Enteroaggregative Shiga toxin-producing Escherichia coli of serotype O104:H4 in Belgium and Luxembourg

Abstract

In 2011, a large outbreak of infections caused by Shiga toxin-producing Escherichia coli (STEC) O104:H4 occurred in Germany. This exceptionally virulent strain combined virulence factors of enteroaggregative E. coli (EAggEC) and STEC. After the outbreak only a few sporadic cases of infection with this rare serotype were reported, most of which were related to travel to the Middle East or North Africa. Here we describe two cases of enteroaggregative STEC (Agg-STEC) O104:H4 infection that occurred in Belgium in 2012 and 2013 respectively. In both cases travel in a Mediterranean country preceded the infection. The first strain was isolated from the stool of a 42-year-old woman presenting bloody diarrhoea, who had travelled to Tunisia the week before. The second case involves a 14-year-old girl who, upon her return from Turkey to Belgium, suffered from an episode of bloody diarrhoea and haemolytic uraemic syndrome. Extended typing of the isolates with pulsed field gel electrophoresis revealed that the strains were closely related, though not exactly the same as the 2011 outbreak strain. This report supports the previously made hypothesis that Agg-STEC has a human reservoir and might be imported by travellers coming from an area where the pathogen is endemic. Furthermore, it emphasizes the concern that these bacteria may cause future outbreaks as evenly virulent O104:H4 isolates seem to be widespread.

Comparative Genomic Analysis of Two Novel Sporadic Shiga Toxin-Producing Escherichia coli O104:H4 Strains Isolated 2011 in Germany

“…The results of our investigation of STEC O104:H4 strains add to the knowledge about this emerging pathogen, concerning a certain diversity within the bacterial core genome as well as loss and gain of accessory elements such as plasmids. Our results do also support the view that distinct new variants of STEC O104:H4 might repeatedly originate from a yet unknown reservoir, rather than that there would be a continuous diversification of a single strain established and circulating in Germany after the large outbreak in 2011 [ 38 , 39 , 40 ].…”

Characteristics of Shiga toxin producing- and enteropathogenic Escherichia coli of the emerging serotype O80:H2 isolated from humans and diarrhoeic calves in Belgium

“…A PCR was executed for the detection of the E. coli virulence genes eae, ehxA, aaiC, aggR and stx subtyping [6]. Disc diffusion susceptibility testing and determination of extended-spectrum blactamase production was performed using antibiotics selected by the Programme for Food-and Waterborne Diseases and Zoonoses (see Supplementary material, Table S1).…”

Comprehensive Characterization of Escherichia coli O104:H4 Isolated from Patients in the Netherlands

“…Recently, two similar isolates of EAEC Stx2a+ O104:H4 causing bloody diarrhea and HUS were reported in Belgium. Patients of both cases traveled to Tunisia and Turkey, respectively, and the infection may have been acquired in those regions ( De Rauw et al, 2014 ). This is similar to our and other studies describing EAEC Stx2a+ O104:H4 infections associated with traveling to Turkey, Tunisia, Egypt, and North Africa ( Ecdc/Efsa, 2011 ; Grad et al, 2013 ).…”