Abstract

In 2011, an outbreak of hemorrhagic colitis and hemolytic uremic syndrome (HUS) was reported in Europe that was related to a hybrid STEAEC of Escherichia coli (E. coli) O104:H4 strain. The current study aimed to analyze strains of E. coli O104 and O9 isolated before 2011. The study included 47 strains isolated from children with and without diarrhea between 1986 and 2009 from different geographic regions, as well as seven reference strains. Serotyping was carried out on 188 anti-O and 53 anti-H sera. PCR was used to identify DEC genes and phylogenetic groups. Resistance profiles to antimicrobials were determined by diffusion in agar, while PFGE was used to analyze genomic similarity. Five serotypes of E. coli O104 and nine of O9 were identified, as well as an antigenic cross-reaction with one anti-E. coli O9 serum. E. coli O104 and O9 presented diarrheagenic E. coli (DEC) genes in different combinations and were located in commensal phylogenetic groups with different antimicrobial resistance. PFGE showed that O104:H4 and O9:(H4, NM) strains from SSI, Bangladesh and México belong to a diverse group located in the same subgroup. E. coli O104 and O9 were classified as commensal strains containing DEC genes. The groups were genetically diverse with pathogenic potential making continued epidemiologic surveillance important.

Highlights

  • In 2011, an outbreak of hemorrhagic colitis (HC) and hemolytic uremic syndrome (HUS) was reported in various European countries [1]

  • The results from this review showed that we housed isolates from Mexico, Egypt, Bangladesh and Argentina, in Mexico there were no reports referring to HUS or HC related to E. coli O104

  • The same assay for the anti-E. coli O104 serum against O9 and O104 antigens showed a response at a dilution of 1:200 and 1:1600, respectively (Supplementary Table S1)

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Summary

Introduction

In 2011, an outbreak of hemorrhagic colitis (HC) and hemolytic uremic syndrome (HUS) was reported in various European countries [1]. Those affected were adults over the age of 20 years and importantly, women were affected in greater numbers than men [2]. While searching for the agent responsible for the outbreak, a strain of Escherichia coli (E. coli) STEC no-O157 of the O104:H4 serotype was identified. Genetic analysis of this strain showed the presence of the aatA, aggR, aap, agg, and aggC genes of enteroaggregative E. coli (EAEC) and stx of Shiga toxin-producing E. coli (STEC), leading to the notion that this was an STEAEC hybrid strain [4,5,6]. The term EAHEC was proposed for strains that contain these genes, and they were identified as being

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