Haemolytic-uraemic syndrome with bacteraemia caused by a new hybrid Escherichia coli pathotype

Mariani-Kurkdjian, P.; Lemaître, C.; Bidet, Philippe; Pérez, Daniel R.; Boggini, L.; Kwon, Thérèsa; Bonacorsi, Stéphane

doi:10.1002/nmi2.49

Cited by 54 publications

(52 citation statements)

References 23 publications

(31 reference statements)

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“…Mariani-Kurkdjian et al described the case of an adult male with a severe episode of HUS caused by STEC O80:H2 containing both Stx 2d and the rare eae ξ variant like the strain described above [7]. Similar to our case, the adult male patient presented with afebrile convulsions followed by coma and, after a few weeks, he developed bacteremia.…”

Section: Discussionsupporting

confidence: 79%

Unusual severe case of hemolytic uremic syndrome due to Shiga toxin 2d-producing E. coli O80:H2

et al. 2017

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BackgroundHemolytic uremic syndrome (HUS) is one of the most common causes of acute renal failure in children, with the majority of cases caused by an infection with Shiga toxin-producing Escherichia coli (STEC). Whereas O157 is still the predominant STEC serotype, non-O157 serotypes are increasingly associated with STEC-HUS. However, little is known about this emerging and highly diverse group of non-O157 serotypes. With supportive therapy, STEC-HUS is often self-limiting, with occurrence of chronic sequelae in just a small proportion of patients.Case diagnosis/treatmentIn this case report, we describe a 16-month-old boy with a highly severe and atypical presentation of STEC-HUS. Despite the presentation with multi-organ failure and extensive involvement of central nervous system due to extensive thrombotic microangiopathy (suggestive of atypical HUS), fecal diagnostics revealed an infection with the rare serotype: shiga toxin 2d-producing STEC O80:H2.ConclusionsThis report underlines the importance of STEC diagnostic tests in all children with HUS, including those with an atypical presentation, and emphasizes the importance of molecular and serotyping assays to estimate the virulence of an STEC strain.

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Section: Discussionsupporting

confidence: 79%

Unusual severe case of hemolytic uremic syndrome due to Shiga toxin 2d-producing E. coli O80:H2

et al. 2017

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“…In northern America and Europe, non-O157 serogroups are increasingly associated with post-STEC-HUS and since the 2010s have even exceeded the number of O157:H7 infections [4,41,43]. Moreover, an unusual serogroup, O80, is currently emerging in France [44][45][46] and Europe [47][48][49]. Several epidemiological and clinical features differentiate O157 and non-O157 serogroups.…”

Section: Ehec: Microbiological Characteristics Of Classic O157:h7 Andmentioning

confidence: 99%

Shiga Toxin-Associated Hemolytic Uremic Syndrome: A Narrative Review

Joseph

Cointe

Kurkdjian

et al. 2020

Toxins

155

132

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The severity of human infection by one of the many Shiga toxin-producing Escherichia coli (STEC) is determined by a number of factors: the bacterial genome, the capacity of human societies to prevent foodborne epidemics, the medical condition of infected patients (in particular their hydration status, often compromised by severe diarrhea), and by our capacity to devise new therapeutic approaches, most specifically to combat the bacterial virulence factors, as opposed to our current strategies that essentially aim to palliate organ deficiencies. The last major outbreak in 2011 in Germany, which killed more than 50 people in Europe, was evidence that an effective treatment was still lacking. Herein, we review the current knowledge of STEC virulence, how societies organize the prevention of human disease, and how physicians treat (and, hopefully, will treat) its potentially fatal complications. In particular, we focus on STEC-induced hemolytic and uremic syndrome (HUS), where the intrusion of toxins inside endothelial cells results in massive cell death, activation of the coagulation within capillaries, and eventually organ failure.

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“…A recent report describes an STEC/extraintestinal pathogenic E. coli O80:H2 hybrid that caused HUS and bacteremia (9). STEC/uropathogenic E. coli O2:H6 hybrid strains have also been reported (10).…”

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confidence: 99%

Hybrid Shiga Toxin-Producing and Enterotoxigenic Escherichia sp. Cryptic Lineage 1 Strain 7v Harbors a Hybrid Plasmid

Leonard

Mammel

Rasko

et al. 2016

Appl Environ Microbiol

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Hybrid isolates of Shiga toxin-producing Escherichia coli (STEC) and enterotoxigenic E. coli (ETEC) encoding heat-stable enterotoxin (ST) are being reported with increasing frequency from a variety of sources. However, information regarding the plasmids that these strains harbor is scarce. In this study, we sequence and characterize a plasmid, p7v, from the STEC/ETEC hybrid strain 7v. Whole-genome phylogenetic analyses of STEC/ETEC hybrid strains and prototype E. coli isolates of other pathotypes placed 7v in the Escherichia sp. cryptic lineage 1 (CL1) clade. The complete plasmid, p7v, was determined to be 229,275 bp and encodes putative virulence factors that are typically carried on STEC plasmids as well as those often carried on ETEC plasmids, indicating that the hybrid nature of the strain extends beyond merely encoding the two toxins. Plasmid p7v carries two copies of sta with identical sequences, which were discovered to be divergent from the sta sequences found in the prototype human ETEC strains. Using a nomenclature scheme based on a phylogeny constructed from sta and stb sequences, the sta encoded on p7v is designated STa4. In silico analysis determined that p7v also encodes the K88 fimbria, a colonization factor usually associated with porcine ETEC plasmids. The p7v sequence and the presence of plasmid-encoded virulence factors are compared to those of other STEC/ETEC CL1 hybrid genomes and reveal gene acquisition/loss at the strain level. In addition, the interrogation of 24 STEC/ETEC hybrid genomes for identification of plasmid replicons, colonization factors, Stx and ST subtypes, and other plasmid-encoded virulence genes highlights the diversity of these hybrid strains. IMPORTANCEHybrid Shiga toxin-producing Escherichia coli/enterotoxigenic Escherichia coli (STEC/ETEC) strains, which have been isolated from environmental, animal, and human clinical samples, may represent an emerging threat as food-borne pathogens. Characterization of these strains is important for assessing virulence potential, aiding in the development of pathogen detection methods, and understanding how the hybrid strains evolve to potentially have a greater impact on public health. This study represents, to our knowledge, both the first characterization of a closed plasmid sequence from a STEC/ETEC hybrid strain and the most comprehensive phylogenetic analysis of available STEC/ETEC hybrid genomes to date. The results demonstrate how the mobility of plasmid-associated virulence genes has resulted in the creation of a diverse plasmid repertoire within the STEC/ ETEC hybrid strains. Pathogenic Escherichia coli strains are categorized into pathotypes or pathovars (pathogenic variants) based on virulenceassociated genes whose expression contributes to particular disease symptoms in the human host (1). The virulence-associated genes that are unique to a pathotype have been used as molecular markers to define the pathotype of a given E. coli isolate. Two E. coli pathotypes that cause a significant burden of illness throughout ...

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Haemolytic-uraemic syndrome with bacteraemia caused by a new hybrid Escherichia coli pathotype

Cited by 54 publications

References 23 publications

Unusual severe case of hemolytic uremic syndrome due to Shiga toxin 2d-producing E. coli O80:H2

Unusual severe case of hemolytic uremic syndrome due to Shiga toxin 2d-producing E. coli O80:H2

Shiga Toxin-Associated Hemolytic Uremic Syndrome: A Narrative Review

Hybrid Shiga Toxin-Producing and Enterotoxigenic Escherichia sp. Cryptic Lineage 1 Strain 7v Harbors a Hybrid Plasmid

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