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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

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Abstract

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 (stx 2 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.

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Abbreviations

EAEC:

Enteroaggregative Escherichia coli

EHEC:

Enterohemorrhagic Escherichia coli

EAHEC:

Enteroaggregative hemorrhagic Escherichia coli

HUS:

Hemolytic–uremic syndrome

Stx:

Shiga toxin

ESBL:

Extended-spectrum β-lactamase

CTX-M-15:

Type of β-lactamase (class A)

TEM:

Type of β-lactamase (class A)

MALDI-TOF MS:

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

NIPH:

National Institute of Public Health

NRL:

National Reference Laboratory

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Acknowledgments

The first author is indebted to Prof. Dr. H. Karch, the Head of the National Consulting Laboratory for Hemolytic–Uremic Syndrome at the Institute for Hygiene, University of Münster (Germany) for the possibility to get trained in this laboratory in diagnosis of EHEC infections. The authors are also thankful to Assoc. Prof. Dr. M. Bielaszewska (from the above Institute) for assistance provided to the Czech NRL for E. coli and Shigella, especially during the hectic time of the German outbreak, and for discussions during the preparation of this manuscript. The authors thank the laboratory colleagues, in particular Ms. M. Vašáková, and the collaborating microbiologists and clinicians for providing the patients’ data. The authors also thank BioVendor Ltd. (Czech Republic) for long-term access to the device Microflex for MALDI-TOF MS identification of bacteria.

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Authors and Affiliations

  1. National Reference Laboratory for E. coli and Shigella, National Institute of Public Health, Šrobárova 48, 100 42, Prague 10, Czech Republic

    M. Marejková & P. Petráš

  2. 3rd Medical Faculty, Charles University in Prague, Prague, Czech Republic

    M. Marejková

  3. Department of Infectious Diseases, University Hospital Bulovka, Prague, Czech Republic

    H. Roháčová & M. Reisingerová

Authors
  1. M. Marejková
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  2. H. Roháčová
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  3. M. Reisingerová
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  4. P. Petráš
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Correspondence to M. Marejková.

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Marejková, M., Roháčová, H., Reisingerová, M. et al. 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. Folia Microbiol 57, 85–89 (2012). https://doi.org/10.1007/s12223-011-0095-0

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