Enterohemorrhagic Escherichia coli O26:H11/H−: A New Virulent Clone Emerges in Europe

Bielaszewska, Martina; Mellmann, Alexander; Bletz, Stefan; Zhang, Wenlan; Köck, Robin; Kossow, Annelene; Prager, Rita; Fruth, Angelika; Orth‐Höller, Dorothea; Marejková, Monika; Morabito, Stefano; Caprioli, Alfredo; Piérard, Denis; Smith, G.; Jenkins, Claire; Čurová, Katarína; Karch, Helge

doi:10.1093/cid/cit055

Cited by 125 publications

(201 citation statements)

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“…We characterized the plasmid gene contents of the 23 strains to compare them with STEC O26 strains circulating in other countries in Europe and described by others (8)(9)(10). The ehxA, katP, espP, and etpD genes were distributed in three different patterns ( Table 2).…”

Section: Resultsmentioning

confidence: 96%

“…Until recently, EHEC O26:H11 strains isolated from humans mostly harbored Shiga toxin 1 (Stx1) (Stx1a subtype) only or, more rarely, Stx1a associated with the Stx2a subtype. In the middle 1990s, however, a new EHEC O26:H11 clone carrying the Shiga toxin Stx2a subtype alone emerged in Europe (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). This new clone has also been observed in South America (19) and in the United States (1).…”

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confidence: 99%

“…Shiga toxin-producing E. coli (STEC) strains carrying the stx 2 gene are usually associated with more severe outcomes (20). Indeed, this new O26:H11 clone appears highly virulent and is significantly associated with HUS (8,9).…”

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confidence: 99%

“…Multilocus sequence typing (MLST) analysis shows that the stx 2a -harboring E. coli O26:H11 strains are mostly divided into 2 related phylogenetic groups, i.e., sequence type 21 (ST21) (which also contains the EHEC O26:H11 strains harboring stx 1a alone or in combination with stx 2a ) and ST29 (which contains the new highly pathogenic clone carrying stx 2a only) (9). The large EHEC plasmids encoding enterohemolysin (ehxA), catalase peroxidase (katP), serine protease (espP), and type II effector (etpD) can be found in most EHEC O26:H11 strains (8,9), and the presence of these specific plasmid virulence determinants can be used to distinguish the 2 clones.…”

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confidence: 99%

“…The large EHEC plasmids encoding enterohemolysin (ehxA), catalase peroxidase (katP), serine protease (espP), and type II effector (etpD) can be found in most EHEC O26:H11 strains (8,9), and the presence of these specific plasmid virulence determinants can be used to distinguish the 2 clones. ST21 is characterized by the plasmid gene combination ehxAϩ/katPϩ/espPϩ/etpDϪ, while ST29 exhibits the distinctive combination ehxAϩ/katPϪ/espPϪ/etpDϩ (9).…”

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Characteristics of Emerging Human-Pathogenic Escherichia coli O26:H11 Strains Isolated in France between 2010 and 2013 and Carrying the stx _2d Gene Only

et al. 2015

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Strains of Escherichia coli O26:H11 that were positive for stx 2 alone (n ‫؍‬ 23), which were not epidemiologically related or part of an outbreak, were isolated from pediatric patients in France between 2010 and 2013. We were interested in comparing these strains with the new highly virulent stx 2a -positive E. coli O26 clone sequence type 29 (ST29) that has emerged recently in Europe, and we tested them by multilocus sequence typing (MLST), stx 2 subtyping, clustered regularly interspaced short palindromic repeat (CRISPR) sequencing, and plasmid (ehxA, katP, espP, and etpD) and chromosomal (Z2098, espK, and espV) virulence gene profiling. We showed that 16 of the 23 strains appeared to correspond to this new clone, but the characteristics of 12 strains differed significantly from the previously described characteristics, with negative results for both plasmid and chromosomal genetic markers. These 12 strains exhibited a ST29 genotype and related CRISPR arrays (CRISPR2a alleles 67 or 71), suggesting that they evolved in a common environment. This finding was corroborated by the presence of stx 2d in 7 of the 12 ST29 strains. This is the first time that E. coli O26:H11 carrying stx 2d has been isolated from humans. This is additional evidence of the continuing evolution of virulent Shiga toxin-producing E. coli (STEC) O26 strains. A new O26:H11 CRISPR PCR assay, SP_O26_E, has been developed for detection of these 12 particular ST29 strains of E. coli O26:H11. This test is useful to better characterize the stx 2 -positive O26:H11 clinical isolates, which are associated with severe clinical outcomes such as bloody diarrhea and hemolytic uremic syndrome. Enterohemorrhagic Escherichia coli (EHEC) is responsible for gastrointestinal diseases such as diarrhea or bloody diarrhea and can lead to hemolytic uremic syndrome (HUS). The most common EHEC serotype associated with human disease is O157: H7. However, a growing number of human EHEC infections are caused by non-O157 EHEC strains (1-4). Among non-O157 EHEC strains, O26:H11 has emerged as the most common serotype associated with severe diarrhea and HUS worldwide (1-6).EHEC O26:H11 strains are very dynamic; they can undergo frequent genetic rearrangements in their chromosome, virulence plasmids, and pathogenicity islands. They also have the ability to rapidly lose and acquire stx-carrying phages (7), which makes them highly adaptable and may account for their global spread. Until recently, EHEC O26:H11 strains isolated from humans mostly harbored Shiga toxin 1 (Stx1) (Stx1a subtype) only or, more rarely, Stx1a associated with the Stx2a subtype. In the middle 1990s, however, a new EHEC O26:H11 clone carrying the Shiga toxin Stx2a subtype alone emerged in Europe (8-18). This new clone has also been observed in South America (19) and in the United States (1). Shiga toxin-producing E. coli (STEC) strains carrying the stx 2 gene are usually associated with more severe outcomes (20). Indeed, this new O26:H11 clone appears highly virulent and is significantly associated wit...

