Enterohemorrhagic escherichia coli O26:H11/H-: A New virulent clone emerges in Europe

Martina Bielaszewska; Alexander Mellmann; Stefan Bletz; Wenlan Zhang; Robin Köck; Annelene Kossow; Rita Prager; Angelika Fruth; Dorothea Orth-Höller; Monika Marejková; Stefano Morabito; Alfredo Caprioli; Denis Piérard; Geraldine Smith; Claire Jenkins; Katarína Čurová; Helge Karch

doi:10.1093/cid/cit055

Enterohemorrhagic escherichia coli O26:H11/H^-: A New virulent clone emerges in Europe

Martina Bielaszewska^*, Alexander Mellmann, Stefan Bletz, Wenlan Zhang, Robin Köck, Annelene Kossow, Rita Prager, Angelika Fruth, Dorothea Orth-Höller, Monika Marejková, Stefano Morabito, Alfredo Caprioli, Denis Piérard, Geraldine Smith, Claire Jenkins, Katarína Čurová, Helge Karch

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

120 Citations (Scopus)

Abstract

Background. Enterohemorrhagic Escherichia coli (EHEC) O26 causes diarrhea and hemolytic uremic syndrome (HUS). Strains harboring the stx_1a gene prevail, but strains with stx_2a as the sole Shiga toxin-encoding gene are now emerging. The traits and virulence of the latter set of strains are unknown. We correlated stx genotypes of 272 EHEC O26 strains isolated in 7 European countries between 1996 and 2012 with disease phenotypes. We determined phylogeny, clonal structure, and plasmid gene profiles of the isolates and portray geographic and temporal distribution of the different subgroups.Methods. The stx genotypes and plasmid genes were identified using polymerase chain reaction, phylogeny was assigned using multilocus sequence typing, and clonal relatedness was established using pulsed-field gel electrophoresis.Results. Of the 272 EHEC O26 isolates, 107 (39.3%), 139 (51.1%), and 26 (9.6%) possessed stx_1a, stx_2a, or both genes, respectively. Strains harboring stx_2a only were significantly associated with HUS (odds ratio, 14.2; 95% confidence interval, 7.9-25.6; P <. 001) compared to other stx genotypes. The stx_2a-harboring strains consist of 2 phylogenetically distinct groups defined by sequence type (ST) 21 and ST29. The ST29 strains are highly conserved and correspond by plasmid genes to the new virulent clone of EHEC O26 that emerged in Germany in the 1990s. This new clone occurred in 6 of the 7 countries and represented approximately 50% of all stx_2a-harboring EHEC O26 strains isolated between 1996 and 2012.Conclusions. A new highly virulent clone of EHEC O26 has emerged in Europe. Its reservoirs and sources warrant identification.

Original language	English
Pages (from-to)	1373-1381
Number of pages	9
Journal	Clinical Infectious Diseases
Volume	56
Issue number	10
DOIs	https://doi.org/10.1093/cid/cit055
Publication status	Published - 15 May 2013

Bibliographical note

Funding Information:
Financial support. This work was supported by the EU Network ERA-NET PathoGenoMics II (grant number 0315443), the Deutsche For-schungsgemeinschaft (grant number ME3205/2-1), the EU FP7 ANTIGONE (grant number 278976), the Federal Ministry of Education and Research cross-sectional activity PBA-Zoo (grant number 01KI1020), and the Medical Faculty of the University of Münster (grant number BD9817044). Potential conflicts of interest. All authors: No potential conflicts.

Keywords

Shiga toxin
enterohemorrhagic Escherichia coli O26
hemolytic uremic syndrome
new clone

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/cid/cit055

Cite this

Bielaszewska, M., Mellmann, A., Bletz, S., Zhang, W., Köck, R., Kossow, A., Prager, R., Fruth, A., Orth-Höller, D., Marejková, M., Morabito, S., Caprioli, A., Piérard, D., Smith, G., Jenkins, C., Čurová, K., & Karch, H. (2013). Enterohemorrhagic escherichia coli O26:H11/H^-: A New virulent clone emerges in Europe. Clinical Infectious Diseases, 56(10), 1373-1381. https://doi.org/10.1093/cid/cit055

