Abstract
Hybrid E. coli pathotypes are representing emerging public health threats with enhanced virulence from different pathotypes. Hybrids of Shiga toxin-producing and enterotoxigenic E. coli (STEC/ETEC) have been reported to be associated with diarrheal disease and hemolytic uremic syndrome (HUS) in humans. Here, we identified and characterized four clinical STEC/ETEC hybrids from diarrheal patients with or without fever or abdominal pain and healthy contact in Sweden. Rare stx2 subtypes were present in STEC/ETEC hybrids. Stx2 production was detectable in stx2a and stx2e containing strains. Different copies of ETEC virulence marker, sta gene, were found in two hybrids. Three sta subtypes, namely, sta1, sta4 and sta5 were designated, with sta4 being predominant. The hybrids represented diverse and rare serotypes (O15:H16, O187:H28, O100:H30, and O136:H12). Genome-wide phylogeny revealed that these hybrids exhibited close relatedness with certain ETEC, STEC/ETEC hybrid and commensal E. coli strains, implying the potential acquisition of Stx-phages or/and ETEC virulence genes in the emergence of STEC/ETEC hybrids. Given the emergence and public health significance of hybrid pathotypes, a broader range of virulence markers should be considered in the E. coli pathotypes diagnostics, and targeted follow up of cases is suggested to better understand the hybrid infection.
Highlights
Have been further classified into three Stx[1] subtypes (Stx1a, Stx1c, and Stx1d) and seven Stx[2] subtypes (Stx2a to 2 g) in E. coli strains based on sequences similarities and phylogenetic analysis[2]
STEC/ETEC hybrids have been identified from animals and humans in Finland[22]
We report four STEC/ ETEC hybrid strains among 195 clinical STEC strains in Sweden over a 15 years-period investigation
Summary
Have been further classified into three Stx[1] subtypes (Stx1a, Stx1c, and Stx1d) and seven Stx[2] subtypes (Stx2a to 2 g) in E. coli strains based on sequences similarities and phylogenetic analysis[2]. ETEC, which is defined by the presence of the plasmid-encoded heat-labile (LT) and/or heat-stable toxins (ST)[8], has been identified as a major cause of significant diarrheal illness worldwide[9,10]. STEC/ETEC hybrids have been recovered from various sources including humans, animals, food, and water[18,19,20,21], and some STEC/ETEC strains have been associated with diarrheal disease and HUS in humans[22,23]. The phylogenomic analysis was used to assess the phylogenetic position of these hybrids among a diverse collection of E. coli and Shigella spp. representing all major pathotypes. Based on these results, we discuss the potential public health importance of these hybrid E. coli strains
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