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Abstract

In summer 2013, an excess of paediatric cases of haemolytic uraemic syndrome (HUS) in a southern region of Italy prompted the investigation of a community-wide outbreak of Shiga toxin 2-producing (STEC) O26:H11 infections. Case finding was based on testing patients with HUS or bloody diarrhoea for STEC infection by microbiological and serological methods. A case–control study was conducted to identify the source of the outbreak. STEC O26 infection was identified in 20 children (median age 17 months) with HUS, two of whom reported severe neurological sequelae. No cases in adults were detected. Molecular typing showed that two distinct STEC O26:H11 strains were involved. The case–control study showed an association between STEC O26 infection and consumption of dairy products from two local plants, but not with specific ready-to-eat products. O26:H11 strains lacking the genes were isolated from bulk milk and curd samples, but their PFGE profiles did not match those of the outbreak isolates. This outbreak supports the view that infections with Stx2-producing O26 in children have a high probability of progressing to HUS and represent an emerging public health problem in Europe.

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/content/10.2807/1560-7917.ES.2016.21.38.30343
2016-09-22
2019-10-13
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2016.21.38.30343
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References

  1. Tarr PI, Gordon CA, Chandler WL. Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet. 2005;365(9464):1073-86. PMID: 15781103 
  2. Caprioli A, Scavia G, Morabito S. Public Health Microbiology of Shiga Toxin-Producing Escherichia coli. In Enterohemorragic Escherichia coli and Other Shiga Toxin-Producing E.coli. Washington, DC: ASM Press; 2014. p. 245-259.
  3. Page AV, Liles WC. Enterohemorrhagic Escherichia coli Infections and the Hemolytic-Uremic Syndrome. Med Clin North Am. 2013;97(4):681-95, xi.  https://doi.org/10.1016/j.mcna.2013.04.001  PMID: 23809720 
  4. Tozzi AE, Caprioli A, Minelli F, Gianviti A, De Petris L, Edefonti A, et al. Hemolytic Uremic Syndrome Study Group. Shiga toxin-producing Escherichia coli infections associated with hemolytic uremic syndrome, Italy, 1988-2000. Emerg Infect Dis. 2003;9(1):106-8.  https://doi.org/10.3201/eid0901.020266  PMID: 12533290 
  5. Bielaszewska M, Mellmann A, Bletz S, Zhang W, Köck R, Kossow A, et al. Enterohemorrhagic Escherichia coli O26:H11/H-: a new virulent clone emerges in Europe. Clin Infect Dis. 2013;56(10):1373-81.  https://doi.org/10.1093/cid/cit055  PMID: 23378282 
  6. Scavia G, Edefonti A, Vidal E, Emma F, Percoraro C, Amore A, et al. A twenty-two year epidemiological surveillance of pediatric aemolytic uremic syndrome in Italy. Pediatr Nephrol. 2011;26:1624-5.
  7. Perelle S, Dilasser F, Grout J, Fach P. Detection by 5′-nuclease PCR of Shiga-toxin producing Escherichia coli O26, O55, O91, O103, O111, O113, O145 and O157:H7, associated with the world’s most frequent clinical cases. Mol Cell Probes. 2004;18(3):185-92.  https://doi.org/10.1016/j.mcp.2003.12.004  PMID: 15135453 
  8. Nielsen EM, Andersen MT. Detection and characterization of verocytotoxin-producing Escherichia coli by automated 5′ nuclease PCR assay. J Clin Microbiol. 2003;41(7):2884-93.  https://doi.org/10.1128/JCM.41.7.2884-2893.2003  PMID: 12843017 
  9. Scavia G, Staffolani M, Fisichella S, Striano G, Colletta S, Ferri G, et al. Enteroaggregative Escherichia coli associated with a foodborne outbreak of gastroenteritis. J Med Microbiol. 2008;57(Pt 9):1141-6.  https://doi.org/10.1099/jmm.0.2008/001362-0  PMID: 18719185 
  10. Caprioli A, Luzzi I, Rosmini F, Resti C, Edefonti A, Perfumo F, et al. Community-wide outbreak of hemolytic-uremic syndrome associated with non-O157 verocytotoxin-producing Escherichia coli. J Infect Dis. 1994;169(1):208-11.  https://doi.org/10.1093/infdis/169.1.208  PMID: 8277184 
  11. Madic J, Peytavin de Garam C, Vingadassalon N, Oswald E, Fach P, Jamet E, et al. Simplex and multiplex real-time PCR assays for the detection of flagellar (H-antigen) fliC alleles and intimin (eae) variants associated with enterohaemorrhagic Escherichia coli (EHEC) serotypes O26:H11, O103:H2, O111:H8, O145:H28 and O157:H7. J Appl Microbiol. 2010;109(5):1696-705. PMID: 20618885 
