We have investigated 677 Shiga toxin-producing Escherichia coli (STEC) strains from humans to determine their serotypes, virulence genes, and clinical signs in patients. Six different Shiga toxin types (1, 1c, 2, 2c, 2d, and 2e) were distributed in the STEC strains. Intimin (eae) genes were present in 62.6% of the strains and subtyped into intimins ␣1, ␤1, ␥1, , , and . Shiga toxin types 1c and 2d were present only in eae-negative STEC strains, and type 2 was significantly (P < 0.001) more frequent in eae-positive STEC strains. Enterohemorrhagic E. coli hemolysin was associated with 96.2% of the eae-positive strains and with 65.2% of the eae-negative strains. Clinical signs in the patients were abdominal pain (8.7%), nonbloody diarrhea (59.2%), bloody diarrhea (14.3%), and hemolytic-uremic syndrome (HUS) (3.5%), and 14.3% of the patients had no signs of gastrointestinal disease or HUS. Infections with eae-positive STEC were significantly (P < 0.001) more frequent in children under 6 years of age than in other age groups, whereas eae-negative STEC infections dominated in adults. We identified 41 STEC strains belonging to 31 serotypes which had not previously been described as human STEC. Twenty-six of these were positive for intimins ␣1 (one serotype), ␤1 (eight serotypes), (two serotypes), and (three serotypes). Our study indicates that different types of STEC strains predominate in infant and adult patients and that new types of STEC strains are present among human isolates.The association of Shiga (Vero) toxin production in Escherichia coli with human pathogenicity was first described in 1979 (82, 85). However, it was the investigation of an outbreak caused by Shiga toxin-producing E. coli (STEC) O157 which provided the major impetus to study these pathogens (65). In the following years, STEC strains were increasingly isolated from humans with diarrhea and hemolytic-uremic syndrome (HUS) and from farm animals, which serve as a natural reservoir for STEC (52,86). Today, more than 200 different E. coli O:H serotypes are known to be associated with the production of Shiga toxins (86; K. A. Bettelheim's VTEC table, May 2003 update, www.sciencenet.com.au/vtectable.htm). Certain STEC strains belonging to serogroups O26, O103, O111, O145, and O157 were more frequently isolated from humans with severe diseases such as hemorrhagic colitis and HUS. Accordingly, these highly virulent STEC strains were also designated as enterohemorrhagic E. coli (EHEC) (42, 52). The search for additional virulence markers in these pathogens revealed that most EHEC strains carry a plasmid which encodes a hemolysin (EHEC hemolysin) and the chromosomally located locus of enterocyte effacement (LEE) pathogenicity island (16,43,70,84). The genes carried by the LEE enable the bacteria to produce attaching and effacing lesions in the host intestinal mucosa cells, which increases the virulence of the bacteria for humans (35,44,60). Intimate attachment of bacteria to the host cell is mediated by the binding of intimin, the product of the eae gene...

We examined 219 Shiga toxin-producing Escherichia coli (STEC) strains from meat, milk, and cheese samples collected in Germany between 2005 and 2006. All strains were investigated for their serotypes and for genetic variants of Shiga toxins 1 and 2 (Stx1 and Stx2). stx 1 or variant genes were detected in 88 (40.2%) strains and stx 2 and variants in 177 (80.8%) strains. Typing of stx genes was performed by stx-specific PCRs and by analysis of restriction fragment length polymorphisms (RFLP) of PCR products. Major genotypes of the Stx1 (stx 1 , stx 1c , and stx 1d ) and the Stx2 (stx 2 , stx 2d , stx 2-O118 , stx 2e , and stx 2g ) families were detected, and multiple types of stx genes coexisted frequently in STEC strains. Only 1.8% of the STEC strains from food belonged to the classical enterohemorrhagic E. coli (EHEC) types O26:H11, O103:H2, and O157:H7, and only 5.0% of the STEC strains from food were positive for the eae gene, which is a virulence trait of classical EHEC. In contrast, 95 (43.4%) of the food-borne STEC strains carried stx 2 and/or mucus-activatable stx 2d genes, an indicator for potential high virulence of STEC for humans. Most of these strains belonged to serotypes associated with severe illness in humans, such as O22:H8, O91:H21, O113:H21, O174:H2, and O174:H21. stx 2 and stx 2d STEC strains were found frequently in milk and beef products. Other stx types were associated more frequently with pork (stx 2e ), lamb, and wildlife meat (stx 1c ). The combination of serotyping and stx genotyping was found useful for identification and for assignment of food-borne STEC to groups with potential lower and higher levels of virulence for humans.

