Abstract
In The Lancet Infectious Diseases, Helge Karch and colleagues 1 Bielaszewska M Mellmann A Zhang W et al. Characterisation of the Escherichia coli strain associated with an outbreak of haemolytic uraemic syndrome in Germany, 2011: a microbiological study. Lancet Infect Dis. 2011; (published online June 23.)https://doi.org/10.1016/S1473-3099(11)70165-7 Summary Full Text Full Text PDF PubMed Scopus (589) Google Scholar characterise the virulence profiles of E coli O104:H4 isolates from 80 patients in the large outbreak in Germany. The researchers show that all the isolates belong to a clone (HUSEC041) first isolated in Germany from a patient with haemolytic uraemic syndrome in 2001. The members of this clone have virulence profiles that combine those of two different enterovirulent E coli—enterohaemorrhagic E coli and enteroaggregative E coli. They have the stx2 locus typical of the first and the so called stacked-brick aggregative adherence typical of the second. The outbreak isolates (but not the 2001 strain) also have an extended spectrum β-lactamase (ESBL) antibiotic resistance profile. Karch and colleagues speculate very reasonably that the blending of enterohaemorrhagic and enteroaggregative virulence traits could explain why so many—about 30% of those infected—in the German outbreak have developed haemolytic uraemic syndrome (a variable combination of renal impairment, thrombocytopaenia, haemolytic anaemia, and CNS and myocardial damage). Characterisation of the Escherichia coli strain associated with an outbreak of haemolytic uraemic syndrome in Germany, 2011: a microbiological studyAugmented adherence of the strain to intestinal epithelium might facilitate systemic absorption of Shiga toxin and could explain the high progression to haemolytic uraemic syndrome. This outbreak demonstrates that blended virulence profiles in enteric pathogens, introduced into susceptible populations, can have extreme consequences for infected people. Full-Text PDF
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