1887

Abstract

This study investigated two foodborne outbreaks of gastroenteritis that occurred 10 days apart among individuals who had meals at the restaurant of a farm holiday resort. Mild gastrointestinal symptoms were reported and none of the patients needed hospitalization. Mean incubation times were 45 and 33 h, and the overall attack rates were 43.5 and 58.3 %, respectively. Stool sample examination was negative for common enteric pathogens in both outbreaks. Specimens from 13 people involved in the second outbreak and 3 restaurant staff were examined for diarrhoeagenic . An enteroaggregative (EAEC) strain of serotype O92 : H33 was isolated from six participants and one member of staff. In particular, the EAEC strain was isolated from five of the six cases of diarrhoea examined. The strain showed an aggregative pattern of adherence to HEp-2 cells, did not produce a biofilm and possessed the virulence-related genes , , and , but not the gene. A retrospective cohort study indicated a pecorino cheese made with unpasteurized sheep milk as the possible source (<0.001). Samples of the cheese had counts higher than 10 c.f.u. g, but the outbreak EAEC strain was not isolated. This report confirms that EAEC infections are probably underdiagnosed because of the limited availability of laboratories capable of identifying this group of pathogenic .

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2008-09-01
2024-04-25
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References

  1. Bisicchia R., Ciammarughi R., Caprioli A., Falbo V., Ruggeri F. M. 1985; Toxin production and haemagglutination in strains of Escherichia coli from diarrhoea in Brescia, Italy. J Hyg (Lond) 95:353–361 [CrossRef]
    [Google Scholar]
  2. Boudailliez B., Berquin P., Mariani-Kurkdjian P., Ilef D., Cuvelier B., Capek I., Tribout B., Bingen E., Piussan C. 1997; Possible person-to-person transmission of Escherichia coli O111 – associated hemolytic uremic syndrome. Pediatr Nephrol 11:36–39 [CrossRef]
    [Google Scholar]
  3. Busani L., Graziani C., Battisti A., Franco A., Ricci A., Vio D., Digiannatale E., Paterlini F., D'Incau M. other authors 2004; Antibiotic resistance in Salmonella enterica serotypes Typhimurium, Enteritidis and Infantis from human infections, foodstuffs and farm animals in Italy. Epidemiol Infect 132:245–251 [CrossRef]
    [Google Scholar]
  4. Caprioli A., Luzzi I., Rosmini F., Pasquini P., Cirrincione R., Gianviti A., Matteucci M. C., Rizzoni G. 1992; Hemolytic-uremic syndrome and verocytotoxin-producing Escherichia coli infection in Italy. J Infect Dis 166:154–158 [CrossRef]
    [Google Scholar]
  5. Cassar C. A., Ottaway M., Paiba G. A., Futter R., Newbould S., Woodward M. J. 2004; Absence of enteroaggregative Escherichia coli in farmed animals in Great Britain. Vet Rec 154:237–239 [CrossRef]
    [Google Scholar]
  6. Czeczulin J. R., Whittam T. S., Henderson I. R., Navarro-Garcia F., Nataro J. P. 1999; Phylogenetic analysis of enteroaggregative and diffusely adherent Escherichia coli . Infect Immun 67:2692–2699
    [Google Scholar]
  7. Dudley E. G., Thomson N. R., Parkhill J., Morin N. P., Nataro J. P. 2006; Proteomic and microarray characterization of the AggR regulon identifies a pheU pathogenicity island in enteroaggregative Escherichia coli . Mol Microbiol 61:1267–1282 [CrossRef]
    [Google Scholar]
  8. Fasano A., Noriega F. R., Maneval D. R. Jr, Chanasongcram S., Russell R., Guandalini S., Levine M. M. 1995; Shigella enterotoxin 1: an enterotoxin of Shigella flexneri 2a active in rabbit small intestine in vivo and in vitro . J Clin Invest 95:2853–2861 [CrossRef]
    [Google Scholar]