@article{14331c47deec43018f6fcd107aef318e,

title = "Enterohemorrhagic escherichia coli O26:H11/H-: A New virulent clone emerges in Europe",

abstract = "Background. Enterohemorrhagic Escherichia coli (EHEC) O26 causes diarrhea and hemolytic uremic syndrome (HUS). Strains harboring the stx1a gene prevail, but strains with stx2a as the sole Shiga toxin-encoding gene are now emerging. The traits and virulence of the latter set of strains are unknown. We correlated stx genotypes of 272 EHEC O26 strains isolated in 7 European countries between 1996 and 2012 with disease phenotypes. We determined phylogeny, clonal structure, and plasmid gene profiles of the isolates and portray geographic and temporal distribution of the different subgroups.Methods. The stx genotypes and plasmid genes were identified using polymerase chain reaction, phylogeny was assigned using multilocus sequence typing, and clonal relatedness was established using pulsed-field gel electrophoresis.Results. Of the 272 EHEC O26 isolates, 107 (39.3\%), 139 (51.1\%), and 26 (9.6\%) possessed stx1a, stx2a, or both genes, respectively. Strains harboring stx2a only were significantly associated with HUS (odds ratio, 14.2; 95\% confidence interval, 7.9-25.6; P <. 001) compared to other stx genotypes. The stx2a-harboring strains consist of 2 phylogenetically distinct groups defined by sequence type (ST) 21 and ST29. The ST29 strains are highly conserved and correspond by plasmid genes to the new virulent clone of EHEC O26 that emerged in Germany in the 1990s. This new clone occurred in 6 of the 7 countries and represented approximately 50\% of all stx2a-harboring EHEC O26 strains isolated between 1996 and 2012.Conclusions. A new highly virulent clone of EHEC O26 has emerged in Europe. Its reservoirs and sources warrant identification.",

keywords = "Shiga toxin, enterohemorrhagic Escherichia coli O26, hemolytic uremic syndrome, new clone",

author = "Martina Bielaszewska and Alexander Mellmann and Stefan Bletz and Wenlan Zhang and Robin K{\"o}ck and Annelene Kossow and Rita Prager and Angelika Fruth and Dorothea Orth-H{\"o}ller and Monika Marejkov{\'a} and Stefano Morabito and Alfredo Caprioli and Denis Pi{\'e}rard and Geraldine Smith and Claire Jenkins and Katar{\'i}na {\v C}urov{\'a} and Helge Karch",

note = "Funding Information: Financial support. This work was supported by the EU Network ERA-NET PathoGenoMics II (grant number 0315443), the Deutsche For-schungsgemeinschaft (grant number ME3205/2-1), the EU FP7 ANTIGONE (grant number 278976), the Federal Ministry of Education and Research cross-sectional activity PBA-Zoo (grant number 01KI1020), and the Medical Faculty of the University of M{\"u}nster (grant number BD9817044). Potential conflicts of interest. All authors: No potential conflicts.",

year = "2013",

month = may,

day = "15",

doi = "10.1093/cid/cit055",

language = "English",

volume = "56",

pages = "1373--1381",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

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Bielaszewska, M, Mellmann, A, Bletz, S, Zhang, W, Köck, R, Kossow, A, Prager, R, Fruth, A, Orth-Höller, D, Marejková, M, Morabito, S, Caprioli, A, Piérard, D, Smith, G, Jenkins, C, Čurová, K & Karch, H 2013, 'Enterohemorrhagic escherichia coli O26:H11/H^-: A New virulent clone emerges in Europe', Clinical Infectious Diseases, vol. 56, no. 10, pp. 1373-1381. https://doi.org/10.1093/cid/cit055

TY - JOUR

T1 - Enterohemorrhagic escherichia coli O26:H11/H-

T2 - A New virulent clone emerges in Europe

AU - Bielaszewska, Martina

AU - Mellmann, Alexander

AU - Bletz, Stefan

AU - Zhang, Wenlan

AU - Köck, Robin

AU - Kossow, Annelene

AU - Prager, Rita

AU - Fruth, Angelika

AU - Orth-Höller, Dorothea

AU - Marejková, Monika

AU - Morabito, Stefano

AU - Caprioli, Alfredo

AU - Piérard, Denis

AU - Smith, Geraldine

AU - Jenkins, Claire

AU - Čurová, Katarína

AU - Karch, Helge

N1 - Funding Information: Financial support. This work was supported by the EU Network ERA-NET PathoGenoMics II (grant number 0315443), the Deutsche For-schungsgemeinschaft (grant number ME3205/2-1), the EU FP7 ANTIGONE (grant number 278976), the Federal Ministry of Education and Research cross-sectional activity PBA-Zoo (grant number 01KI1020), and the Medical Faculty of the University of Münster (grant number BD9817044). Potential conflicts of interest. All authors: No potential conflicts.