  12. Scheutz F, Teel LD, Beutin L, Piérard D, Buvens G, Karch H, et al. Multicenter evaluation of a sequence-based protocol for subtyping Shiga toxins and standardizing Stx nomenclature. J Clin Microbiol. 2012;50(9):2951-63.  https://doi.org/10.1128/JCM.00860-12  PMID: 22760050 
  13. Wirth T, Falush D, Lan R, Colles F, Mensa P, Wieler LH, et al. Sex and virulence in Escherichia coli: an evolutionary perspective. Mol Microbiol. 2006;60(5):1136-51.  https://doi.org/10.1111/j.1365-2958.2006.05172.x  PMID: 16689791 
  14. European Centre for Disease Prevention and Control (ECDC). Surveillance of seven priority food- and waterborne diseases in the EU/EEA. Stockholm: ECDC; 2015. Available from: http://ecdc.europa.eu/en/publications/publications/food-and-waterborne-diseases-surveillance-report-2015.pdf
  15. Gerber A, Karch H, Allerberger F, Verweyen HM, Zimmerhackl LB. Clinical course and the role of shiga toxin-producing Escherichia coli infection in the hemolytic-uremic syndrome in pediatric patients, 1997-2000, in Germany and Austria: a prospective study. J Infect Dis. 2002;186(4):493-500.  https://doi.org/10.1086/341940  PMID: 12195376 
  16. Espié E, Grimont F, Mariani-Kurkdjian P, Bouvet P, Haeghebaert S, Filliol I, et al. Surveillance of hemolytic uremic syndrome in children less than 15 years of age, a system to monitor O157 and non-O157 Shiga toxin-producing Escherichia coli infections in France, 1996-2006. Pediatr Infect Dis J. 2008;27(7):595-601.  https://doi.org/10.1097/INF.0b013e31816a062f  PMID: 18520972 
  17. Käppeli U, Hächler H, Giezendanner N, Beutin L, Stephan R. Human infections with non-O157 Shiga toxin-producing Escherichia coli, Switzerland, 2000-2009. Emerg Infect Dis. 2011;17(2):180-5.  https://doi.org/10.3201/eid1702.100909  PMID: 21291586 
  18. Rivas M, Miliwebsky E, Chinen I, Roldán CD, Balbi L, García B, et al. Case-Control Study Group. Characterization and epidemiologic subtyping of Shiga toxin-producing Escherichia coli strains isolated from hemolytic uremic syndrome and diarrhea cases in Argentina. Foodborne Pathog Dis. 2006;3(1):88-96.  https://doi.org/10.1089/fpd.2006.3.88  PMID: 16602984 
  19. Ricotti GC, Buonomini MI, Merlitti A, Karch H, Luzzi I, Caprioli A. A fatal case of hemorrhagic colitis, thrombocytopenia, and renal failure associated with verocytotoxin-producing, non-O157 Escherichia coli. Clin Infect Dis. 1994;19(4):815-6.  https://doi.org/10.1093/clinids/19.4.815  PMID: 7803672 
  20. Pollock KG, Bhojani S, Beattie TJ, Allison L, Hanson M, Locking ME, et al. Highly virulent Escherichia coli O26, Scotland. Emerg Infect Dis. 2011;17(9):1777-9.  https://doi.org/10.3201/eid1709.110199  PMID: 21888827 
  21. Zieg J, Dusek J, Marejkova M, Limrova P, Blazek D, Pavlicek P, et al. Fatal case of diarrhea-associated hemolytic uremic syndrome with severe neurologic involvement. Pediatr Int. 2012;54(1):166-7.  https://doi.org/10.1111/j.1442-200X.2011.03533.x  PMID: 22335333 
  22. Zimmerhackl LB, Rosales A, Hofer J, Riedl M, Jungraithmayr T, Mellmann A, et al. Enterohemorrhagic Escherichia coli O26:H11-Associated Hemolytic Uremic Syndrome: Bacteriology and Clinical Presentation. Semin Thromb Hemost. 2010;36(6):586-93.  https://doi.org/10.1055/s-0030-1262880  PMID: 20865635 
  23. Institut de Veille Sanitaire (InVS). Epidémie d'infections à E.coli producteurs de Shiga toxins non-O157 liée à la consommation de camembert au lait cru, Nord-Ouest de la France, Octobre-Décembre 2005. [Outbreak of Shiga toxin 2-producing Escherichia coli infections linked to consumption of raw-milk camembert, north-west France, October–December 2005]. France: Production scientifique InVS; 2007. [Accessed 21 Jun 2015]. French. Available from: http://opac.invs.sante.fr/index.php?lvl=notice_display&id=9416
  24. Peron E, Zaharia A, Zota L C, Severi E, Mardh O, Usein C, et al. Early findings in outbreak of haemolytic uraemic syndrome among young children caused by Shiga toxin-producing Escherichia coli, Romania, January to February 2016. Euro Surveill. 2016;21(11):30170
  25. King LA, Mailles A, Mariani-Kurkdjian P, Vernozy-Rozand C, Montet MP, Grimont F, et al. Community-wide outbreak of Escherichia coli O157:H7 associated with consumption of frozen beef burgers. Epidemiol Infect. 2009;137(6):889-96.  https://doi.org/10.1017/S0950268808001490  PMID: 18945376 
  26. Ammon A, Petersen LR, Karch H. A large outbreak of hemolytic uremic syndrome caused by an unusual sorbitol-fermenting strain of Escherichia coli O157:H-. J Infect Dis. 1999;179(5):1274-7.  https://doi.org/10.1086/314715  PMID: 10191236 
