Folia Microbiologica

, Volume 57, Issue 2, pp 85–89

An imported case of bloody diarrhea in the Czech Republic caused by a hybrid enteroaggregative hemorrhagic Escherichia coli (EAHEC) O104:H4 strain associated with the large outbreak in Germany, May 2011

  • M. Marejková
  • H. Roháčová
  • M. Reisingerová
  • P. Petráš

DOI: 10.1007/s12223-011-0095-0

Cite this article as:
Marejková, M., Roháčová, H., Reisingerová, M. et al. Folia Microbiol (2012) 57: 85. doi:10.1007/s12223-011-0095-0


A large outbreak caused by a rare Shiga toxin-producing Escherichia coli serotype O104:H4 occurred in Germany in May to July 2011. The National Reference Laboratory for E. coli and Shigella investigated the stool sample from an American tourist with bloody diarrhea who arrived in the Czech Republic from Germany where she consumed salads with raw vegetable a week ago. Using culture of the enriched stool on extended-spectrum β-lactamase agar, we isolated E. coli strain which belonged to serotype O104:H4 as determined by conventional and molecular serotyping. The strain contained the major virulence characteristics of enterohemorrhagic E. coli (stx2 encoding Shiga toxin 2) and enteroaggregative E. coli (aggA encoding aggregative adherence fimbriae I). This unique combination of virulence traits demonstrated that this strain belongs to the hybrid enteroaggregative hemorrhagic E. coli clone which caused the German outbreak. Using advanced culture and molecular biological approaches is the prerequisite for identification of new, unusual pathogens.



Enteroaggregative Escherichia coli


Enterohemorrhagic Escherichia coli


Enteroaggregative hemorrhagic Escherichia coli


Hemolytic–uremic syndrome


Shiga toxin


Extended-spectrum β-lactamase


Type of β-lactamase (class A)


Type of β-lactamase (class A)


Matrix-assisted laser desorption ionization time-of-flight mass spectrometry


National Institute of Public Health


National Reference Laboratory

Copyright information

© Institute of Microbiology, Academy of Sciences of the Czech Republic, v.v.i. 2012

Authors and Affiliations

  • M. Marejková
    • 1
    • 2
  • H. Roháčová
    • 3
  • M. Reisingerová
    • 3
  • P. Petráš
    • 1
  1. 1.National Reference Laboratory for E. coli and ShigellaNational Institute of Public HealthPrague 10Czech Republic
  2. 2.3rd Medical Faculty, Charles University in PraguePragueCzech Republic
  3. 3.Department of Infectious DiseasesUniversity Hospital BulovkaPragueCzech Republic