PY - 2013/5/15

Y1 - 2013/5/15

N2 - Background. Enterohemorrhagic Escherichia coli (EHEC) O26 causes diarrhea and hemolytic uremic syndrome (HUS). Strains harboring the stx1a gene prevail, but strains with stx2a as the sole Shiga toxin-encoding gene are now emerging. The traits and virulence of the latter set of strains are unknown. We correlated stx genotypes of 272 EHEC O26 strains isolated in 7 European countries between 1996 and 2012 with disease phenotypes. We determined phylogeny, clonal structure, and plasmid gene profiles of the isolates and portray geographic and temporal distribution of the different subgroups.Methods. The stx genotypes and plasmid genes were identified using polymerase chain reaction, phylogeny was assigned using multilocus sequence typing, and clonal relatedness was established using pulsed-field gel electrophoresis.Results. Of the 272 EHEC O26 isolates, 107 (39.3%), 139 (51.1%), and 26 (9.6%) possessed stx1a, stx2a, or both genes, respectively. Strains harboring stx2a only were significantly associated with HUS (odds ratio, 14.2; 95% confidence interval, 7.9-25.6; P <. 001) compared to other stx genotypes. The stx2a-harboring strains consist of 2 phylogenetically distinct groups defined by sequence type (ST) 21 and ST29. The ST29 strains are highly conserved and correspond by plasmid genes to the new virulent clone of EHEC O26 that emerged in Germany in the 1990s. This new clone occurred in 6 of the 7 countries and represented approximately 50% of all stx2a-harboring EHEC O26 strains isolated between 1996 and 2012.Conclusions. A new highly virulent clone of EHEC O26 has emerged in Europe. Its reservoirs and sources warrant identification.

AB - Background. Enterohemorrhagic Escherichia coli (EHEC) O26 causes diarrhea and hemolytic uremic syndrome (HUS). Strains harboring the stx1a gene prevail, but strains with stx2a as the sole Shiga toxin-encoding gene are now emerging. The traits and virulence of the latter set of strains are unknown. We correlated stx genotypes of 272 EHEC O26 strains isolated in 7 European countries between 1996 and 2012 with disease phenotypes. We determined phylogeny, clonal structure, and plasmid gene profiles of the isolates and portray geographic and temporal distribution of the different subgroups.Methods. The stx genotypes and plasmid genes were identified using polymerase chain reaction, phylogeny was assigned using multilocus sequence typing, and clonal relatedness was established using pulsed-field gel electrophoresis.Results. Of the 272 EHEC O26 isolates, 107 (39.3%), 139 (51.1%), and 26 (9.6%) possessed stx1a, stx2a, or both genes, respectively. Strains harboring stx2a only were significantly associated with HUS (odds ratio, 14.2; 95% confidence interval, 7.9-25.6; P <. 001) compared to other stx genotypes. The stx2a-harboring strains consist of 2 phylogenetically distinct groups defined by sequence type (ST) 21 and ST29. The ST29 strains are highly conserved and correspond by plasmid genes to the new virulent clone of EHEC O26 that emerged in Germany in the 1990s. This new clone occurred in 6 of the 7 countries and represented approximately 50% of all stx2a-harboring EHEC O26 strains isolated between 1996 and 2012.Conclusions. A new highly virulent clone of EHEC O26 has emerged in Europe. Its reservoirs and sources warrant identification.

KW - Shiga toxin

KW - enterohemorrhagic Escherichia coli O26

KW - hemolytic uremic syndrome

KW - new clone

UR - https://www.scopus.com/pages/publications/84876167891

U2 - 10.1093/cid/cit055

DO - 10.1093/cid/cit055

M3 - Article

C2 - 23378282

AN - SCOPUS:84876167891

SN - 1058-4838

VL - 56

SP - 1373

EP - 1381

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 10

ER -