Wiener klinische Wochenschrift

, Volume 121, Issue 3–4, pp 108–112 | Cite as

Sorbitol-fermenting Shiga toxin-producing Escherichia coli O157 in Austria

  • Dorothea Orth
  • Katharina Grif
  • Lothar Bernd Zimmerhackl
  • Reinhard Würzner
Review article

Summary

Infections with enterohemorrhagic Escherichia coli (EHEC) are the major cause of hemolytic uremic syndrome (HUS), the most common cause of acute renal failure in childhood. Shiga toxins are considered to be the most important virulence factor of EHEC strains. Non-sorbitol-fermenting EHEC O157:H7 is still the most prevalent serotype isolated worldwide; however, sorbitol-fermenting (SF) EHEC O157:H- (H- indicates nonmotility) strains are increasingly reported. Thirteen SF EHEC O157:H- strains (11 of human origin, two from animals) were detected in Austria between 2002 and 2008. Among the 11 human cases, seven suffered from HUS, two from diarrhea and the remaining two were asymptomatic. Seven of the cases were identified in patients living in or visiting (in one case) the province Salzburg, four were in patients from the province Vorarlberg. Three outbreaks with no more than three persons involved were detected, the other four cases occurred sporadically. The pulsed-field gel-electrophoresis banding patterns of the 13 SF EHEC O157:H- isolates were grouped into three distinct clusters (groups 1, 2 and 3). Strains of the three outbreaks were identical (except for one outbreak strain with one band difference) within each outbreak. In comparison, the Bavarian epidemic strain showed a pattern different from all SF O157:H- strains isolated in Austria. For effective detection of SF EHEC O157:H-, screening for Shiga toxins by ELISA and/or Shiga toxin genes by PCR is absolutely necessary; screening on the basis of phenotypic characteristics such as sorbitol-non-fermentation is not sufficient. Typing methods relying solely on investigation of O157 will detect these strains but should nevertheless also be avoided, so that the prevalent non-O157 strains causing HUS are not missed.

Keywords

EHEC SF O157:H- HUS Outbreak PFGE 

Sorbit-fermentierende Shigatoxin-produzierende Escherichia coli O157 in Österreich

Zusammenfassung

Infektionen mit enterohämorrhagischen Escherichia coli (EHEC) sind die Hauptursache für das hämolytisch urämische Syndrom (HUS), die häufigste Ursache für akutes Nierenversagen im Kindesalter. Shigatoxine stellen den Hauptvirulenzfaktor von EHEC Stämmen dar. Nicht-sorbit-fermentierende EHEC O157:H7 sind zwar immer noch der am häufigsten isolierte Serotyp weltweit, es wird jedoch zunehmend von Sorbit-fermentierenden (SF) O157:H- (H- bezeichnet die fehlende Motilität) berichtet. In Österreich wurden 13SF EHEC O157:H- (11 humanen und zwei tierischen Ursprungs) in den Jahren 2002–2008 isoliert. Unter den 11 humanen Fällen waren sieben Patienten an einem HUS erkrankt, zwei litten an Diarrhö und zwei weitere waren asymptomatisch. Die Mehrheit der SF O157:H- Fälle (n = 7) wurde von Kindern aus Salzburg und vier von Patienten aus Vorarlberg isoliert. Unter den SF O157:H- Fällen wurden drei Ausbrüche mit jedoch nicht mehr als drei Beteiligten und vier sporadische Fälle diagnostiziert. Das Pulsfeld-Gelelektrophorese (PFGE) Bandenmuster der 13 SF O157:H- ergab drei verschiedene Cluster (Gruppen 1, 2 und 3). Die Stämme der drei Ausbrüche zeigten identische Bandenmuster (bzw. in einem Stamm eine Bande Unterschied) untereinander. Der Bayrische Ausbruchstamm zeigte ein anderes Bandenmuster als alle SF O157:H- Stämme, die in Österreich isoliert wurden. Für eine erfolgreiche Detektion von SF EHEC O157:H- ist ein Screening auf Shigatoxine mittels ELISA und/oder Shigatoxin Gene mittels PCR unerlässlich, ein Screening basierend auf phänotypischen Charakteristika, wie die fehlende Sorbitfermentation ist nicht ausreichend. Typisierungsmethoden, die alleine auf dem Nachweis von O157 beruhen, werden zwar diese Stämme identifizieren, sollten aber ebenso verlassen werden, um die prävalenten non-O157 Stämme, die auch HUS verursachen, nicht zu übersehen.

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Dorothea Orth
    • 1
  • Katharina Grif
    • 1
  • Lothar Bernd Zimmerhackl
    • 2
  • Reinhard Würzner
    • 1
  1. 1.Austrian Reference Center for Enterohemorrhagic Escherichia coli, Department of Hygiene, Microbiology and Social MedicineInnsbruck Medical UniversityInnsbruckAustria
  2. 2.Department of PediatricsInnsbruck Medical UniversityInnsbruckAustria

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