Verotoxinogenic<i>Citrobacter freundii</i>associated with severe gastroenteritis and cases of haemolytic uraemic syndrome in a nursery school: green butter as the infection source

Tschäpe, Helmut; Prager, Rita; Streckel, Wiebke; Fruth, Angelika; Böhme, G

doi:10.1017/s0950268800052158

Cited by 153 publications

(81 citation statements)

References 29 publications

(33 reference statements)

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“…Nevertheless, under unknown conditions Stx phages are able to infect EAEC strains, thus pointing to an extended host range. Previous findings about the presence of Stx phages and stx genes in Enterobacteriaceae other than E. coli also show this possibility (35,36,52).…”

Section: Discussionmentioning

confidence: 73%

Spread of a Distinct Stx2-Encoding Phage Prototype among Escherichia coli O104:H4 Strains from Outbreaks in Germany, Norway, and Georgia

Beutin

Hammerl

Strauch

et al. 2012

J Virol

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Shiga toxin 2 (Stx2)-producing Escherichia coli (STEC) O104:H4 caused one of the world's largest outbreaks of hemorrhagic colitis and hemolytic uremic syndrome in Germany in 2011. These strains have evolved from enteroaggregative E. coli (EAEC) by the acquisition of the Stx2 genes and have been designated enteroaggregative hemorrhagic E. coli . Nucleotide sequencing has shown that the Stx2 gene is carried by prophages integrated into the chromosome of STEC O104:H4. We studied the properties of Stx2-encoding bacteriophages which are responsible for the emergence of this new type of E. coli pathogen. For this, we analyzed Stx bacteriophages from STEC O104:H4 strains from Germany (in 2001 and 2011), Norway (2006), and the Republic of Georgia (2009). Viable Stx2-encoding bacteriophages could be isolated from all STEC strains except for the Norwegian strain. The Stx2 phages formed lysogens on E. coli K-12 by integration into the wrbA locus, resulting in Stx2 production. The nucleotide sequence of the Stx2 phage P13374 of a German STEC O104:H4 outbreak was determined. From the bioinformatic analyses of the prophage sequence of 60,894 bp, 79 open reading frames were inferred. Interestingly, the Stx2 phages from the German 2001 and 2011 outbreak strains were found to be identical and closely related to the Stx2 phages from the Georgian 2009 isolates. Major proteins of the virion particles were analyzed by mass spectrometry. Stx2 production in STEC O104:H4 strains was inducible by mitomycin C and was compared to Stx2 production of E. coli K-12 lysogens.

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Section: Discussionmentioning

confidence: 73%

Spread of a Distinct Stx2-Encoding Phage Prototype among Escherichia coli O104:H4 Strains from Outbreaks in Germany, Norway, and Georgia

Beutin

Hammerl

Strauch

et al. 2012

J Virol

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“…However, it is important to mention the possibility of stx genes being occasionally present in members of Enterobacteriaceae other than E. coli, such as Citrobacter freundii (21) or Enterobacter cloacae (22). Even though PCR detection of stx genes does not allow one to distinguish STECs from other organisms which can occasionally carry these genes, some reports suggest they might be equally important from the clinical perspective, as they have been found to be associated with cases of gastroenteritis and hemolytic uremic syndrome (21,22).…”

Section: Discussionmentioning

confidence: 99%

Improved Detection of Bacterial Pathogens in Patients Presenting with Gastroenteritis by Use of the EntericBio Real-Time Gastro Panel I Assay

