Hemolytic Uremic Syndrome After an Escherichia coli O111 Outbreak

Piercefield, Emily; Bradley, Kristy; Coffman, Rebecca; Mallonee, Sue

doi:10.1001/archinternmed.2010.346

Cited by 53 publications

(23 citation statements)

References 39 publications

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“…EHEC O111 stx 2 isolates are very rare in Japan, consistent with data from other countries (11)(12)(13). Although some serious outbreaks due to EHEC O111 isolates have been reported in Western countries (14)(15)(16), EHEC O111 outbreaks with serious complications, like HUS, have been rare in Japan.…”

supporting

confidence: 83%

Characterization of Enterohemorrhagic Escherichia coli O111 and O157 Strains Isolated from Outbreak Patients in Japan

et al. 2014

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In April and May 2011, there was a serious food-poisoning outbreak in Japan caused by enterohemorrhagic Escherichia coli (EHEC) strains O111:H8 and O157:H7 from raw beef dishes at branches of a barbecue restaurant. This outbreak involved 181 infected patients, including 34 hemolytic-uremic syndrome (HUS) cases (19%). Among the 34 HUS patients, 21 developed acute encephalopathy (AE) and 5 died. Patient stool specimens yielded E. coli O111 and O157 strains. We also detected both EHEC O111 stx 2 and stx-negative E. coli O111 strains in a stock of meat block from the restaurant. Pulsed-field gel electrophoresis (PFGE) and multilocus variable-number tandem-repeat analysis (MLVA) showed that the stx-negative E. coli O111 isolates were closely related to EHEC O111 stx 2 isolates. Although the EHEC O157 strains had diverse stx gene profiles (stx 1 , stx 2 , and stx 1 stx 2 ), the PFGE and MLVA analyses indicated that these isolates originated from a single clone. Deletion of the Stx2-converting prophage from the EHEC O111 stx 2 isolates was frequently observed during in vitro growth, suggesting that strain conversion from an EHEC O111 stx 2 to an stx-negative strain may have occurred during infection.

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supporting

confidence: 83%

Characterization of Enterohemorrhagic Escherichia coli O111 and O157 Strains Isolated from Outbreak Patients in Japan

et al. 2014

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“…Piercefield et al used admission white blood cell count >20 000 cells/µL as a proxy for illness severity; however, adjustment did not change their results (adjusted values not provided) [20]. Smith et al adjusted for vomiting, fever, bloody diarrhea, and sex [25].…”

Section: Qualitative Review Of Results Adjusting For Covariatesmentioning

confidence: 99%

Shiga Toxin–ProducingEscherichia coliInfection, Antibiotics, and Risk of Developing Hemolytic Uremic Syndrome: A Meta-analysis

et al. 2016

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Background. Antibiotic administration to individuals with Shiga toxin-producing Escherichia coli (STEC) infection remains controversial. We assessed if antibiotic administration to individuals with STEC infection is associated with development of hemolytic uremic syndrome (HUS).Methods. The analysis included studies published up to 29 April 2015, that provided data from patients (1) with STEC infection, (2) who received antibiotics, (3) who developed HUS, and (4) for whom data reported timing of antibiotic administration in relation to HUS. Risk of bias was assessed; strength of evidence was adjudicated. HUS was the primary outcome. Secondary outcomes restricted the analysis to low-risk-of-bias studies employing commonly used HUS criteria. Pooled estimates of the odds ratio (OR) were obtained using random-effects models.Results. Seventeen reports and 1896 patients met eligibility; 8 (47%) studies were retrospective, 5 (29%) were prospective cohort, 3 (18%) were case-control, and 1 was a trial. The pooled OR, including all studies, associating antibiotic administration and development of HUS was 1.33 (95% confidence interval [CI], .89-1.99; I 2 = 42%). The repeat analysis including only studies with a low risk of bias and those employing an appropriate definition of HUS yielded an OR of 2.24 (95% CI, 1.45-3.46; I 2 = 0%).Conclusions. Overall, use of antibiotics was not associated with an increased risk of developing HUS; however, after excluding studies at high risk of bias and those that did not employ an acceptable definition of HUS, there was a significant association. Consequently, the use of antibiotics in individuals with STEC infections is not recommended.

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“…Outbreaks caused by non-O157 EHEC have for several years been highlighted as a potential risk [52] and are well documented again in some industrialised countries [53]. One of the common non-O157 VTECs in the USA is O111:H8 and one of the largest outbreaks was caused by an EHEC O111 (ST and H group not given) in the USA in 2008 causing 341 illnesses [54]. Another strain of EHEC O111:H2 (unknown ST) caused an outbreak in 1998 [55] and had features very similar to those of the German outbreak strain: eae negative, EAEC aggregative adherence, and associated with HUS.…”

Section: Outbreaks Of Ehecmentioning

confidence: 99%

Enteroaggregative E. coli O104 from an outbreak of HUS in Germany 2011, could it happen again?

Chattaway

Dallman

Okeke

et al. 2011

J Infect Dev Ctries

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Enterohaemorrhagic E. coli (EHEC) particularly O157:H7 (Sequence type 11 complex), is the best documented and most well-known of E. coli that cause diarrhoea. The importance of EHEC lies in the severity of disease. Outbreaks can infect thousands of people causing bloody diarrhoea and haemolytic uremic syndrome (HUS) that in turn can result in protracted illness or even death. The ability of EHEC to colonise the human gut is normally associated with the presence of genes from another group of diarrhoeagenic E. coli, the enteropathogenic E. coli (EPEC), via the locus of enterocyte effacement. However, the massive outbreak in Germany was caused by an EHEC which had acquired virulence genes from yet another group of diarrhoeagenic E. coli, the enteroaggregative E. coli (EAEC). In reality EAEC is probably the most common bacterial cause of diarrhoea but is not identified in most diagnostic laboratories. This outbreak emphasises the importance of being able to detect all diarrhoeagenic E. coli and not to focus on E. coli O157:H7 alone. Routine surveillance systems for EAEC, a once ignored global pathogen, would go a long way to reaching this goal. This review describes methods for identifying non-O157 EHEC and describes the key genetic features of EHEC and EAEC. Our aim is to provide information for laboratories and policy makers which enables them to make informed decisions about the best methods available for detecting newly emergent strains of diarrhoeagenic E. coli.

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Hemolytic Uremic Syndrome After an Escherichia coli O111 Outbreak

Cited by 53 publications

References 39 publications

Characterization of Enterohemorrhagic Escherichia coli O111 and O157 Strains Isolated from Outbreak Patients in Japan

Characterization of Enterohemorrhagic Escherichia coli O111 and O157 Strains Isolated from Outbreak Patients in Japan

Shiga Toxin–ProducingEscherichia coliInfection, Antibiotics, and Risk of Developing Hemolytic Uremic Syndrome: A Meta-analysis

Enteroaggregative E. coli O104 from an outbreak of HUS in Germany 2011, could it happen again?

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