  9. Gomes T. A., Vieira M. A., Abe C. M., Rodrigues D., Griffin P. M., Ramos S. R. 1998; Adherence patterns and adherence-related DNA sequences in Escherichia coli isolates from children with and without diarrhoea in São Paulo city. J Clin Microbiol 36:3609–3613
    [Google Scholar]
  10. Huang D. B., Mohanty A., DuPont H. L., Okhuysen P. C., Chiang T. 2006; A review of an emerging enteric pathogen: enteroaggregative Escherichia coli . J Med Microbiol 55:1303–1311 [CrossRef]
    [Google Scholar]
  11. Huang D. B., Mohamed J. A., Nataro J. P., DuPont H. L., Jiang Z. D., Okhuysen P. C. 2007; Virulence characteristics and the molecular epidemiology of enteroaggregative Escherichia coli isolates from travellers to developing countries. J Med Microbiol 56:1386–1392 [CrossRef]
    [Google Scholar]
  12. ISO 2001; Microbiology of Food and Animal Feeding Stuffs – Horizontal Method for the Detection of Escherichia coli O157. ISO 16654, 2001 (Geneva: International Organization for Standardization;
    [Google Scholar]
  13. Itoh Y., Nagano I., Kunishima M., Ezaki T. 1997; Laboratory investigation of enteroaggregative Escherichia coli O untypeable : H10 associated with a massive outbreak of gastrointestinal illness. J Clin Microbiol 35:2546–2550
    [Google Scholar]
  14. Jenkins C., Tembo M., Chart H., Cheasty T., Willshaw G. A., Phillips A. D., Tompkins D., Smith H. 2006; Detection of enteroaggregative Escherichia coli in faecal samples from patients in the community with diarrhoea. J Med Microbiol 55:1493–1497 [CrossRef]
    [Google Scholar]
  15. Jiang Z. D., Greenberg D., Nataro J. P., Steffen R., DuPont H. L. 2002; Rate of occurrence and pathogenic effect of enteroaggregative Escherichia coli virulence factors in international travelers. J Clin Microbiol 40:4185–4190 [CrossRef]
    [Google Scholar]
  16. Mathewson J. J., Johnson P. C., DuPont H. L., Satterwhite T. K., Winsor D. K. 1986; Pathogenicity of enteroadherent Escherichia coli in adult volunteers. J Infect Dis 154:524–527 [CrossRef]
    [Google Scholar]
  17. Mohamed J. A., Huang D. B., Jiang Z. D., DuPont H. L., Nataro J. P., Belkind-Gerson J., Okhuysen P. C. 2007; Association of putative enteroaggregative Escherichia coli virulence genes and biofilm production in isolates from travelers to developing countries. J Clin Microbiol 45:121–126 [CrossRef]
    [Google Scholar]
  18. Morabito S., Karch H., Mariani-Kurkdjian P., Schmidt H., Minelli F., Bingen E., Caprioli A. 1998; Enteroaggregative, Shiga toxin-producing Escherichia coli O111 : H2 associated with an outbreak of hemolytic-uremic syndrome. J Clin Microbiol 36:840–842
    [Google Scholar]
  19. Morabito S., Dell'Omo G., Agrimi U., Schmidt H., Karch H., Cheasty T., Caprioli A. 2001; Detection and characterization of Shiga toxin-producing Escherichia coli in feral pigeons. Vet Microbiol 82:275–283 [CrossRef]
    [Google Scholar]
  20. Morelli R., Baldassarri L., Falbo V., Donelli G., Caprioli A. 1994; Detection of enteroadherent Escherichia coli associated with diarrhoea in Italy. J Med Microbiol 41:399–404 [CrossRef]
    [Google Scholar]
  21. Nataro J. P. 2005; Enteroaggregative Escherichia coli pathogenesis. Curr Opin Gastroenterol 21:4–8
    [Google Scholar]
  22. Nataro J. P., Kaper J. B. 1998; Diarrheagenic Escherichia coli . Clin Microbiol Rev 11:142–201
    [Google Scholar]
  23. Nataro J. P., Yikang D., Yingkang D., Walker K. 1994; AggR, a transcriptional activator of aggregative adherence fimbria I expression in enteroaggregative Escherichia coli . J Bacteriol 176:4691–4699
    [Google Scholar]
  24. Nataro J. P., Deng Y., Cookson S., Cravioto A., Savarino S. J., Guers L. D., Levine M. M., Tacket C. O. 1995; Heterogeneity of enteroaggregative Escherichia coli virulence demonstrated in volunteers. J Infect Dis 171:465–468 [CrossRef]
