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Strong Association Between Shiga Toxin-Producing Escherichia coli O157 and Virulence Genes stx 2 and eae as Possible Explanation for Predominance of Serogroup O157 in Patients with Haemolytic Uraemic Syndrome

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Abstract

The aim of this study was to investigate the association between Shiga toxin-producing Escherichia coli (STEC) O157 and the simultaneous presence of the virulence genes stx 2 and eae in STEC from patients with gastroenteritis. In Germany, the proportion of serogroup O157 is substantially higher among STEC isolates from patients with haemolytic uraemic syndrome (HUS) than among STEC isolates from patients with gastroenteritis. The reason for this is unknown. Independent of serogroup, the virulence genes stx 2 and eae have been associated with severe disease. Data collected in 2000–2001 from a Germany-wide laboratory-based surveillance system for STEC-associated gastroenteritis in patients <15 years were analysed. Overall, 18% of the STEC isolates belonged to serogroup O157. Compared with non-O157 strains, 0157 isolates were strongly associated with the simultaneous presence of both an stx 2 gene and the eae gene (OR, 76; 95%CI, 27–230). Within the subset of STEC isolates that carried both virulence genes, 60% belonged to serogroup O157, a proportion similar to that found in STEC isolates from pediatric patients with HUS in Germany and Austria (67%, P=0.35). These data suggest that the more frequent carriage of both virulence genes, i.e. stx 2 and eae, forms the basis of why STEC O157 predominates in patients with HUS.

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Acknowledgements

We thank Dr. Hermann Claus for providing the NRC with a sophisticated database and Susanne Behnke for technical assistance. Financial support was provided by the German Ministry of Education and Research, Project “Emerging Foodborne Pathogens in Germany” (grant no. 01KI0202).

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Author notes

  1. M. H. Kramer

    Present address: Referat 325, Bundesministerium für Gesundheit und Soziale Sicherung, Am Propsthof 78a, 53121, Bonn, Germany

Authors and Affiliations

  1. Department for Infectious Disease Epidemiology, Robert Koch-Institut, Seestrasse 10, 13353, Berlin, Germany

    D. Werber, U. Buchholz, M. H. Kramer & A. Ammon

  2. National Reference Centre for Salmonella and Other Bacterial Enteric Pathogens, Robert Koch-Institut, Burgstrasse 37, 38855, Wernigerode, Germany

    A. Fruth, R. Prager & H. Tschäpe

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  1. D. Werber
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  2. A. Fruth
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  3. U. Buchholz
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  7. H. Tschäpe
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Correspondence to D. Werber.

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Werber, D., Fruth, A., Buchholz, U. et al. Strong Association Between Shiga Toxin-Producing Escherichia coli O157 and Virulence Genes stx 2 and eae as Possible Explanation for Predominance of Serogroup O157 in Patients with Haemolytic Uraemic Syndrome. Eur J Clin Microbiol Infect Dis 22, 726–730 (2003). https://doi.org/10.1007/s10096-003-1025-0

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