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Virulence factors and O groups of Escherichia coli isolates from patients with acute pyelonephritis, cystitis and asymptomatic bacteriuria

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Abstract

The relationship between the presence of bacterial virulence factors and the severity of urinary tract infection (UTI) was analized in this study. The production of α-hemolysin (Hly), the expression of P-fimbriae and the mannose-resistant hemagglutination (MRHA) type IVa (associated with the presence of P-fimbriae), were all detected more frequently in Escherichia coli strains from acute pyelonephritis than in strains isolated from cystitis and asymptomatic bacteriuria. In contrast, the production of cytotoxic necrotizing factor type 1 (CNF1) and the expression of MRHA types III and IVb were distributed uniformly between strains causing different clinical categories of UTI. Thus 88% of the E. coli strains from acute pyelonephritis showed some of the virulence factors investigated in this study, whereas only 60% (p < 0.01) and 56% (p < 0.01) repectively of the strains isolated from cystitis and asymptomatic bacteriuria possessed virulence factors. There were no significant differences in the prevalence of virulence properties between strains isolated from patients with or without complicating factors. Only 16% (p < 0.001) of the fecal isolates from healthy individuals showed virulence factors. The virulence factors were concentrated in strains belonging to 10 (O1, O2, O4, O6, O7, O14, O18, O22, O75 and 083) of the 12 serogroups most frequently detected in uropathogenic E.coli strains. The majority of uropathogenic O4, O6, O14, O22, O75 and O83 E.coli strains were Hly+CNF1+ and expressed P-fimbriae or MRHA type III, whereas the strains of serogroup O18 were Hly+CNFI− and P-fimbriated. Among O1 and O7 strains we found Hly− CNF1−strains that expressed P-fimbriae. Among O2 strains we found Hly+CNF1+ strains that expressed P-fimbriae or MRHA type III and other Hly−CNF1−strains that possessed P-fimbriae. We conclude that E.coli strains isolated from pyelonephritis show virulence factors more frequently than those from cystitis and asymptomatic bacteriuria, and that strains that cause urinary tract infections in Spain belong to the same serogroups as uropathogenic E.coli isolated in other areas of the world. Our results support the special pathogenicity theory and suggest that many cases of serious urogenital disease may be caused by a limited number of P-fimbriated E.coli strains that usually produce α-hemolysin.

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References

  1. Johnson JR. Virulence factors in Escherichia coli urirany tract infection. Clin Microbiol Rev 1991; 4: 80–128.

    Google Scholar 

  2. Ørskov I, Ørskov F. Escherichia coli in extraintestinal infections. J Hyg Camb 1985; 95: 551–575.

    Google Scholar 

  3. Korhonen TK, Virkola R, Westerlund B, Tarkkanen AM, Lähteenmäki K, Sareneva T, Parkkinen J, Kuusela P, Holthöfer H. Tissue interactions of Escherichia coli adhesins. Antonie van Leeuwenhoek 1988; 54: 411–420.

    Google Scholar 

  4. Svanborg Edén C, Hansson HA. Escherichia coli pili as possible mediators of attachment to human urinary tract epithelial cells. Infect Immun 1978; 21: 229–237.

    Google Scholar 

  5. Källenius G, Möllby R. Adhesion of Escherichia coli to human periurethral cells correlated to mannoseresistant agglutination of human erythrocytes. FEMS Microbiol Lett 1979; 5: 295–299.

    Google Scholar 

  6. Blanco J, Alonso MP, Blanco M, Blanco JE, Gonzäléz EA, Garabal JI. Establishment of three categories of P-fimbriated Escherichia coli strains that show different phenotypes and belong to particular O serogroups. FEMS Microbiol Lett 1992; 99: 131–136.

    Google Scholar 

  7. Domingue GJ, Roberts JA, Laucirica R, Ratner MH, Bell DP, Suarez GM, Kallenius G, Svenson S. Pathogenic significance of P-fimbriated Escherichia coli in urinary tract infections. J Urol 1985; 133: 983–989.

