Shiga Toxin–Producing<i>Escherichia coli</i>Infections Associated with Hemolytic Uremic Syndrome, Italy, 1988–2000

Tozzi, Alberto Eugenio; Caprioli, Alfredo; Minelli, Fabio; Gianviti, Alessandra; Petris, Laura De; Edefonti, Alberto; Montini, Giovanni; Ferretti, Alfonso; Palo, Tommaso De; Gaido, Maurizio; Rizzoni, Gianfranco

doi:10.3201/eid0901.020266

Cited by 181 publications

(155 citation statements)

References 15 publications

(29 reference statements)

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“…Theoretically, this ability has clear implications for the severity of Stx-mediated disease symptoms, commensurate with an increased number of toxin gene copies and increased toxin load, but previously this had not been directly and unequivocally demonstrated. Different stx genes, associated with different prophages or prophage remnants, are regularly found in combination within a single host (Allison et al, 2003;Bielaszewska et al, 2007;Eklund et al, 2002;Muniesa et al, 2003;Zheng et al, 2008), and virulence profiles comprising two stx2 genes are frequently associated with HUS and bloody diarrhoea (Banatvala et al, 1996;Eklund et al, 2002;Elliott et al, 2001;Tozzi et al, 2003;Woodward et al, 2002). Furthermore, the presence of two stx operons can lead to increased in vitro toxin expression (Bielaszewska et al, 2006;Cornick et al, 2002;Eklund et al, 2002;Muniesa et al, 2003), though this observation is not without exceptions (Serra-Moreno et al, 2008), nor does it necessarily equate to more severe clinical disease (Bielaszewska et al, 2006;Cornick et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

Cumulative effect of prophage burden on Shiga toxin production in Escherichia coli

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Cumulative effect of prophage burden on Shiga toxin production in Escherichia coli

et al. 2012

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“…A small number (,15) of isolates of non-O157 VTEC are identified annually in England and Wales by diagnostic testing in the LGP using a combination of PCR and culture of faeces from cases of haemolytic uraemic syndrome (HUS) and bloody diarrhoea but their true incidence is unknown. In other countries, non-O157 VTEC has been identified as a significant cause of infectious intestinal disease, including HUS (Tozzi et al, 2003;Mellmann et al, 2008), and its incidence has been found to exceed that of VTEC O157. This may reflect both actual prevalence and differences in testing methods.…”

Section: Introductionmentioning

confidence: 99%

Assessment of a real-time PCR for the detection and characterization of verocytotoxigenic Escherichia coli

Jenkins¹,

Lawson²,

Cheasty³

et al. 2012

Journal of Medical Microbiology

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The European Union Reference Laboratory (EU-RL) has produced guidelines for a real-time PCR for the detection of verocytotoxigenic Escherichia coli (VTEC). In this study, we validated the EU-RL assay on 545 strains of VTEC and evaluated the utility of the assay for the detection of VTEC from stool specimens. The validation study on cultures showed that the EU-RL VTEC PCR was 99.3% sensitive for the detection of vtx genes; only strains harbouring vtx2f genes were not detected. The assay was 100% sensitive and 100% specific for the detection of both the eae and O157 rfbE genes. In a prospective study involving 500 stool samples, the EU-RL VTEC PCR detected vtx genes in 12.4% of specimens, compared to 3.8% specimens found to be culturepositive for E. coli O157 using the Health Protection Agency national standard culture method. This study showed that the EU-RL VTEC assay was reliable and robust, and an effective rapid screening method for the detection of VTEC from stool specimens.

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“…Such a rapid epidemiological assessment together with a more effective risk communication effort might have been the best strategy for minimizing the public anxiety that accompanied this outbreak and for deciding more appropriate interventions. Unfortunately, this approach was not adopted, mainly due to an insufficient knowledge of the characteristics of STEC outbreaks, which are relatively uncommon in Italy [8,26].…”

Section: Discussionmentioning

confidence: 99%

“…The system involves most Italian paediatric nephrology units, which notify HUS cases and collect samples for laboratory diagnosis of STEC infection, carried out at the ISS. Between 1988 and 2000, the surveillance system has observed 342 cases of HUS, 73 % of which were shown to be associated with STEC infection [8].…”

Section: Introductionmentioning

confidence: 99%

Public health implications of a case of haemolytic–uraemic syndrome associated with a concomitant outbreak of mild gastroenteritis in a small rural community

et al. 2005

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implications of a case of haemolytic-uraemic syndrome associated with a concomitant outbreak of mild gastroenteritis in a small rural community. Epidemiology and infection, 134 (2 SUMMARYThe concomitant occurrence of a case of haemolytic-uraemic syndrome (HUS) and 62 cases of mild gastroenteritis in schools of a small rural community in southern Italy induced the health authorities to suspect a foodborne outbreak of shiga-toxin-producing Escherichia coli (STEC) infection. The schools were closed and the catering service involved was investigated. However, STEC were not isolated from the HUS case or from the 56 cases of gastroenteritis examined, and the HUS case and the outbreak of gastroenteritis were probably just coincidental. A retrospective cohort study failed to show any correlation with consumption of school meals and suggested that the outbreak probably started outside the school setting and then spread within the schools by person-to-person transmission. All the cases examined were negative for common enteric pathogens and the responsible agent for the cases of gastroenteritis was not identified. The concern raised in the small community by the occurrence of a severe case of HUS and the lack of a rapid epidemiological assessment excluding the occurrence of a STEC outbreak, turned an epidemic episode of mild gastroenteritis into a public health emergency with relevant socioeconomic consequences. Prompt intervention in outbreaks following timely and effective risk communication are crucial for taking the most appropriate control measures and avoiding the spread of fear and panic in the community.

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Shiga Toxin–ProducingEscherichia coliInfections Associated with Hemolytic Uremic Syndrome, Italy, 1988–2000

Cited by 181 publications

References 15 publications

Cumulative effect of prophage burden on Shiga toxin production in Escherichia coli

Cumulative effect of prophage burden on Shiga toxin production in Escherichia coli

Assessment of a real-time PCR for the detection and characterization of verocytotoxigenic Escherichia coli

Public health implications of a case of haemolytic–uraemic syndrome associated with a concomitant outbreak of mild gastroenteritis in a small rural community

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