  27. Werber D, Fruth A, Liesegang A, Littmann M, Buchholz U, Prager R, et al. A multistate outbreak of Shiga toxin-producing Escherichia coli O26:H11 infections in Germany, detected by molecular subtyping surveillance. J Infect Dis. 2002;186(3):419-22.  https://doi.org/10.1086/341457  PMID: 12134240 
  28. Ethelberg S, Smith B, Torpdahl M, Lisby M, Boel J, Jensen T, et al. Outbreak of non-O157 Shiga toxin-producing Escherichia coli infection from consumption of beef sausage. Clin Infect Dis. 2009;48(8):e78-81.  https://doi.org/10.1086/597502  PMID: 19272017 
  29. Luna-Gierke RE, Wymore K, Sadlowski J, Clogher P, Gierke RW, Tobin-D’Angelo M, et al. Multiple-aetiology enteric infections involving non-O157 Shiga toxin-producing Escherichia coli--FoodNet, 2001-2010. Zoonoses Public Health. 2014;61(7):492-8.  https://doi.org/10.1111/zph.12098  PMID: 24484079 
  30. De Schrijver K, Buvens G, Possé B, Van den Branden D, Oosterlynck O, De Zutter L, et al. Outbreak of verocytotoxin-producing E. coli O145 and O26 infections associated with the consumption of ice cream produced at a farm, Belgium, 2007. Euro Surveill. 2008;13(7):13. PMID: 18445416 
  31. Jenkins C, Evans J, Chart H, Willshaw GA, Frankel G. Escherichia coli serogroup O26--a new look at an old adversary. J Appl Microbiol. 2008;104(1):14-25. PMID: 18171379 
  32. Allerberger F, Friedrich AW, Grif K, Dierich MP, Dornbusch HJ, Mache CJ, et al. Hemolytic-uremic syndrome associated with enterohemorrhagic Escherichia coli O26:H infection and consumption of unpasteurized cow’s milk. Int J Infect Dis. 2003;7(1):42-5.  https://doi.org/10.1016/S1201-9712(03)90041-5  PMID: 12718809 
  33. Bielaszewska M, Prager R, Köck R, Mellmann A, Zhang W, Tschäpe H, et al. Shiga toxin gene loss and transfer in vitro and in vivo during enterohemorrhagic Escherichia coli O26 infection in humans. Appl Environ Microbiol. 2007;73(10):3144-50.  https://doi.org/10.1128/AEM.02937-06  PMID: 17400784 
Community-wide outbreak of haemolytic uraemic syndrome associated with Shiga toxin 2-producing Escherichia coli O26:H11 in southern Italy, summer 2013
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Cinzia+Germinario&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Germinario Cinzia</a>, <a href="/search?value1=Alfredo+Caprioli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Caprioli Alfredo</a>, <a href="/search?value1=Mario+Giordano&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Giordano Mario</a>, <a href="/search?value1=Maria+Chironna&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Chironna Maria</a>, <a href="/search?value1=Maria+Serena+Gallone&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gallone Maria Serena</a>, <a href="/search?value1=Silvio+Tafuri&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tafuri Silvio</a>, <a href="/search?value1=Fabio+Minelli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Minelli Fabio</a>, <a href="/search?value1=Antonella+Maugliani&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Maugliani Antonella</a>, <a href="/search?value1=Valeria+Michelacci&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Michelacci Valeria</a>, <a href="/search?value1=Luisa+Santangelo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Santangelo Luisa</a>, <a href="/search?value1=Onofrio+Mongelli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mongelli Onofrio</a>, <a href="/search?value1=Cosimo+Montagna&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Montagna Cosimo</a>, <a href="/search?value1=Gaia+Scavia&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Scavia Gaia</a>, <a href="/search?value1=on+behalf+of+all+participants+of+the+Outbreak+investigation+team&option1=author&noRedirect=true" class="nonDisambigAuthorLink">on behalf of all participants of the Outbreak investigation team</a></span>. Community-wide outbreak of haemolytic uraemic syndrome associated with Shiga toxin 2-producing Escherichia coli O26:H11 in southern Italy, summer 2013. <a href="/content/ecdc">Euro Surveill.</a> 2016;21(38):pii=30343. <a href="https://doi.org/10.2807/1560-7917.ES.2016.21.38.30343" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2016.21.38.30343</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 03 Jul 2015;&nbsp;&nbsp; <span class="generated">Accepted</span>: 18 Oct 2015 </span> </p>
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