Unusual Features of Shiga Toxin Producing Escherichia Coli O104: H4 Outbreak

Topics: Escherichia coli O157:H7, Escherichia coli, Shiga toxin Pages: 5 (3281 words) Published: May 6, 2013
Unusual features of Shiga toxin producing Escherichia coli O104: H4 outbreak, Germany 2011 The Escherichia coli O104: H4 outbreak of 2011 originated in northern Germany and lasted from May through to June of the same year. “The outbreak was characterized by several unusual features: a high incidence in adults (especially women), a greatly increased incidence of the haemolytic–Uraemic syndrome (in approximately 25% of patients, as compared with 1 to 15% in previous outbreaks of Shiga-toxin–producing E.coli), a predominance of female patients among cases of the haemolytic–uraemic syndrome, and a rare serotype of Shiga-toxin–producing E. coli that had been linked to only two sporadic cases of the haemolytic–uraemic syndrome”1 (Open-Source Genomic Analysis of Shiga-Toxin–Producing E. coli O104:H4 Holger Rohde, M.D., Junjie Qin, Ph.D., Yujun Cui, Ph.D., Dongfang Li, M.E., Nicholas J. Loman, M.B., B.S., Moritz Hentschke, M.D., Wentong Chen, B.S., Fei Pu, B.S., Yangqing Peng, B.S., Junhua Li, B.E., Feng Xi, B.E.,Shenghui Li, B.S., Yin Li, B.S., Zhaoxi Zhang, B.S., Xianwei Yang, B.S.,Meiru Zhao, M.S., Peng Wang, B.M., Yuanlin Guan, B.E., Zhong Cen, M.E.,Xiangna Zhao, B.S., Martin Christner, M.D., Robin Kobbe, M.D.,Sebastian Loos, M.D., Jun Oh, M.D., Liang Yang, Ph.D.,Antoine Danchin, Ph.D., George F. Gao, Ph.D., Yajun Song, Ph.D.,Yingrui Li, B.S., Huanming Yang, Ph.D., Jian Wang, Ph.D.,Jianguo Xu, M.D., Ph.D., Mark J. Pallen, M.D., Ph.D, Jun Wang, Ph.D.,Martin Aepfelbacher, M.D., Ruifu Yang, M.D., Ph.D.,and the E. coli O104:H4 Genome Analysis Crowd-Sourcing Consortium) At first the outbreak was attributed to cucumber imports from Spain, however this claim was unjustified. Eventually the blame was laid upon a German sprout farm by Reinhard Burger, head of Germany's centre for disease control “People who ate sprouts were nine times more likely to have bloody diarrhoea than those who did not”2 although none of the tests on the sprouts had come back positive “the epidemiological investigation of the pattern of the outbreak had produced enough evidence to draw the conclusion”3 as “60 of the people taken ill had eaten sprouts from the farm”4 (http://www.bbc.co.uk/news/world-europe-13725953) During mid-June as the German outbreak began to decrease more cases involving the same E.coli strain were reported in the Bordeaux region of France, this lead to the accusation by the European Food Safety Authority of fenugreek seeds imported from Egypt (which are used to help grow sprouts) being the cause of both outbreaks. “The food safety authority’s report said the fenugreek seeds came into Europe from Egypt in two shipments, one in 2009 and one in 2010.”5 “seeds from the 2010 lot were sold to the German sprouter implicated in the outbreak there”6 and “seeds from the 2009 lot went to a British company that packed them and sold them to a retailer in France.”7 French authorities followed this up and stated that the seeds purchased where linked to the Bordeaux E.coli outbreak. The report also added “there is still much uncertainty about whether this is truly the common cause of the infections because tests on the seeds had not yet found any of the deadly E. coli, a rare strain known as O104:H4. Food safety experts say, however, that the bacteria can contaminate one seed in thousands and that it is very difficult to isolate in seed samples.”8 (http://www.nytimes.com/2011/06/30/world/middleeast/30ecoli.html?_r=1) On the other hand an increasing volume of evidence was amounting that the strain responsible had been circulating in people (not animals as previously thought) for the past decade. Lothar Beutin, head of the national E. coli lab at the German Federal Institute for Risk Assessment states that “It is likely to have got into food via human faeces”9 “because we have never seen an aggregative strain in animals.”10 Evidence for this comes from several laboratories that sequenced the genome of a similar strain from a girl who had HUS in 2001,...
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