1887

Abstract

Shiga toxin-producing (STEC) are foodborne pathogens that may cause diarrhoeal outbreaks and occasionally are associated with haemolytic-uraemic syndrome (HUS). We report on STEC O26:H11 associated with a cluster of four HUS cases in South Africa in 2017.

All case-patients were female and aged 5 years and under. Standard microbiological tests were performed for culture and identification of STEC from specimens (human stool and food samples). Further analysis of genomic DNA extracted from bacterial cultures and specimens included PCR for specific virulence genes, whole-genome sequencing and shotgun metagenomic sequencing.

. For 2/4 cases, stool specimens revealed STEC O26:H11 containing , and virulence genes. All food samples were found to be negative for STEC. No epidemiological links could be established between the HUS cases. Dried meat products were the leading food item suspected to be the vehicle of transmission for these cases, as 3/4 case-patients reported they had eaten this. However, testing of dried meat products could not confirm this.

. Since STEC infection does not always lead to severe symptoms, it is possible that many more cases were associated with this cluster and largely went unrecognized.

Loading

Article metrics loading...

/content/journal/acmi/10.1099/acmi.0.000061
2019-11-01
2020-01-25
Loading full text...

Full text loading...

/deliver/fulltext/acmi/1/9/acmi000061.html?itemId=/content/journal/acmi/10.1099/acmi.0.000061&mimeType=html&fmt=ahah