    Google Scholar 

  8. Alonso P, Blanco J, Blanco M, González EA. Frequent production of toxins by Escherichia coli strains isolated from human urinary tract infections: relation with haemagglutination. FEMS Microbiol Lett 1987; 48: 391–396.

    Google Scholar 

  9. Blanco J, Blanco M, Alonso MP, Blanco JE, González EA, Garabal JI. Characteristics of haemolytic Escherichia coli with particular reference to production of cytotoxic necrotizing factor type 1 (CNF1). Res Microbiol 1992; 143: 869–878.

    Google Scholar 

  10. Caprioli A, Falbo V, Ruggeri FM, Minelli F, Ørskov I, Donelli G. Relationship between cytotoxic necrotizing factor production and serotype in hemolytic Escherichia coli. J Clin Microbiol 1989; 27: 758–761.

    Google Scholar 

  11. 11.Czirók E. Virulence factors of Escherichia coli. II. Antigens 04, 06 and 018, haemolysin production and mannose resistant haemagglutinating capacity are closely associated. Acta Microbiol Hung 1985; 32: 183–192.

    Google Scholar 

  12. Blanco JE, Blanco J, Blanco M, Alonso MP, Jansen WH. Serotypes of CNF1-producing Escherichia coli strains that cause extraintestinal infections in humans. Eur J Epidemiol 1994; 10: 707–711.

    Google Scholar 

  13. Ikäheimo R, Siitonen A, Kärkkäinen U, Mäkelä PH. Virulence characteristics of Escherichia coli in nosocomial urinary tract infection. Clin Infect Dis 1993; 16: 785–791.

    Google Scholar 

  14. Siegfried L, Kmetova M, Puzova H, Molokacova M, Filka J. Virulence-associated factors in Escherichia coli strains isolated from children with urinary tract infections. J Med Microbiol 1994; 41: 127–132.

    Google Scholar 

  15. Ulleryd P, Lincoln K, Scheutz F, Sandberg T. Virulence characteristics of Escherichia coli in relation to host response in men with symptomatic urinary tract infection. Clin Infect Dis 1994; 18: 579–584.

    Google Scholar 

  16. Hughes C, Hacker J, Roberts A, Goebel W. Hemolysin production as a virulence marker in symptomatic and asymptomatic urinary tract infections caused by Escherichia coli. Infect Immun 1983; 39: 546–551.

    Google Scholar 

  17. De Ree JM, Van den Bosch JF. Fimbrial serotypes of Escherichia coli strains isolated from extra-intestinal infections. J Med Microbiol 1989; 29: 95–99.

    Google Scholar 

  18. Devine DA, Robinson L, Roberts AP. Occurrence of K1, K5 and O antigens in Escherichia coli isolates from patients with urinary tract infections or bacteraemia. J Med Microbiol 1989; 30: 295–299.

    Google Scholar 

  19. Blanco J, González EA, Blanco M, Garabal JI, Alonso MP, Jansen WH, Guinee PAM. Prevalence of enterotoxigenic Escherichia coli strains in outbreaks and sporadic cases of diarrhoea in Spain. Eur J Clin Microbiol Infect Dis 1989; 8: 396–400.

    Google Scholar 

  20. Blanco J, Alonso MP, Gonzälez EA, Blanco M, Garabal JI. Virulence factors of bacteraemic Escherichia coli with particular reference to production of cytotoxic necrotizing factor (CNF) by P-fimbriate strains. J Med Microbiol 1990; 31: 175–183.

    Google Scholar 

  21. Blanco J, Blanco M, Gonzälez EA, Alonso MP, Garabal JI. Comparative evaluation of three tests for the detection of Escherichia coli cytotoxic necrotizing factors (CNF1 and CNF2) using filtrates of cultures treated with mitomycin C. FEMS Microbiol Lett 1990; 69: 311–316.

