An outbreak of hemolytic uremic syndrome associated with ingestion of fresh apple juice

Steele, Brian T.; Murphy, Noel B.; Arbus, Gerald S.; Rance, C.P.

doi:10.1016/s0022-3476(82)80021-8

Cited by 121 publications

(52 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The occurrence of outbreaks of HUS (55,56,112,188) Of the 20 outbreaks summarized in Table 1, 9 (45%) were in nursing homes, 3 (15%) were among institutionalized children (day-care center, girls' camp, and kindergarten children on a farm trip), and the remainder were in the family and community setting. This pattern of outbreaks is similar to that associated with salmonellosis (6).…”

Section: Hemorrhagic Colitismentioning

confidence: 99%

Infection by verocytotoxin-producing Escherichia coli

1989

View full text Add to dashboard Cite

Verocytotoxin (VT)-producing Escherichia coli (VTEC) are a newly recognized group of enteric pathogens which are increasingly being recognized as common causes of diarrhea in some geographic settings. Outbreak studies indicate that most patients with VTEC infection develop mild uncomplicated diarrhea. However, a significant risk of two serious and potentially life-threatening complications, hemorrhagic colitis and the hemolytic uremic syndrome, makes VTEC infection a public health problem of serious concern. The main reservoirs of VTEC appear to be the intestinal tracts of animals, and foods of animal (especially bovine) origin are probably the principal sources for human infection. The term VT refers to a family of subunit exotoxins with high biological activity. Individual VTEC strains elaborate one or both of at least two serologically distinct, bacteriophage-mediated VTs (VT1 and VT2) which are closely related to Shiga toxin and are thus also referred to as Shiga-like toxins. The holotoxins bind to cells, via their B subunits, to a specific receptor which is probably the glycolipid, globotriosyl ceramide (Gb3). Binding is followed by internalization of the A subunit, which, after it is proteolytically nicked and reduced to the A1 fragment, inhibits protein synthesis in mammalian cells by inactivating 60S ribosomal subunits through selective structural modification of 28S ribosomal ribonucleic acid. The mechanism of VTEC diarrhea is still controversial, and the relative roles of locally acting VT and "attaching and effacing adherence" of VTEC to the mucosa have yet to be resolved. There is increasing evidence that hemolytic uremic syndrome and possibly hemorrhagic colitis result from the systemic action of VT on vascular endothelial cells. The role of antitoxic immunity in preventing the systemic complications of VTEC infection is being explored. Antibiotics appear to be contraindicated in the treatment of VTEC infection. The most common VTEC serotype associated with human disease is O157:H7, but over 50 different VT-positive O:H serotypes have now been identified. The best strategies for diagnosing human VTEC infection include testing for the presence of free VT in fecal filtrates and examining fecal cultures for VTEC by means of deoxyribonucleic acid probes that specify genes encoding VT1 and VT2. Both methods are currently confined to specialized laboratories and await commercial development for wider use. In the meantime, most laboratories should continue to screen for the most common human VTEC serotype, O157:H7, using a sorbitol-containing MacConkey medium.

show abstract

Section: Hemorrhagic Colitismentioning

confidence: 99%

Infection by verocytotoxin-producing Escherichia coli

1989

View full text Add to dashboard Cite

show abstract

“…One particularly prevalent enterohemorrhagic type, E. coli O157:H7, can cause lifethreatening hemorrhagic colitis and, in very severe cases, hemolytic uremic syndrome (47). Several outbreaks have been linked to fresh fruits and vegetables (1,53,59). The source of contamination likely occurs postharvest from a variety of animal sources, including humans (58) Alternatively, preharvest contamination could occur via manure application, contaminated irrigation water, animals, or use of contaminated seed.…”

mentioning

confidence: 99%

Colonization of Arabidopsis thaliana with Salmonella enterica and Enterohemorrhagic Escherichia coli O157:H7 and Competition by Enterobacter asburiae