References

  1. Germinario C, Caprioli A, Giordano M, Chironna M, Gallone MS et al. Community-wide outbreak of haemolytic uraemic syndrome associated with Shiga toxin 2-producing Escherichia coli O26:H11 in southern Italy, summer 2013. Euro Surveill 2016;21: [CrossRef]
    [Google Scholar]
  2. Tahden M, Manitz J, Baumgardt K, Fell G, Kneib T et al. Epidemiological and Ecological Characterization of the EHEC O104:H4 Outbreak in Hamburg, Germany, 2011. PLoS One 2016;11:e0164508 [CrossRef]
    [Google Scholar]
  3. Luna-Gierke RE, Griffin PM, Gould LH, Herman K, Bopp CA et al. Outbreaks of non-O157 Shiga toxin-producing Escherichia coli infection: USA. Epidemiol Infect 2014;142:2270–2280 [CrossRef]
    [Google Scholar]
  4. Vygen-Bonnet S, Rosner B, Wilking H, Fruth A, Prager R et al. Ongoing haemolytic uraemic syndrome (HUS) outbreak caused by sorbitol-fermenting (SF) Shiga toxin-producing Escherichia coli (STEC) O157, Germany, December 2016 to May 2017. Euro Surveill2017:22
    [Google Scholar]
  5. Furukawa I, Suzuki M, Masaoka T, Nakajima N, Mitani E et al. Outbreak of Enterohemorrhagic Escherichia coli O157:H7 Infection Associated with Minced Meat Cutlets Consumption in Kanagawa, Japan. Jpn J Infect Dis 2018;71:436–441 [CrossRef]
    [Google Scholar]
  6. Wilson D, Dolan G, Aird H, Sorrell S, Dallman TJ et al. Farm-to-fork investigation of an outbreak of Shiga toxin-producing Escherichia coli O157. Microb Genom 2018;4: [CrossRef]
    [Google Scholar]
  7. Mikhail AFW, Jenkins C, Dallman TJ, Inns T, Douglas A et al. An outbreak of Shiga toxin-producing Escherichia coli O157:H7 associated with contaminated salad leaves: epidemiological, genomic and food trace back investigations. Epidemiol Infect 2018;146:187–196 [CrossRef]
    [Google Scholar]
  8. Sharapov UM, Wendel AM, Davis JP, Keene WE, Farrar J et al. Multistate Outbreak of Escherichia coli O157:H7 Infections Associated with Consumption of Fresh Spinach: United States, 2006. J Food Prot 2016;79:2024–2030 [CrossRef]
    [Google Scholar]
  9. Gardiner D, Gobin M, Verlander NQ, Oliver I, Hawker J. Use of an ingredient-based analysis to investigate a national outbreak of Escherichia coli O157, United Kingdom, July 2016. Euro Surveill2018:23
    [Google Scholar]
  10. Jaakkonen A, Salmenlinna S, Rimhanen-Finne R, Lundström H, Heinikainen S et al. Severe Outbreak of Sorbitol-Fermenting Escherichia coli O157 via Unpasteurized Milk and Farm Visits, Finland 2012. Zoonoses Public Health 2017;64:468–475 [CrossRef]
    [Google Scholar]
  11. Probert WS, Miller GM, Ledin KE. Contaminated Stream Water as Source for Escherichia coli O157 Illness in Children. Emerg Infect Dis 2017;23:1216–1218 [CrossRef]
    [Google Scholar]
  12. Mellor GE, Fegan N, Duffy LL, McMILLAN KE, Jordan D et al. National survey of Shiga toxin-producing Escherichia coli serotypes O26, O45, O103, O111, O121, O145, and O157 in Australian beef cattle feces. J Food Prot 2016;79:1868–1874 [CrossRef]
    [Google Scholar]
  13. Elder JR, Bugarel M, den Bakker HC, Loneragan GH, Nightingale KK. Interrogation of single nucleotide polymorphisms in gnd provides a novel method for molecular serogrouping of clinically important Shiga toxin producing Escherichia coli (STEC) targeted by regulation in the United States, including the "big six" non-O157 STEC and STEC O157. J Microbiol Methods 2016;129:85–93 [CrossRef]
    [Google Scholar]
  14. Moran-Gilad J, Rokney A, Danino D, Ferdous M, Alsana F et al. Real-time genomic investigation underlying the public health response to a Shiga toxin-producing Escherichia coli O26:H11 outbreak in a nursery. Epidemiol Infect 2017;145:2998–3006 [CrossRef]
    [Google Scholar]
  15. Peron E, Zaharia A, Zota LC, Severi E, Mardh O et al. Early findings in outbreak of haemolytic uraemic syndrome among young children caused by Shiga toxin-producing Escherichia coli, Romania, January to February 2016. Euro Surveill2016:21
    [Google Scholar]
  16. Browning NG, Botha JR, Sacho H, Moore PJ. Escherichia coli O157:H7 haemorrhagic colitis. Report of the first South African case. S Afr J Surg 1990;28:28–29