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Section: Resultsmentioning

confidence: 96%

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confidence: 99%

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confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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Characteristics of Emerging Human-Pathogenic Escherichia coli O26:H11 Strains Isolated in France between 2010 and 2013 and Carrying the stx _2d Gene Only

et al. 2015

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Heteropathogenic virulence and phylogeny reveal phased pathogenic metamorphosis in Escherichia coli O2:H6

et al. 2014

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Extraintestinal pathogenic and intestinal pathogenic (diarrheagenic) Escherichia coli differ phylogenetically and by virulence profiles. Classic theory teaches simple linear descent in this species, where non-pathogens acquire virulence traits and emerge as pathogens. However, diarrheagenic Shiga toxin-producing E. coli (STEC) O2:H6 not only possess and express virulence factors associated with diarrheagenic and uropathogenic E. coli but also cause diarrhea and urinary tract infections. These organisms are phylogenetically positioned between members of an intestinal pathogenic group (STEC) and extraintestinal pathogenic E. coli. STEC O2:H6 is, therefore, a ‘heteropathogen,’ and the first such hybrid virulent E. coli identified. The phylogeny of these E. coli and the repertoire of virulence traits they possess compel consideration of an alternate view of pathogen emergence, whereby one pathogroup of E. coli undergoes phased metamorphosis into another. By understanding the evolutionary mechanisms of bacterial pathogens, rational strategies for counteracting their detrimental effects on humans can be developed.Subject Categories Microbiology, Virology & Host Pathogen Interaction

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Enterohemorrhagic E. coli (EHEC): Environmental-Vehicle-Human Interface

Correa-Martínez

Leopold

Köck

et al. 2022

Zoonoses: Infections Affecting Humans and Animals

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Enterohemorrhagic Escherichia coli O26:H11/H−: A New Virulent Clone Emerges in Europe

Abstract: A new highly virulent clone of EHEC O26 has emerged in Europe. Its reservoirs and sources warrant identification.

Cited by 125 publications

References 35 publications

Characteristics of Emerging Human-Pathogenic Escherichia coli O26:H11 Strains Isolated in France between 2010 and 2013 and Carrying the stx _2d Gene Only

Characteristics of Emerging Human-Pathogenic Escherichia coli O26:H11 Strains Isolated in France between 2010 and 2013 and Carrying the stx _2d Gene Only

Heteropathogenic virulence and phylogeny reveal phased pathogenic metamorphosis in Escherichia coli O2:H6

Enterohemorrhagic E. coli (EHEC): Environmental-Vehicle-Human Interface

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Enterohemorrhagic Escherichia coli O26:H11/H−: A New Virulent Clone Emerges in Europe

Abstract: A new highly virulent clone of EHEC O26 has emerged in Europe. Its reservoirs and sources warrant identification.

Cited by 125 publications

References 35 publications

Characteristics of Emerging Human-Pathogenic Escherichia coli O26:H11 Strains Isolated in France between 2010 and 2013 and Carrying the stx 2d Gene Only

Characteristics of Emerging Human-Pathogenic Escherichia coli O26:H11 Strains Isolated in France between 2010 and 2013 and Carrying the stx 2d Gene Only

Heteropathogenic virulence and phylogeny reveal phased pathogenic metamorphosis in Escherichia coli O2:H6

Enterohemorrhagic E. coli (EHEC): Environmental-Vehicle-Human Interface

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Characteristics of Emerging Human-Pathogenic Escherichia coli O26:H11 Strains Isolated in France between 2010 and 2013 and Carrying the stx _2d Gene Only

Characteristics of Emerging Human-Pathogenic Escherichia coli O26:H11 Strains Isolated in France between 2010 and 2013 and Carrying the stx _2d Gene Only