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Shiga toxin 2e (Stx2e)-producing strains from food (n ‫؍‬ 36), slaughtered pigs (n ‫؍‬ 25), the environment (n ‫؍‬ 21), diseased pigs (n ‫؍‬ 19), and humans (n ‫؍‬ 9) were investigated for production of Stx2e by enzymelinked immunosorbent assay, for virulence markers by PCR, and for their serotypes to evaluate their role as potential human pathogens. Stx2e production was low in 64% of all 110 strains. Stx2e production was inducible by mitomycin C but differed considerably between strains. Analysis by nucleotide sequencing and transcription of stx 2e genes in high-and low-Stx2e-producing strains showed that toxin production correlated with transcription rates of stx 2e genes. DNA sequences specific for the int, Q, dam, and S genes of the stx 2e bacteriophage P27 were found in 109 strains, indicating cryptic P27-like prophages, although 102 of these were not complete for all genes tested. Genes encoding intimin (eae), enterohemorrhagic Escherichia coli hemolysin (ehx), or other stx 1 or stx 2 variants were not found, whereas genes for heat-stable enterotoxins STI, STII, or EAST1 were present in 54.5% of the strains. Seven major serotypes that were associated with diseased pigs (O138:H14, O139:H1, and O141:H4) or with slaughter pigs, food, and the environment (O8:H4, O8:H9, O100:H30, and O101:H9) accounted for 60% of all Stx2e strains. The human Stx2e isolates did not belong to these major serotypes of Stx2e strains, and high production of Stx2e in human strains was not related to diarrheal disease. The results from this study and other studies do not point to Stx2e as a pathogenicity factor for diarrhea and hemolytic uremic syndrome in humans.

Aims:  To evaluate the suitability of the commercially distributed Ridascreen® Verotoxin enzyme immunoassay (EIA) for detection of known genetic types of the Vero (Shiga) toxins 1 (Stx1) and 2 (Stx2) families and to determine its relative sensitivity and specificity. Methods and Results:  The Ridascreen‐EIA was compared with the Vero cell assay, a P1‐glycoprotein receptor EIA and with stx gene‐specific PCs for detection of Stx with 43 Shiga toxin‐producing strains of Escherichia coli (STEC) reference strains and with 241 test strains. The Ridascreen‐EIA detects strains producing Stx1 and variants Stx1c and Stx1d, as well as Stx2 and variants Stx2d1, Stx2d2, Stx2e, Stx2d, Stx2‐O118 (Stx2d‐ount), Stx2‐NV206, Stx2f and Stx2g. The assay showed a relative sensitivity of 95·7% and a relative specificity of 98·7%. Some of the Stx2‐O118‐, Stx2e‐ and Stx2g‐producing STEC were not detected with the Ridascreen‐EIA probably because of low amount of toxin produced by these strains. Conclusions:  The Ridascreen‐EIA is able to detect all known types of Stx and is applicable for routine screening of bacterial isolates owing to its high specificity. It is less applicable for testing samples where low amounts of Stx are expected, such as mixed cultures and certain Stx2 variants. Significance and Impact of the Study:  This study presents a first comprehensive evaluation of the Ridascreen‐EIA, a rapid standardized STEC screening test for routine diagnostic laboratories. Data are presented on the type of the spectrum of Stx that are detected with this immunoassay and its advantages and limits for practical use.

Twenty-three Escherichia coli O26 strains from humans, cattle, sheep, pigs and chicken were investigated for virulence markers and for genetic similarity by pulsed field gel electrophoresis and multi locus sequence typing. Two groups of genetically closely related O26 strains were defined. One group is formed by enteropathogenic (EPEC) and enterohemorrhagic (EHEC) E. coli strains, which do not ferment rhamnose and dulcitol and most of these carry a plasmid encoding enterohemolysin. The other group consists of rhamnose and dulcitol fermenting EPEC strains, which carry plasmids encoding alpha-hemolysin. Multiple species of domestic animals were shown to serve as a reservoir for human pathogenic O26 EPEC and EHEC strains.