    [Google Scholar]
  17. Effler E, Isaäcson M, Arntzen L, Heenan R, Canter P et al. Factors contributing to the emergence of Escherichia coli O157 in Africa. Emerg Infect Dis 2001;7:812–819 [CrossRef]
    [Google Scholar]
  18. Isaäcson M, Canter PH, Effler P, Arntzen L, Bomans P et al. Haemorrhagic colitis epidemic in Africa. The Lancet 1993;341:961 [CrossRef]
    [Google Scholar]
  19. Smith AM, Tau NP, Sooka A, Keddy KH. Surveillance for enterohaemorrhagic Escherichia coli associated with human diarrhoea in South Africa, 2006-2009. J Med Microbiol 2011;60:681–683 [CrossRef]
    [Google Scholar]
  20. Kalule JB, Keddy KH, Nicol MP. Characterisation of STEC and other diarrheic E. coli isolated on CHROMaga STEC at a tertiary referral Hospital, Cape town. BMC Microbiol 2018;18:55 [CrossRef]
    [Google Scholar]
  21. Iweriebor BC, Iwu CJ, Obi LC, Nwodo UU, Okoh AI. Multiple antibiotic resistances among Shiga toxin producing Escherichia coli O157 in feces of dairy cattle farms in Eastern Cape of South Africa. BMC Microbiol 2015;15: [CrossRef]
    [Google Scholar]
  22. Iwu CJ, Iweriebor BC, Obi LC, Okoh AI. Occurrence of non-O157 Shiga toxin-producing Escherichia coli in two commercial swine farms in the Eastern Cape Province, South Africa. Comp Immunol Microbiol Infect Dis 2016;44:48–53 [CrossRef]
    [Google Scholar]
  23. Ateba CN, Mbewe M. Detection of Escherichia coli O157:H7 virulence genes in isolates from beef, pork, water, human and animal species in the northwest province, South Africa: public health implications. Res Microbiol 2011;162:240–248 [CrossRef]
    [Google Scholar]
  24. Plessis EMdu, Govender S, Pillay B, Korsten L. Exploratory study into the microbiological quality of spinach and cabbage purchased from street vendors and Retailers in Johannesburg, South Africa. J Food Prot 2017;80:1726–1733 [CrossRef]
    [Google Scholar]
  25. Jongman M, Korsten L. Genetic Diversity and Antibiotic Resistance of Escherichia coli Isolates from Different Leafy Green Production Systems. J Food Prot 2016;79:1846–1853 [CrossRef]
    [Google Scholar]
  26. Abong'o BO, Momba MNB, Mwambakana JN. Prevalence and antimicrobial susceptibility of Escherichia coli O157:H7 in vegetables sold in the Amathole District, Eastern Cape Province of South Africa. J Food Prot 2008;71:816–819 [CrossRef]
    [Google Scholar]
  27. Ojo OE, Ajuwape ATP, Otesile EB, Owoade AA, Oyekunle MA et al. Potentially zoonotic shiga toxin-producing Escherichia coli serogroups in the faeces and meat of food-producing animals in Ibadan, Nigeria. Int J Food Microbiol 2010;142:214–221 [CrossRef]
    [Google Scholar]
  28. Orskov I, Orskov F, Jann B, Jann K. Serology, chemistry, and genetics of O and K antigens of Escherichia coli. Bacteriol Rev 1977;41:667–710
    [Google Scholar]
  29. Tau NP, Meidany P, Smith AM, Sooka A, Keddy KH et al. Escherichia coli O104 associated with human diarrhea, South Africa, 2004-2011. Emerg Infect Dis 2012;18:1314–1317 [CrossRef]
    [Google Scholar]
  30. Naccache SN, Federman S, Veeraraghavan N, Zaharia M, Lee D et al. A cloud-compatible bioinformatics pipeline for ultrarapid pathogen identification from next-generation sequencing of clinical samples. Genome Res 2014;24:1180–1192 [CrossRef]
    [Google Scholar]
  31. Smith AM, Bosco KJ, Nicol MP, Kleynhans J, McCulloch M et al. Genome Sequence for Shiga Toxin-Producing Escherichia coli O26:H11, Associated with a Cluster of Hemolytic-Uremic Syndrome Cases in South Africa, 2017. Genome Announc 2017;5: [CrossRef]
    [Google Scholar]
  32. Croxen MA, Law RJ, Scholz R, Keeney KM, Wlodarska M et al. Recent advances in understanding enteric pathogenic Escherichia coli. Clin Microbiol Rev 2013;26:822–880 [CrossRef]
    [Google Scholar]
  33. Bielaszewska M, Friedrich AW, Aldick T, Schürk-Bulgrin R, Karch H. Shiga toxin activatable by intestinal mucus in Escherichia coli isolated from humans: predictor for a severe clinical outcome. Clin Infect Dis 2006;43:1160–1167 [CrossRef]