et al. 2013

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bIn this study, we evaluated the use of EntericBio real-time Gastro Panel I (Serosep, Limerick, Ireland) for routine use in a clinical microbiology laboratory for simultaneous detection of Campylobacter jejuni, coli, and lari, Shiga toxin-producing Escherichia coli (STEC), Salmonella spp., and Shigella spp. in feces. This system differs from its predecessor (the EntericBio Panel II system, Serosep) in that it allows real-time detection of pathogens directly from feces, without pre-enrichment. It also specifically detects Campylobacter jejuni, coli, and lari rather than all Campylobacter species, as is the case with the previous system. A total of 528 samples from patients presenting with acute gastroenteritis were screened prospectively with this assay, and results were compared with those of the current method, which combines screening the samples with a molecular assay (the EntericBio Panel II assay) and retrospective culture of the specimens in which the target was detected. Discrepancy analysis was conducted using culture and molecular methods. A cute infectious gastroenteritis is common and has important economic and social consequences for both communities and health systems due to its high rate of occurrence (1). Worldwide, it is associated with a high incidence of morbidity and mortality (2), particularly among children (3).Most clinical microbiology laboratories still use traditional, culture-based diagnostic techniques for routine detection of bacterial enteric pathogens. These are both time-consuming and laborious and, in addition, have a prolonged delay in the reporting of results. This can have a significant impact on institutions such as hospitals or nursing homes, where early detection and prevention of disease spread is crucial. Molecular detection of pathogens has, however, been shown to be faster and more sensitive than traditional culture (4, 5). It is especially important where culturebased pathogen detection is problematic or lacks sensitivity. The best example of this is the genus Campylobacter, certain members of which, such as C. jejuni, can remain viable but noncultivable (6), therefore producing false-negative results if detection is based solely on a culture. Moreover, some species which can cause gastroenteritis, such as C. upsaliensis, are unlikely to be correctly isolated and identified on common media (7). Furthermore, the exact role of some fastidious Campylobacter spp. (such as C. ureolyticus or C. concisus) in gastroenteritis is still under investigation despite their being detected in large proportions of samples from patients with gastroenteritis (8, 9).Here, we present a validation study of EntericBio real-time Gastro Panel I (Serosep, Limerick, Ireland), a commercial realtime PCR system (CE marked for in vitro use) for simultaneous detection of Campylobacter jejuni, coli, and lari, Shiga toxin-producing Escherichia coli (STEC) (through detection of Stx1 and Stx2), Shigella spp., and Salmonella spp. directly from patients' feces. MATERIALS AND METHODSPatient samples. Between ...

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“…They found that 43% of these children had an E. coli strain other than O157:H7 in their stool: O26: H11/H-(15%), O157:H-(10%), O145: 28/H-(9%), O103/H2/H-(3%) and O111/H8/H (3%). E. coli is the most commonly involved species, Shigella Dysenteriae typeⅠ and Citrobacter freundii have less frequently observed [26] .…”

Section: Epidemiologymentioning

confidence: 99%

Update on hemolytic uremic syndrome: Diagnostic and therapeutic recommendations

Salvadori

Bertoni²

2013

WJN

114

111

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Hemolytic uremic syndrome (HUS) is a rare disease. In this work the authors review the recent findings on HUS, considering the different etiologic and pathogenetic classifications. New findings in genetics and, in particular, mutations of genes that encode the complement-regulatory proteins have improved our understanding of atypical HUS. Similarly, the complement proteins are clearly involved in all types of thrombotic microangiopathy: typical HUS, atypical HUS and thrombotic thrombocytopenic purpura (TTP). Furthermore, several secondary HUS appear to be related to abnormalities in complement genes in predisposed patients. The authors highlight the therapeutic aspects of this rare disease, examining both "traditional therapy" (including plasma therapy, kidney and kidneyliver transplantation) and "new therapies". The latter include anti-Shiga-toxin antibodies and anti-C5 monoclonal antibody "eculizumab". Eculizumab has been recently launched for the treatment of the atypical HUS, but it appears to be effective in the treatment of typical HUS and in TTP. Future therapies are in phases Ⅰ and Ⅱ. They include anti-C5 antibodies, which are more purified, less immunogenic and absorbed orally and, anti-C3 antibodies, which are more powerful, but potentially less safe. Additionally, infusions of recombinant complement-regulatory proteins are a potential future therapy.

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VerotoxinogenicCitrobacter freundiiassociated with severe gastroenteritis and cases of haemolytic uraemic syndrome in a nursery school: green butter as the infection source

Cited by 153 publications

References 29 publications

Spread of a Distinct Stx2-Encoding Phage Prototype among Escherichia coli O104:H4 Strains from Outbreaks in Germany, Norway, and Georgia

Spread of a Distinct Stx2-Encoding Phage Prototype among Escherichia coli O104:H4 Strains from Outbreaks in Germany, Norway, and Georgia

Improved Detection of Bacterial Pathogens in Patients Presenting with Gastroenteritis by Use of the EntericBio Real-Time Gastro Panel I Assay

Update on hemolytic uremic syndrome: Diagnostic and therapeutic recommendations

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