Abstract
The Shiga toxins of Shiga toxin-producing Escherichia coli (STEC) can be divided into Shiga toxin 1 (Stx1) and Shiga toxin 2 (Stx2) with several sub-variants. Variant Stx2f is one of the latest described, but has been rarely associated with symptomatic human infections. In the enhanced STEC surveillance in the Netherlands, 198 STEC O157 cases and 351 STEC non-O157 cases, including 87 stx2f STEC isolates, were reported between 2008 and 2011. Most stx2f strains belonged to the serogroups O63:H6 (n=47, 54%), O113:H6 (n=12, 14%) and O125:H6 (n=12, 14%). Of the 87 stx2f isolates, 84 (97%) harboured the E. coli attaching and effacing (eae) gene, but not the enterohaemorrhagic E. coli haemolysin (hly) gene. stx2f STEC infections show milder symptoms and a less severe clinical course than STEC O157 infections. Almost all infections with stx2f (n=83, 95%) occurred between June and December, compared to 170/198 (86%) of STEC O157 and 173/264 (66%) of other STEC non-O157. stx2f STEC infections in the Netherlands are more common than anticipated, and form a distinct group within STEC with regard to virulence genes and the relatively mild disease.
Highlights
Shiga toxin-producing Escherichia coli (STEC) is an important pathogen worldwide, associated with human illness, most notably diarrhoea, bloody diarrhoea, haemorrhagic colitis, and haemolytic uraemic syndrome (HUS) [1,2]
Putative STEC colonies are tested by polymerase chain reaction (PCR) for the presence of the Shiga toxin 1, Shiga toxin 2, E. coli attaching and effacing and enterohaemorrhagic E. coli haemolysin genes using primers as described by Paton et al [14]
Between 2008 and 2011, a total of 549 STEC cases were reported for which the STEC could be isolated and typed, resulting in 198 O157 infections and 351 non-O157 infections (Table 1)
Summary
Shiga toxin-producing Escherichia coli (STEC) is an important pathogen worldwide, associated with human illness, most notably diarrhoea, bloody diarrhoea, haemorrhagic colitis, and haemolytic uraemic syndrome (HUS) [1,2]. Shiga toxin is an essential factor for the development of severe symptoms like HUS and can be divided into two main types: Shiga toxin 1 (Stx1) and Shiga toxin 2 (Stx). Shiga toxin is an essential factor for the development of severe symptoms like HUS and can be divided into two main types: Shiga toxin 1 (Stx1) and Shiga toxin 2 (Stx2) Within both groups, several variants are distinguished. Reports of human illness due to stx2f STEC are scarce [5,8,9]. Prager et al [12] presented data from 32 stx2f STEC cases identified between 2004 and 2007 in Germany, suggesting that this might be an emerging pathogen. During a multi-centre study in the Netherlands (2005–2006), isolates of 21 STEC cases were tested for stx2f of which three (14%) tested positive, which, at that time, was already higher than expected based on the previous international reports [13]
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