    Google Scholar 

  22. De Rycke J, Gonzälez EA, Blanco J, Oswald E, Blanco M, Boivin R. Evidence for two types of cytotoxic necrotizing factor in human and animal clinical isolates of Escherichia coli. J Clin Microbiol 1990; 28: 694–699.

    Google Scholar 

  23. Kärkkäinen U, Ikäheimo R, Katila ML, Mäntyjärvi R. P fimbriation of Escherichia coli strains from patients with urosepsis demonstrated by a commercial agglutination test (PF TEST). J Clin Microbiol 1991; 29: 221–224.

    Google Scholar 

  24. Guinée PAM, Agterberg CM, Jansen WH. Escherichia coli O antigen typing by means of a mechanized microtechnique. Appl Microbiol 1972; 24: 127–131.

    Google Scholar 

  25. Blanco J, Blanco M, Alonso MP, Blanco JE, Garabal JI, Gonzälez EA. Serogroups of Escherichia coli strains producing cytotoxic necrotizing factors CNF1 and CNF2. FEMS Microbiol Lett 1992; 96: 155–160.

    Google Scholar 

  26. Van den Bosch JF, Postma P, Koopman PAR, de Graaff J, MacLaren DM, Van Brenk DG, Guinée PAM. Virulence of urinary and faecal Escherichia coli in relation to serotype, haemolysis and haemagglutination. J Hyg Camb 1982; 88: 567–577.

    Google Scholar 

  27. Källenius G, Möllby R, Svenson SB, Helin I, Hultberg H, Cedergren B, Winberg J. Occurrence of P-fimbriated Escherichia coli in urinary tract infections. Lancet 1981; ii: 1369–1372.

    Google Scholar 

  28. Väisänen V, Elo J, Tallgren LG, Siitonen A, Mäkelä PH, Svanborg-Edén C, Källenius G, Svenson SB, Hultberg H, Korhonen T. Mannose-resistant heamagglutination and P antigen recognition are characteristic of Escherichia coli causing primary pyelonephritis. Lancet 1981; ii: 1366–1369.

    Google Scholar 

  29. Westerlund B, Siitonen A, Elo J, Williams PH, Korhonen TK, Mäkelä PH. Properties of Escherichia coli isolates from urinary tract infections in boys. J Infect Dis 1988; 158: 996–1002.

    Google Scholar 

  30. Green CP, Thomas VL. Hemagglutination of human type O erythrocytes, hemolysin production, and serogrouping of Escherichia coli isolates from patients with acute pyelonephritis, cystitis, and asymptomatic bacteriuria. Infect Immun 1981; 31: 309–315.

    Google Scholar 

  31. Sandberg T, Kaijser B, Lidin-Janson G, Lincoln K, Ørskov F, Ørskov I, Stokland E, Svanborg-Edén C. Virulence of Escherichia coli in relation to host factors in women with symptomatic urinary tract infection. J Clin Microbiol 1988; 26: 1471–1476.

    Google Scholar 

  32. Johnson JR, Roberts PL, Stamm WE. P fimbriae and other virulence factors in Escherichia coli urosepsis: association with patients' characteristics. J Infect Dis 1987; 156: 225–229.

    Google Scholar 

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Authors and Affiliations

  1. Departamento de Microbioloxia e Parasitoloxía, Facultade de Veterinaria, Universidade de Santiago de Compostela, Lugo, Spain

    Miguel Blanco, Jesús E. Blanco & Jorge Blanco

  2. Unidade de Microbioloxia, Complexo Hospitalario Xeral-Calde, Lugo, Spain

    M. Pilar Alonso

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  1. Miguel Blanco
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  2. Jesús E. Blanco
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  3. M. Pilar Alonso
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  4. Jorge Blanco
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Blanco, M., Blanco, J.E., Alonso, M.P. et al. Virulence factors and O groups of Escherichia coli isolates from patients with acute pyelonephritis, cystitis and asymptomatic bacteriuria. Eur J Epidemiol 12, 191–198 (1996). https://doi.org/10.1007/BF00145506

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