EHEC O111:H8 strain and norovirus GII.4 Sydney [P16] causing an outbreak in a daycare center, Brazil, 2019

Lays Paula Bondi Volpini,Liliana Cruz Spano,Ricardo Pinto Schuenck,Celia Regina Nascimento Recco,Luís Fernando dos Santos,Caroline Gastaldi Guerrieri,Elizabeth Boina,Jaqueline Pegoretti Goulart,Tulio Machado Fumian,Rodrigo Ribeiro-Rodrigues

doi:10.1186/s12866-021-02161-x

Lays Paula Bondi Volpini, Liliana Cruz Spano + Show 8 more

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https://doi.org/10.1186/s12866-021-02161-x

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Abstract

BackgroundThis study describes the investigation of an outbreak of diarrhea, hemorrhagic colitis (HC), and hemolytic uremic syndrome (HUS) at a daycare center in southeastern Brazil, involving fourteen children, six staff members, six family members, and one nurse. All bacterial and viral pathogens detected were genetically characterized.ResultsTwo isolates of a strain of enterohemorrhagic Escherichia coli (EHEC) serotype O111:H8 were recovered, one implicated in a case of HUS and the other in a case of uncomplicated diarrhea. These isolates had a clonal relationship of 94% and carried the stx2a and eae virulence genes and the OI-122 pathogenicity island. The EHEC strain was determined to be a single-locus variant of sequence type (ST) 327. EHEC isolates were resistant to ofloxacin, doxycycline, tetracycline, ampicillin, and trimethoprim-sulfamethoxazole and intermediately resistant to levofloxacin and ciprofloxacin. Rotavirus was not detected in any samples, and norovirus was detected in 46.7% (14/30) of the stool samples, three of which were from asymptomatic staff members. The noroviruses were classified as the recombinant GII.4 Sydney [P16] by gene sequencing.ConclusionIn this outbreak, it was possible to identify an uncommon stx2a + EHEC O111:H8 strain, and the most recent pandemic norovirus strain GII.4 Sydney [P16]. Our findings reinforce the need for surveillance and diagnosis of multiple enteric pathogens by public health authorities, especially during outbreaks.

Highlights

This study describes the investigation of an outbreak of diarrhea, hemorrhagic colitis (HC), and hemolytic uremic syndrome (HUS) at a daycare center in southeastern Brazil, involving fourteen children, six staff members, six family members, and one nurse
Enterohemorrhagic/Shiga toxin-producing Escherichia coli (EHEC/STEC) is an important human pathogen that has been responsible for several outbreaks of hemorrhagic colitis (HC) and hemolytic uremic
An outbreak of gastroenteritis occurred in Vila Velha, Espírito Santo State, Brazil, from March 15 to April 7, 2019

Summary

Introduction

This study describes the investigation of an outbreak of diarrhea, hemorrhagic colitis (HC), and hemolytic uremic syndrome (HUS) at a daycare center in southeastern Brazil, involving fourteen children, six staff members, six family members, and one nurse. Enterohemorrhagic/Shiga toxin-producing Escherichia coli (EHEC/STEC) is an important human pathogen that has been responsible for several outbreaks of hemorrhagic colitis (HC) and hemolytic uremic. EHEC/STEC infection is considered to be associated with the consumption of meat and unpasteurized dairy products contaminated with cattle excrement during harvesting or processing. These animals are recognized as important hosts of O157 and non-O157 [8,9,10,11]. The severity of infection in human hosts is strongly correlated with toxin subtype. A low frequency of severe cases is observed in Brazil, which could partially be explained by the high frequency of isolates carrying only Stx and the low frequency of carriage of the Locus of Enterocyte Effacement (LEE) [5]

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