    [Google Scholar]
  25. Nishi J., Sheikh J., Mizuguchi K., Luisi B., Burland V., Boutin A., Rose D. J., Blattner F. R., Cataro J. P. 2003; The export of coat protein from enteroaggregative Escherichia coli by a specific ATP-binding cassette transporter system. J Biol Chem 278:45680–45689 [CrossRef]
    [Google Scholar]
  26. Pai M., Kang G., Ramakrishna B. S., Venkataraman A., Muliyil J. 1997; An epidemic of diarrhoea in South India caused by enteroaggregative Escherichia coli . Indian J Med Res 106:7–12
    [Google Scholar]
  27. Samie A., Obi C. L., Dillingham R., Pinkerton R. C., Guerrant R. L. 2007; Enteroaggregative Escherichia coli in Venda, South Africa: distribution of virulence-related genes by multiplex polymerase chain reaction in stool samples of human immunodeficiency virus (HIV)-positive and HIV-negative individuals and primary school children. Am J Trop Med Hyg 77:142–150
    [Google Scholar]
  28. Savarino S. J., Fasano A., Watson J., Martin B. M., Levine M. M., Guandalini S., Guerry P. 1993; Enteroaggregative Escherichia coli heat-stable enterotoxin 1 represents another subfamily of E. coli heat-stable toxin. Proc Natl Acad Sci U S A 90:3093–3097 [CrossRef]
    [Google Scholar]
  29. Schmidt H., Knop C., Franke S., Aleksic S., Heesemann J., Karch H. 1995; Development of PCR for screening of enteroaggregative Escherichia coli . J Clin Microbiol 33:701–705
    [Google Scholar]
  30. Sheikh J., Czeczulin J. R., Harrington S., Hicks S., Henderson I. R., Le Bouguénec C., Gounon P., Phillips A., Nataro J. P. 2002; A novel dispersin protein in enteroaggregative Escherichia coli . J Clin Invest 110:1329–1337 [CrossRef]
    [Google Scholar]
  31. Smith H. R., Cheasty T., Rowe B. 1997; Enteroaggregative Escherichia coli and outbreaks of gastroenteritis in UK. Lancet 350:814–815 [CrossRef]
    [Google Scholar]
  32. Tompkins D. S., Hudson M. J., Smith H. R., Eglin R. P., Wheeler J. G., Brett M. M., Owen R. J., Brazier J. S., Cumberland P. other authors 1999; A study of infectious intestinal disease in England: microbiological findings in cases and controls. Commun Dis Public Health 2:108–113
    [Google Scholar]
  33. Tzipori S., Montanaro J., Robins-Browne R. M., Vial P., Gibson R., Levine M. M. 1992; Studies with enteroaggregative Escherichia coli in the gnotobiotic piglet gastroenteritis model. Infect Immun 60:5302–5306
    [Google Scholar]
  34. Uber A. P., Trabulsi L. R., Irino K., Beutin L., Ghilardi A. C., Gomes T. A., Liberatore A. M., de Castro A. F., Elias W. P. 2006; Enteroaggregative Escherichia coli from humans and animals differ in major phenotypical traits and virulence genes. FEMS Microbiol Lett 256:251–257 [CrossRef]
    [Google Scholar]
  35. Vinjé J., Koopmans M. P. G. 1996; Molecular detection and epidemiology of small round-structured viruses in outbreaks of gastroenteritis in the Netherlands. J Infect Dis 174:610–615 [CrossRef]
    [Google Scholar]
  36. Weintraub A. 2007; Enteroaggregative Escherichia coli : epidemiology, virulence and detection. J Med Microbiol 56:4–8 [CrossRef]
    [Google Scholar]
  37. Wilson A., Evans J., Chart H., Cheasty T., Wheeler J. G., Tompkins D., Smith H. R. 2001; Characterisation of strains of enteroaggregative Escherichia coli isolated during the infectious intestinal disease study in England. Eur J Epidemiol 17:1125–1130 [CrossRef]
    [Google Scholar]
  38. Yatsuyanagi J., Saito S., Sato H., Miyajima Y., Amano K., Enomoto K. 2002; Characterization of enteropathogenic and enteroaggregative Escherichia coli isolated from diarrheal outbreaks. J Clin Microbiol 40:294–297 [CrossRef]
    [Google Scholar]
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