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Sorbitol-fermenting enterohaemorrhagic Escherichia coli O157:H causes another outbreak of haemolytic uraemic syndrome in children

  • K. ALPERS (a1), D. WERBER (a1), C. FRANK (a1), J. KOCH (a1), A. W. FRIEDRICH (a2), H. KARCH (a2), M. AN DER HEIDEN (a1), R. PRAGER (a3), A. FRUTH (a3), M. BIELASZEWSKA (a2), G. MORLOCK (a4), A. HEISSENHUBER (a4), A. DIEDLER (a5), A. GERBER (a6) and A. AMMON (a1)...
Abstract
SUMMARY

An outbreak of haemolytic uraemic syndrome (HUS) among children caused by infection with sorbitol-fermenting enterohaemorrhagic Escherichia coli O157:H (SF EHEC O157:H) occurred in Germany in 2002. This pathogen has caused several outbreaks so far, yet its reservoir and routes of transmission remain unknown. SF EHEC O157:H is easily missed as most laboratory protocols target the more common sorbitol non-fermenting strains. We performed active case-finding, extensive exploratory interviews and a case-control study. Clinical and environmental samples were screened for SF EHEC O157:H and the isolates were subtyped by pulsed-field gel electrophoresis. We identified 38 case-patients in 11 federal states. Four case-patients died during the acute phase (case-fatality ratio 11%). The case-control study could not identify a single vehicle or source. Further studies are necessary to identify the pathogen's reservoir(s). Stool samples of patients with HUS should be tested with an adequate microbiological set-up to quickly identify SF EHEC O157:H.

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Corresponding author
*Author for correspondence: K. Alpers, M.D., M.Sc. (Epi), DTM&H, Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 10, D-13353 Berlin, Germany. (Email: alpersk@rki.de)
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1.  PI Tarr , CA Gordon , WL. Chandler Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet 2005; 365: 10731086.

3.  A Ammon , LR Petersen , H. Karch A large outbreak of hemolytic uremic syndrome caused by an unusual sorbitol-fermenting strain of Escherichia coli O157:H. Journal of Infectious Diseases 1999; 179: 12741277.

5.  JM Rangel , Epidemiology of Escherichia coli O157:H7 outbreaks, United States, 1982–2002. Emerging Infectious Diseases 2005; 11: 603609.

9.  A Gerber , 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. Journal of Infectious Diseases 2002; 186: 493500.

12.  M Eklund , Molecular and phenotypic profiling of sorbitol-fermenting Escherichia coli O157:H human isolates from Finland. Clinical Microbiology and Infection 2006; 12: 634641.

13.  KA Bettelheim , First isolation outside Europe of sorbitol-fermenting verocytotoxigenic Escherichia coli (VTEC) belonging to O group O157. Journal of Medical Microbiology 2002; 51: 713714.

14.  JH Lee , SJ. Choi Isolation and characteristics of sorbitol-fermenting Escherichia coli O157 strains from cattle. Microbes and Infection 2006; 8: 20212026.

16.  AW Friedrich , Distribution of the urease gene cluster among and urease activities of enterohemorrhagic Escherichia coli O157 isolates from humans. Journal of Clinical Microbiology 2005; 43: 546550.

17.  M Bielaszewska , Phenotypic and molecular analysis of tellurite resistance among enterohemorrhagic Escherichia coli O157:H7 and sorbitol-fermenting O157:NM clinical isolates. Journal of Clinical Microbiology 2005; 43: 452454.

20.  SB Hunter , Establishment of a universal size standard strain for use with the PulseNet standardized pulsed-field gel electrophoresis protocols: converting the national databases to the new size standard. Journal of Clinical Microbiology 2005; 43: 10451050.

21.  M Bitzan , High incidence of serum antibodies to Escherichia coli O157 lipopolysaccharide in children with hemolytic-uremic syndrome. Journal of Pediatrics 1991; 119: 380385.

22.  A Mellmann , Enterohemorrhagic Escherichia coli in human infection: in vivo evolution of a bacterial pathogen. Clinical Infectious Diseases 2005; 41: 785792.

23.  SH Cody , An outbreak of Escherichia coli O157:H7 infection from unpasteurized commercial apple juice. Annals of Internal Medicine 1999; 130: 202209.

24.  CM Taylor , The expression of blood group P1 in post-enteropathic haemolytic uraemic syndrome. Pediatric Nephrology 1990; 4: 59561.

26.  S Ethelberg , Virulence factors for hemolytic uremic syndrome, Denmark. Emerging Infectious Diseases 2004; 10: 842847.

27.  D Werber , Strong association between shiga toxin-producing Escherichia coli O157 and virulence genes stx2 and eae as possible explanation for predominance of serogroup O157 in patients with haemolytic uraemic syndrome. European Journal of Clinical Microbiology & Infectious Disease 2003; 22: 726730.

29.  M Bielaszewska , Chromosomal dynamism in progeny of outbreak-related sorbitol-fermenting enterohemorrhagic Escherichia coli O157:NM. Applied and Environmental Microbiology 2006; 72: 19001909.

30.  D Werber , Shiga toxin-producing Escherichia coli infection in Germany: different risk factors for different age groups. American Journal of Epidemiology 2007; 165: 425434.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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