Shiga Toxin-Producing Escherichia coli in Children: Diagnosis and Clinical Manifestations of O157:H7 and Non-O157:H7 Infection

Hermos, Christina; Janineh, Marcie; Han, Lijin; McAdam, Alexander J.

doi:10.1128/jcm.02119-10

Cited by 57 publications

(38 citation statements)

References 29 publications

(40 reference statements)

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“…Given the limited analytical sensitivity of the EIA methods, it is unlikely that PCR was insensitive compared to the EIA. The specificity of the EIA has been reported to be 99.7% (27,28), which is consistent with our data. These apparently false-negative BD Max EBP results may represent either false-positive EIA results or the presence of toxin in specimens in which stx 1 or stx 2 nucleic acids were degraded.…”

Section: Discussionsupporting

confidence: 83%

Multicenter Evaluation of the BD Max Enteric Bacterial Panel PCR Assay for Rapid Detection of Salmonella spp., Shigella spp., Campylobacter spp. (C. jejuni and C. coli), and Shiga Toxin 1 and 2 Genes

et al. 2015

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i Diarrhea due to enteric bacterial pathogens causes significant morbidity and mortality in the United States and worldwide. However, bacterial pathogens may be infrequently identified. Currently, culture and enzyme immunoassays (EIAs) are the primary methods used by clinical laboratories to detect enteric bacterial pathogens. We conducted a multicenter evaluation of the BD Max enteric bacterial panel (EBP) PCR assay in comparison to culture for the detection of Salmonella spp., Shigella spp., Campylobacter jejuni, and Campylobacter coli and an EIA for Shiga toxins 1 and 2. A total of 4,242 preserved or unpreserved stool specimens, including 3,457 specimens collected prospectively and 785 frozen, retrospective samples, were evaluated. Compared to culture or EIA, the positive percent agreement (PPA) and negative percent agreement (NPA) values for the BD Max EBP assay for all specimens combined were as follows: 97.1% and 99.2% for Salmonella spp., 99.1% and 99.7% for Shigella spp., 97.2% and 98.4% for C. jejuni and C. coli, and 97.4% and 99.3% for Shiga toxins, respectively. Discrepant results for prospective samples were resolved with alternate PCR assays and bidirectional sequencing of amplicons. Following discrepant analysis, PPA and NPA values were as follows: 97.3% and 99.8% for Salmonella spp., 99.2% and 100% for Shigella spp., 97.5% and 99.0% for C. jejuni and C. coli, and 100% and 99.7% for Shiga toxins, respectively. No differences in detection were observed for samples preserved in Cary-Blair medium and unpreserved samples. In this large, multicenter study, the BD Max EBP assay showed superior sensitivity compared to conventional methods and excellent specificity for the detection of enteric bacterial pathogens in stool specimens. The World Health Organization reports that, worldwide, there are nearly 1.7 billion cases of diarrheal disease every year and that diarrheal disease is the second leading cause of death of children Ͻ5 years old. Each year, diarrhea kills ϳ760,000 children under the age of 5 years, and most importantly, it is preventable and treatable. Diarrhea is also a leading cause of malnutrition in this same age group. Most of this disease is related to unsafe drinking water, inadequate sanitation, and poor hygiene (1, 2).Acute gastroenteritis is caused by a number of bacterial, viral, and parasitic agents (3). In the United States, noroviruses cause most cases of self-limited, acute gastroenteritis. However, Salmonella, Campylobacter, Shigella, and Shiga toxin-producing Escherichia coli (STEC) are the most common diarrheagenic bacteria, and they are usually associated with foodborne illness (4). Furthermore, Shigella is more frequently transmitted from person to person due to the low infectious dose. Importantly, agents of gastroenteritis may not be distinguished clinically. Identifying the cause of diarrhea is important for both the treatment of individual patients and public health intervention through outbreak management (5).Conventional microbiological cultures remain the gold standard...

