A large outbreak caused by a rare Shiga toxin-producing Escherichia coli serotype O104:H4 occurred in Germany in May to July 2011. The National Reference Laboratory for E. coli and Shigella investigated the stool sample from an American tourist with bloody diarrhea who arrived in the Czech Republic from Germany where she consumed salads with raw vegetable a week ago. Using culture of the enriched stool on extended-spectrum β-lactamase agar, we isolated E. coli strain which belonged to serotype O104:H4 as determined by conventional and molecular serotyping. The strain contained the major virulence characteristics of enterohemorrhagic E. coli (stx (2) encoding Shiga toxin 2) and enteroaggregative E. coli (aggA encoding aggregative adherence fimbriae I). This unique combination of virulence traits demonstrated that this strain belongs to the hybrid enteroaggregative hemorrhagic E. coli clone which caused the German outbreak. Using advanced culture and molecular biological approaches is the prerequisite for identification of new, unusual pathogens.
The aim of this study was to describe epidemiological and clinical characteristics of imported enteric fever in Czech travellers and to determine the antimicrobial susceptibility of isolated strains. Retrospective descriptive study included adult patients treated with enteric fever at Hospital Na Bulovce during January 2004-December 2012. A case of typhoid or paratyphoid fever was defined as isolation of Salmonella Typhi or Paratyphi from blood or stool. During the study period, there have been diagnosed 19 cases of enteric fever (12 males and 7 females) with age median of 30 years; 14 cases were caused by Salmonella Typhi and 5 cases by S. Paratyphi A. The infection has been acquired in South Asia (16 patients; 84.2 %), in Africa (Egypt, Angola) in two cases (10.5 %), and in Mexico (1; 5.3 %). Symptoms included fever (all patients), diarrhoea (16 cases; 84.2 %), headache (9; 47.4 %), and abdominal pain (7; 36.8 %). Seventeen patients (89.5 %) were treated with fluoroquinolones; however, the treatment failure was observed in seven of them (41.2 %). Decreased ciprofloxacin susceptibility was detected in eight strains (66.7 %), and one strain (8.3 %) was multidrug resistant. Sequence analysis of quinolone resistance-determining regions (QRDR) of the gyrA gene revealed the presence of amino acid substitutions in all tested isolates with decreased ciprofloxacin susceptibility. Typhoid and paratyphoid fevers represent epidemiologically important diseases that may lead to potentially life-threatening complications. Major issue in the management of enteric fever represents the non-susceptibility of Salmonella strains to fluoroquinolones and other antimicrobials.
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