Skip to main content

Advertisement

SpringerLink
Log in

Diarrheagenic enteroaggregative Escherichia coli causing urinary tract infection and bacteremia leading to sepsis

  • Case Report
  • Published:
Infection Aims and scope Submit manuscript

Abstract

We report a case of a 55-year-old immunocompromised female who presented to the emergency department with severe diarrhea and vomiting following travel to the Philippines. Stool bacteriology revealed a mixed infection involving an enteropathogenic Escherichia coli and two distinct strains of enteroaggregative Escherichia coli (EAEC). During hospitalization, urine and blood culture tested positive for one of the diarrheagenic EAEC strains, necessitating urinary catheterization, intensive care, and antimicrobial treatment with trimethoprim–sulfamethoxazole, followed by meropenem. Although known to occasionally cause urinary tract infections, EAEC have not been previously associated with sepsis. Our report highlights the potential of EAEC to cause severe extraintestinal infections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Huang DB, Nataro JP, DuPont HL, Kamat PP, Mhatre AD, Okhuysen PC, et al. Enteroaggregative Escherichia coli is a cause of acute diarrheal illness: a meta-analysis. Clin Infect Dis. 2006;43:556–63.

    Article  PubMed  Google Scholar 

  2. Kaur P, Chakraborti A, Asea A. Enteroaggregative Escherichia coli: an emerging enteric food borne pathogen. Interdiscip Perspect Infect Dis. 2010;2010:254159.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  3. Rasko DA, Webster DR, Sahl JW, Bashir A, Boisen N, Scheutz F, et al. Origins of the E. coli strain causing an outbreak of hemolytic-uremic syndrome in Germany. N Engl J Med. 2011;365:709–17.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  4. Olesen B, Scheutz F, Andersen RL, Menard M, Boisen N, Johnston B, et al. Enteroaggregative Escherichia coli O78:H10, the cause of an outbreak of urinary tract infection. J Clin Microbiol. 2012;50:3703–11.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Murray PR, Baron EJ. Manual of clinical microbiology. Washington, D.C.: ASM Press; 2007.

    Google Scholar 

  6. Schmidt H, Knop C, Franke S, Aleksic S, Heesemann J, Karch H. Development of PCR for screening of enteroaggregative Escherichia coli. J Clin Microbiol. 1995;33:701–5.

    PubMed Central  PubMed  CAS  Google Scholar 

  7. Bernier C, Gounon P, Le Bouguénec C. Identification of an aggregative adhesion fimbria (AAF) type III-encoding operon in enteroaggregative Escherichia coli as a sensitive probe for detecting the AAF-encoding operon family. Infect Immun. 2002;70:4302–11.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  8. Karch H, Böhm H, Schmidt H, Gunzer F, Aleksic S, Heesemann J. Clonal structure and pathogenicity of Shiga-like toxin-producing, sorbitol-fermenting Escherichia coli O157:H-. J Clin Microbiol. 1993;31:1200–5.

    PubMed Central  PubMed  CAS  Google Scholar 

  9. Peters TM, Maguire C, Threlfall EJ, Fisher IS, Gill N, Gatto AJ; Salm-gene project. The Salm-gene project—a European collaboration for DNA fingerprinting for food-related salmonellosis. Euro Surveill. 2003;8:46–50.

    PubMed  CAS  Google Scholar 

  10. Wirth T, Falush D, Lan R, Colles F, Mensa P, Wieler LH, et al. Sex and virulence in Escherichia coli: an evolutionary perspective. Mol Microbiol. 2006;60:1136–51.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  11. Afset JE, Bruant G, Brousseau R, Harel J, Anderssen E, Bevanger L, et al. Identification of virulence genes linked with diarrhea due to atypical enteropathogenic Escherichia coli by DNA microarray analysis and PCR. J Clin Microbiol. 2006;44:3703–11.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  12. Boisen N, Scheutz F, Rasko DA, Redman JC, Persson S, Simon J, et al. Genomic characterization of enteroaggregative Escherichia coli from children in Mali. J Infect Dis. 2012;205:431–44.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  13. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; Twenty-first informational supplement. CLSI document M100-S21. Wayne, PA: CLSI. 2011.

  14. Boll EJ, Struve C, Boisen N, Olesen B, Stahlhut SG, Krogfelt KA. Role of enteroaggregative Escherichia coli virulence factors in uropathogenesis. Infect Immun. 2013;81:1164–71.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  15. Abe CM, Salvador FA, Falsetti IN, Vieira MAM, Blanco J, Blanco JE, et al. Uropathogenic Escherichia coli (UPEC) strains may carry virulence properties of diarrhoeagenic E. coli. FEMS Immunol Med Microbiol. 2008;52:397–406.

    Article  PubMed  CAS  Google Scholar 

  16. Navarro-Garcia F, Gutierrez-Jimenez J, Garcia-Tovar C, Castro LA, Salazar-Gonzalez H, Cordova V. Pic, an autotransporter protein secreted by different pathogens in the Enterobacteriaceae family, is a potent mucus secretagogue. Infect Immun. 2010;78:4101–9.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank R. Zbinden, Institute for Medical Microbiology, University of Zurich, Switzerland, for the mycobacterial analyses, and the Swiss Tropical Institute, Basel, Switzerland, for the parasitical analyses. We thank the Swiss Federal Office for Public Health for financial support in favor of the National Centre for Enteropathogenic Bacteria and Listeria at the Institute for Food Safety and Hygiene of the University of Zurich.

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Institute of Laboratory Medicine, Cantonal Hospital Frauenfeld, 8501, Frauenfeld, Switzerland

    K. Herzog

  2. Department of Nephrology and Internal Medicine, Cantonal Hospital Frauenfeld, 8501, Frauenfeld, Switzerland

    J. Engeler Dusel & M. Hugentobler

  3. National Reference Laboratory for Escherichia coli, Federal Institute for Risk Assessment, Berlin, Germany

    L. Beutin

  4. National Centre for Enteropathogenic Bacteria and Listeria, Institute for Food Safety and Hygiene, Vetsuisse Faculty, University of Zurich, Winterthurerstr. 272, 8057, Zurich, Switzerland

    G. Sägesser, R. Stephan, H. Hächler & M. Nüesch-Inderbinen

Authors
  1. K. Herzog
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Engeler Dusel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Hugentobler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Beutin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Sägesser
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Stephan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. H. Hächler
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. Nüesch-Inderbinen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Hächler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Herzog, K., Engeler Dusel, J., Hugentobler, M. et al. Diarrheagenic enteroaggregative Escherichia coli causing urinary tract infection and bacteremia leading to sepsis. Infection 42, 441–444 (2014). https://doi.org/10.1007/s15010-013-0569-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-013-0569-x

Keywords

Search

Navigation