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Section: Discussionsupporting

confidence: 83%

Multicenter Evaluation of the BD Max Enteric Bacterial Panel PCR Assay for Rapid Detection of Salmonella spp., Shigella spp., Campylobacter spp. (C. jejuni and C. coli), and Shiga Toxin 1 and 2 Genes

et al. 2015

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“…Based on this study, the rate of clinical HUS following a positive test for STEC of 22.6% (12/53 cases) is similar to reported rates at academic pediatric institutions (26,27). However, the proportion of STEC O157 specimens with the stx Ϫ /stx2 ϩ genotype, i.e., 54% during this study period, differs from findings reported for our area (28).…”

Section: Discussioncontrasting

confidence: 55%

Real-Time PCR Assay for Detection and Differentiation of Shiga Toxin-Producing Escherichia coli from Clinical Samples

et al. 2015

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“…Enterohaemorrhagic Escherichia coli /Shiga-toxin producing Escherichia coli (EHEC/STEC) is among the diarrhoeagenic E.coli (DEC) pathogenic strains which cause gastroenteritis cases ranging from non-invasive diarrhoea to bloody diarrhoea and haemorrhagic colitis (Hermos et al, 2011). STEC infection can also complicate into a life threatening condition known as haemolyticuremic syndrome(HUS) characterized by haemolytic anaemia, thrombocytopenia and renal insufficiency or failure (Klein et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

“…A typical case is characterized by diarrhoea, fever, and abdominal cramps (Crump et al, 2002;Sep, 2006). STEC serotype O157:H7 has been found to be mostly associated with HUS and Escherichia coli O157 infection to predominantly occur in children below five years (Hermos et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Prevalence and antimicrobial sensitivity of Shiga-toxin-producing Escherichia coli among underfives presenting with diarrhoea at hospitals in Mwanza City, Tanzania

Moremi¹,

Othman

Msaki³

et al. 2017

Tanzania J Hlth Res

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Background: Escherichia coli is among the most common causes of diarrhoea in children below five years of age in developing countries. Diarrhoeal diseases rank the second most common cause of morbidity and mortality in developing countries. Here we report the magnitude of Shiga toxin-producing Escherichia coli (STEC) infection among underfives with diarrhoea in Mwanza, Tanzania. Methods: This study was carried out at Nyamagana and Sekou Toure hospitals in Mwanza, Tanzania. Between July, 2015 and March, 2016, children aged < 5 years with diarrhoea were included in the study. Demographics and relevant information were recorded. Stool specimens were cultured onto MacConkey and Salmonella-Shigella Agars. CHROMagar STEC was used to identify STEC. Antimicrobial susceptibility testing was performed to all pathogenic bacteria using disc diffusion method. Results: A total of 304 children were include in the study. The mean (±standard deviation) age of the enrolled children was 1.4 (±1.03) years. Out of 304 diarrhoea cases, 32 (10.5%) were positive for STEC and 12 (3.9%) were due to other pathogenic bacteria (Salmonella and Shigella species.). Of 32 STEC isolates, 22 (68.8%) and 20 (62.5%) were resistant to amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole respectively and 3 (9.4%) were found to produce extended spectrum beta lactamases (ESBL). Use of water from wells (p=0.006) was found to be the predictor of the presence of pathogenic bacteria. Conclusion: Clinicians should consider STEC as the potential pathogens causing diarrhoea in the region. More than 60% of pathogenic bacteria were resistant to commonly prescribed antimicrobials like amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole. There is a need to emphasize on the provision of safe water, health education together with improvements in sanitation and personal hygiene as key strategies to reduce these infections.

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Shiga Toxin-Producing Escherichia coli in Children: Diagnosis and Clinical Manifestations of O157:H7 and Non-O157:H7 Infection

Cited by 57 publications

References 29 publications

Multicenter Evaluation of the BD Max Enteric Bacterial Panel PCR Assay for Rapid Detection of Salmonella spp., Shigella spp., Campylobacter spp. (C. jejuni and C. coli), and Shiga Toxin 1 and 2 Genes

Multicenter Evaluation of the BD Max Enteric Bacterial Panel PCR Assay for Rapid Detection of Salmonella spp., Shigella spp., Campylobacter spp. (C. jejuni and C. coli), and Shiga Toxin 1 and 2 Genes

Real-Time PCR Assay for Detection and Differentiation of Shiga Toxin-Producing Escherichia coli from Clinical Samples

Prevalence and antimicrobial sensitivity of Shiga-toxin-producing Escherichia coli among underfives presenting with diarrhoea at hospitals in Mwanza City, Tanzania

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