Haemolytic-uraemic syndrome with bacteraemia caused by a new hybrid Escherichia coli pathotype.

P Mariani-Kurkdjian,L Boggini,D Perez,S Bonacorsi,C Lemaître,T Kwon,P Bidet

doi:10.1002/nmi2.49

Abstract

We describe a new atypical Shiga-toxin-producing Escherichia coli (STEC) responsible for a severe episode of haemolytic–uraemic syndrome in an adult with a relapse associated with bacteraemia. This STECs train of serotype O80:H2 harboured stx2c and stx2d gene subtypes, the rare eae ξ variant and a ColV plasmid with a conserved virulence plasmidic region involved in virulence of human and avian extraintestinal pathogenic E. coli. This atypical hybrid pathotype, which represents a new threat, is a further demonstration that STEC may be a recipient for extraintestinal virulence factors and raises again the question of antibiotic therapy during STEC infection.

Highlights

Among the intestinal pathogenic Escherichia coli, Shiga-toxin-producing E. coli (STEC) are major food-borne emerging pathogens that cause bloody diarrhoea, which may be complicated by the potentially fatal haemolytic–uraemic syndrome (HUS), an important cause of acute renal failure [1]
As the STEC strain was isolated from blood cultures, major virulence factors of extraintestinal pathogenic E. coli (ExPEC) were sought by PCR
A first screening indicated the presence of genes encoding salmochelin and aerobactin, whose combination suggested the presence of a conserved virulence plasmidic region characteristic of ColV plasmids described in ExPEC strains [4,5]

Summary

Introduction

Among the intestinal pathogenic Escherichia coli, Shiga-toxin-producing E. coli (STEC) are major food-borne emerging pathogens that cause bloody diarrhoea, which may be complicated by the potentially fatal haemolytic–uraemic syndrome (HUS), an important cause of acute renal failure [1]. While other intestinal virulence factors have been described in STEC, extraintestinal manifestations are rare and virulence factors characteristic of extraintestinal pathogenic E. coli (ExPEC) have been rarely reported. Stool cultures yielded a Shiga-toxin-2-producing E. coli, which confirmed the diagnosis of HUS. Three weeks after his admission, while blood parameters were returning to normal, the patient again presented severe anaemia (haemoglobin, 6.1 g/dL) with thrombopenia (48 000/ mm3) and schistocytes (1.7%).

Results

Conclusion