Possible person-to-person transmission of Escherichia coli O111 - associated hemolytic uremic syndrome

Abstract

Over a 3-month period, ten children (aged 1-13 years) from a 15-km radius in southern Picardy developed typical D+ hemolytic uremic syndrome (HUS). Polymerase chain reaction, using two pairs of verocytotoxin 1-(VT1) and VT2-specific oligonucleotide primers and an internal control was used to detect VT genes directly from stools samples. VT2 gene was detected in seven of nine patients' stools and in 5 of 14 contacts' stool samples. A VT2-producing Escherichia coli (VTEC) O111 was isolated from five of nine children's stools and in 3 adults' stools of the 14 tested. A retrospective case-control study was performed which showed a higher rate of absence in school A, where the first four cases were detected, compared with a control school. The odds ratio for the whole school was 2.77 (confidence interval 1.46-5.26), and 15 (confidence interval 2.54-115.6) if only the nursery classes were considered. A culture of all food samples from households was always negative for VTEC. A retrospective cohort study performed in 89% of children attending school A showed no linkage between food or drink and gastroenteritis. These findings emphasize the potential for person-to-person transmission of VT2-producing E. coli O111, since the only salient risk factor was close contact.

Characteristics of the enteroaggregative Shiga toxin/verotoxin-producing Escherichia coli O104:H4 strain causing the outbreak of haemolytic uraemic syndrome in Germany, May to June 2011

“…A strain of serotype O111:H2 [14] caused a small outbreak of HUS in France in 1995, but the episode involved children, as is typical for STEC/VTEC [15]. As in the present outbreak in Germany, the association of the French strains with severe disease (HUS) supports the view that this unusual combination of virulence factors might confer a very high degree of virulence.…”

Prevalence and clinical course of typical hemolytic uremic syndrome among sibling

“…5,6 Although gastrointestinal symptoms in family contacts were less common in our study, it has been reported that approximately 40% of household contacts of children with HUS have the free toxin identified in their feces. 6,7 HUS outbreaks may start due to simultaneous exposure of several individuals to a common food source, although secondary person-toperson transmission may occur within small communities or families.…”

“…5 It has been described that family members who come in contact with children with typical HUS commonly have STEC colonization, and Shiga toxin has been frequently identified in the members of the same family. 6,7 The development and severity of person-to-person transmission may also depend on other factors, such as the amount of inoculum ingested and individual susceptibility.…”

Shigatoxigenic Escherichia coli serogroups O157, O111 and O113 in feces, water and milk samples from dairy farms

“…Although this prevalence is relatively low, it should be pointed out that serogroup O111 has been involved in most non-O157 STEC infections (2). Besides, STEC O111 has been reported as responsible for outbreaks (6,8,9,23,37) and also sporadic cases (15,18,19,46). STEC strains carrying the eae gene are considered more virulent for humans than strains lacking eae (1).…”