    [Google Scholar]
  34. Beutin L, Martin A. Outbreak of Shiga toxin-producing Escherichia coli (STEC) O104:H4 infection in Germany causes a paradigm shift with regard to human pathogenicity of STEC strains. J Food Prot 2012;75:408–418 [CrossRef]
    [Google Scholar]
  35. Fuller CA, Pellino CA, Flagler MJ, Strasser JE, Weiss AA. Shiga toxin subtypes display dramatic differences in potency. Infect Immun 2011;79:1329–1337 [CrossRef]
    [Google Scholar]
  36. Usein CR, Ciontea AS, Militaru CM, Condei M, Dinu S et al. Molecular characterisation of human Shiga toxin-producing Escherichia coli O26 strains: results of an outbreak investigation, Romania, February to August 2016. Euro Surveill2017:22
    [Google Scholar]
  37. Scavia G, Gianviti A, Labriola V, Chiani P, Maugliani A et al. A case of haemolytic uraemic syndrome (HUS) revealed an outbreak of Shiga toxin-2-producing Escherichia coli O26:H11 infection in a nursery, with long-lasting shedders and person-to-person transmission, Italy 2015. J Med Microbiol 2018;67:775–782 [CrossRef]
    [Google Scholar]
  38. Burfoot D, Everis L, Mulvey L. Literature review on microbiological hazards associated with biltong and similar dried meat products. https://www.food.gov.uk/sites/default/files/media/document/574-1-1007_B13015_Final_Report.pdf 15 February 2019
  39. Shale K, Malebo NJ. Quantification and antibiotic susceptibility profiles of Staphylococcus aureus and Bacillus cereus strains isolated from BILTONG. J Food Saf 2011;31:559–569 [CrossRef]
    [Google Scholar]
  40. Mhlambi SG, Naidoo K, Lindsay D. Enterotoxin-producing Staphylococcus strains associated with south african biltong at point of sale. J Food Saf 2010;30:307–317 [CrossRef]
    [Google Scholar]
  41. Conedera G, Mattiazzi E, Russo F, Chiesa E, Scorzato I et al. A family outbreak of Escherichia coli O157 haemorrhagic colitis caused by pork meat salami. Epidemiol Infect 2007;135:311–314 [CrossRef]
    [Google Scholar]
  42. Paton AW, Ratcliff RM, Doyle RM, Seymour-Murray J, Davos D et al. Molecular microbiological investigation of an outbreak of hemolytic-uremic syndrome caused by dry fermented sausage contaminated with Shiga-like toxin-producing Escherichia coli. J Clin Microbiol 1996;34:1622–1627
    [Google Scholar]
  43. Tilden J, Young W, McNamara AM, Custer C, Boesel B et al. A new route of transmission for Escherichia coli: infection from dry fermented salami. Am J Public Health 1996;86:1142–1145 [CrossRef]
    [Google Scholar]
  44. Keene WE, Sazie E, Kok J, Rice DH, Hancock DD et al. An outbreak of Escherichia coli O157:H7 infections traced to jerky made from deer meat. JAMA 1997;277:1229–1231 [CrossRef]
    [Google Scholar]
  45. Mindlin MJ, Lang N, Maguire H, Walsh B, Verlander NQ et al. Outbreak investigation and case-control study: penta-resistant Salmonella Typhimurium DT104 associated with biltong in London in 2008. Epidemiol Infect 2013;141:1920–1927 [CrossRef]
    [Google Scholar]
  46. Gossner CM, van Cauteren D, Le Hello S, Weill FX, Terrien E et al. Nationwide outbreak of Salmonella enterica serotype 4,[5],12:i:- infection associated with consumption of dried pork sausage, France, November to December 2011. Euro Surveill 2012;17:pii: 20071. [CrossRef]
    [Google Scholar]
  47. Arnedo-Pena A, Sabater-Vidal S, Herrera-León S, Bellido-Blasco JB, Silvestre-Silvestre E et al. An outbreak of monophasic and biphasic Salmonella Typhimurium, and Salmonella Derby associated with the consumption of dried pork sausage in Castellon (Spain). Enfermedades Infecciosas y Microbiología Clínica 2016;34:544–550 [CrossRef]
    [Google Scholar]
  48. Crespin FH, Eason B, Gorbitz K, Grass T. Outbreak of Salmonellosis associated with beef jerky - New Mexico, 1995. MMWR Morbid Mortal Weekly Report 1995;44:785–788
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/acmi/10.1099/acmi.0.000061
Loading
/content/journal/acmi/10.1099/acmi.0.000061
Loading

Data & Media loading...

Most cited articles

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error