates the emergence of new pathogens.
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Affiliation(s)
- David A Rasko
- University of Maryland School of Medicine, Institute for Genome Sciences and Department of Microbiology, Baltimore, USA
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Scheutz F, Nielsen EM, Frimodt-Møller J, Boisen N, Morabito S, Tozzoli R, Nataro JP, Caprioli A. Characteristics of the enteroaggregative Shiga toxin/verotoxin-producing Escherichia coli O104:H4 strain causing the outbreak of haemolytic uraemic syndrome in Germany, May to June 2011. ACTA ACUST UNITED AC 2011; 16. [PMID: 21699770 DOI: 10.2807/ese.16.24.19889-en] [Citation(s) in RCA: 181] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Escherichia coli strain causing a large outbreak of haemolytic uraemic syndrome and bloody diarrhoea in Germany in May and June 2011 possesses an unusual combination of pathogenic features typical of enteroaggregative E. coli together with the capacity to produce Shiga toxin. Through rapid national and international exchange of information and strains the known occurrence in humans was quickly assessed.We describe simple diagnostic screening tools to detect the outbreak strain in clinical specimens and a novel real-time PCR for its detection in foods.
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Affiliation(s)
- F Scheutz
- World Health Organization Collaborating Centre for Reference and Research on Escherichia and Klebsiella, Department of Microbiological Surveillance and Research, Copenhagen, Denmark.
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Boisen N, Ruiz-Perez F, Scheutz F, Krogfelt KA, Nataro JP. Short report: high prevalence of serine protease autotransporter cytotoxins among strains of enteroaggregative Escherichia coli. Am J Trop Med Hyg 2009; 80:294-301. [PMID: 19190229 PMCID: PMC2660206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Enteroaggregative Escherichia coli (EAEC) pathogenesis is thought to comprise intestinal colonization followed by the release of enterotoxins and cytotoxins. Here, we use a polymerase chain reaction (PCR) to determine the prevalence of 10 genes encoding serine protease autotransporter toxins (SPATEs) in a collection of clinical EAEC isolates. Eighty-six percent of EAEC strains harbored genes encoding one or more class I cytotoxic SPATE proteins (Pet, Sat, EspP, or SigA). Two Class II, non-cytotoxic, SPATE genes were found among EAEC strains: pic and sepA, each originally described in Shigella flexneri 2a. Using a multiplex PCR for five SPATE genes (pet, sat, sigA, pic, and sepA), we found that most of the Shigella isolates also harbored more than one SPATE, whereas members of most other E. coli pathotypes rarely harbored a cytotoxic SPATE gene. SPATEs may be relevant to the pathogenesis of both EAEC and Shigella spp.
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Affiliation(s)
- Nadia Boisen
- Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark
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Boisen N, Nataro JP, Scheutz F, Krogfelt KA, Ruiz-Perez F. High Prevalence of Serine Protease Autotransporter Cytotoxins among Strains of Enteroaggregative Escherichia coli. Am J Trop Med Hyg 2009. [DOI: 10.4269/ajtmh.2009.80.294] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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