A total of 140 Shiga toxin-producing Escherichia coli (STEC) strains from wildlife meat (deer, wild boar, and hare) isolated in Germany between 1998 and 2006 were characterized with respect to their serotypes and virulence markers associated with human pathogenicity. The strains grouped into 38 serotypes, but eight O groups (21, 146, 128, 113, 22, 88, 6, and 91) and four H types (21, 28, 2, and 8) accounted for 71.4% and 75.7% of all STEC strains from game, respectively. Eighteen of the serotypes, including enterohemorrhagic E. coli (EHEC) O26:[H11] and O103:H2, were previously found to be associated with human illness. Genes linked to high-level virulence for humans (stx 2 , stx 2d , and eae) were present in 46 (32.8%) STEC strains from game. Fifty-four STEC isolates from game belonged to serotypes which are frequently found in human patients (O103:H2, O26:H11, O113:H21, O91:H21, O128:H2, O146:H21, and O146:H28). These 54 STEC isolates were compared with 101 STEC isolates belonging to the same serotypes isolated from farm animals, from their food products, and from human patients. Within a given serotype, most STEC strains were similar with respect to their stx genotypes and other virulence attributes, regardless of origin. The 155 STEC strains were analyzed for genetic similarity by XbaI pulsed-field gel electrophoresis. O103:H2, O26:H11, O113:H21, O128:H2, and O146:H28 STEC isolates from game were 85 to 100% similar to STEC isolates of the same strains from human patients. By multilocus sequence typing, game EHEC O103:H2 strains were attributed to a clonal lineage associated with hemorrhagic diseases in humans. The results from our study indicate that game animals represent a reservoir for and a potential source of human pathogenic STEC and EHEC strains.Shiga toxin-producing Escherichia coli (STEC) strains represent an important emerging group of food-borne zoonotic pathogens causing diarrhea, hemorrhagic colitis (HC), and the life-threatening hemolytic uremic syndrome (HUS) in humans (30). Production of potent cytotoxins, which are called Shiga toxins (Stx) or Vero toxins (VT) and are encoded on the genomes of temperate lambdoid bacteriophages, is the major virulence determinant of STEC strains. Additional virulence factors, such as genes encoding the attaching and effacing function and virulence plasmid-encoding genes, contribute to the pathogenicity of STEC strains. These virulence genes are closely associated with a subgroup of STEC strains that are frequently isolated from patients with hemorrhagic diseases (HC and HUS) and were therefore designated enterohemorrhagic E. coli (EHEC) strains. Strains belonging to serogroups O157, O26, O103, O111, and O145 are the EHEC types most frequently isolated from humans with HC and HUS (33).STEC strains are part of the gut flora of different animal species, and ruminants, particularly cattle, have been identified as a major reservoir of STEC strains that are highly virulent to humans (27). Today, it is evident that STEC strains can be transmitted from their animal r...

Enterohemorrhagic Escherichia coli (EHEC) O157:H7 and enteropathogenic E. coli (EPEC) trigger actin polymerization at the site of bacterial adhesion by inducing different signaling pathways. Actin assembly by EPEC requires tyrosine phosphorylation of Tir, which subsequently binds the host adaptor protein Nck. In contrast, Tir EHEC O157 is not tyrosine phosphorylated and instead of Nck utilizes the bacterially encoded Tir-cytoskeleton coupling protein (TccP)/EspF U , which mimics the function of Nck. tccP is carried on prophage CP-933U/Sp14 (TccP). Typical isolates of EHEC O157:H7 harbor a pseudo-tccP gene that is carried on prophage CP-933 M/Sp4 (tccP2). Here we report that atypical, ␤-glucuronidase-positive and sorbitol-fermenting, strains of EHEC O157 harbor intact tccP and tccP2 genes, both of which are secreted by the LEE-encoded type III secretion system. Non-O157 EHEC strains, including O26, O103, O111, and O145, are typically tccP negative and translocate a Tir protein that encompasses an Nck binding site. Unexpectedly, we found that most clinical non-O157 EHEC isolates carry a functional tccP2 gene that encodes a secreted protein that can complement an EHEC O157:H7 ⌬tccP mutant. Using discriminatory, allele-specific PCR, we have demonstrated that over 90% of tccP2-positive non-O157 EHEC strains contain a Tir protein that can be tyrosine phosphorylated. These results suggest that the TccP pathway can be used by both O157 and non-O157 EHEC and that non-O157 EHEC can also trigger actin polymerization via the Nck pathway.Enterohemorrhagic Escherichia coli (EHEC) is a subgroup of verocytotoxin (VT)-producing E. coli (VTEC) that can cause bloody diarrhea, hemorrhagic colitis, and hemolytic-uremic syndrome (reviewed in references 31 and 32). There are two major types of VT (VT1 and VT2), and VT2 can be subdivided into at least five subtypes (26). E. coli O157:H7 is the most common and virulent EHEC serotype, and it is implicated worldwide in human disease (31). Typical strains of EHEC O157:H7 do not ferment sorbitol and lack ␤-D-glucuronidase activity. However, ␤-D-glucuronidase-positive and sorbitol-fermenting EHEC O157:HϪ strains have been implicated in diarrhea and hemolytic-uremic syndrome in Germany and in other European countries (22). Recent epidemiological studies show that there is a steady increase in the isolation of non-O157 EHEC from humans (1, 35) and animals (21, 27), particularly of serogroups O26, O111, and O103. A case control study of risk factors associated with EHEC infection in Argentina revealed that while EHEC O157 was responsible for 60% of cases, EHEC O145 and O121 were found in 14.5% and 1% of the cases, respectively (29).The hallmark of infections with EHEC and enteropathogenic E. coli (EPEC), a major cause of infantile diarrhea in developing countries (8), is the ability of the bacteria to modulate, while remaining extracellular, the cytoskeleton of eukaryotic cells (reviewed in reference 6), which respond to infection by producing elongated actin-rich pedestal-like structures under...