Cooley

Miller

Mandrell

2003

Appl Environ Microbiol

263

217

View full text Add to dashboard Cite

Enteric pathogens, such as Salmonella enterica and Escherichia coli O157:H7, have been shown to contaminate fresh produce. Under appropriate conditions, these bacteria will grow on and invade the plant tissue. We have developed Arabidopsis thaliana (thale cress) as a model system with the intention of studying plant responses to human pathogens. Under sterile conditions and at 100% humidity, S. enterica serovar Newport and E. coli O157:H7 grew to 10 9 CFU g ؊1 on A. thaliana roots and to 2 ؋ 10 7 CFU g ؊1 on shoots. Furthermore, root inoculation led to contamination of the entire plant, indicating that the pathogens are capable of moving on or within the plant in the absence of competition. Inoculation with green fluorescent protein-labeled S. enterica and E. coli O157:H7 showed invasion of the roots at lateral root junctions. Movement was eliminated and invasion decreased when nonmotile mutants of S. enterica were used. Survival of S. enterica serovar Newport and E. coli O157:H7 on soil-grown plants declined as the plants matured, but both pathogens were detectable for at least 21 days. Survival of the pathogen was reduced in unautoclaved soil and amended soil, suggesting competition from indigenous epiphytes from the soil. Enterobacter asburiae was isolated from soil-grown A. thaliana and shown to be effective at suppressing epiphytic growth of both pathogens under gnotobiotic conditions. Seed and chaff harvested from contaminated plants were occasionally contaminated. The rate of recovery of S. enterica and E. coli O157:H7 from seed varied from undetectable to 19% of the seed pools tested, depending on the method of inoculation. Seed contamination by these pathogens was undetectable in the presence of the competitor, Enterobacter asburiae. Sampling of 74 pools of chaff indicated a strong correlation between contamination of the chaff and seed (P ‫؍‬ 0.025). This suggested that contamination of the seed occurred directly from contaminated chaff or by invasion of the flower or silique. However, contaminated seeds were not sanitized by extensive washing and chlorine treatment, indicating that some of the bacteria reside in a protected niche on the seed surface or under the seed coat.

show abstract

“…Recently, fruit and vegetable products, including apple cider, have been identified as vehicles for infection (3,19). Apple cider was implicated in a disease outbreak caused by E. coli O157:H7 in the early 1980s in Canada (34), and the frequency of outbreaks has increased over the last decade. These particular outbreaks have raised concerns about the acid tolerance of E. coli O157:H7 and consequently the safety of high-acid foods.…”

mentioning

confidence: 99%

Influence of Apple Cultivars on Inactivation of Different Strains of Escherichia coli O157:H7 in Apple Cider by UV Irradiation

Basaran

Quintero‐Ramos

Moake

et al. 2004

Appl Environ Microbiol

100

View full text Add to dashboard Cite

This study examined the effect of different apple cultivars upon the UV inactivation of Escherichia coli O157:H7 strains within unfiltered apple cider. Apple cider was prepared from eight different apple cultivars, inoculated with approximately 10 6 to 10 7 CFU of three strains of E. coli O157:H7 per ml (933, ATCC 43889, and ATCC 43895), and exposed to 14 mJ of UV irradiation per cm 2 . Bacterial populations for treated and untreated samples were then enumerated by using nonselective media. E. coli O157:H7 ATCC 43889 showed the most sensitivity to this disinfection process with an average 6.63-log reduction compared to an average log reduction of 5.93 for both strains 933 and ATCC 43895. The highest log reduction seen, 7.19, occurred for strain ATCC 43889 in Rome cider. The same cider produced the lowest log reductions: 5.33 and 5.25 for strains 933 and ATCC 43895, respectively. Among the apple cultivars, an average log reduction range of 5.78 (Red Delicious) to 6.74 (Empire) was observed, with two statistically significant (␣ < 0.05) log reduction groups represented. Within the paired cultivar-strain analysis, five of eight ciders showed statistically significant (␣ < 0.05) differences in at least two of the E. coli strains used. Comparison of log reductions among the E. coli strains to the cider parameters of°Brix, pH, and malic acid content failed to show any statistically significant relationship (R 2 > 0.95). However, the results of this study indicate that regardless of the apple cultivar used, a minimum 5-log reduction is achieved for all of the strains of E. coli O157:H7 tested.

show abstract

An outbreak of hemolytic uremic syndrome associated with ingestion of fresh apple juice

Cited by 121 publications

References 3 publications

Infection by verocytotoxin-producing Escherichia coli

Infection by verocytotoxin-producing Escherichia coli

Colonization of Arabidopsis thaliana with Salmonella enterica and Enterohemorrhagic Escherichia coli O157:H7 and Competition by Enterobacter asburiae

Influence of Apple Cultivars on Inactivation of Different Strains of Escherichia coli O157:H7 in Apple Cider by UV Irradiation

Contact Info

Product

Resources

About