Chapter 2 : Taxonomy Meets Public Health: The Case of Shiga Toxin-Producing

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The term enteropathogenic was originally used to refer to strains belonging to a limited number of O groups epidemiologically associated with infantile diarrhea ( ). Subsequently, strains isolated from intestinal diseases have been grouped into at least six main categories on the basis of epidemiological evidence, phenotypic traits, clinical features of the disease they produce, and specific virulence factors. The well-described intestinal pathotypes or categories of diarrheagenic groups are enteropathogenic (EPEC), Shiga toxin-producing (STEC) or verocytotoxin-producing (VTEC) (including enterohemorrhagic [EHEC]), enterotoxigenic (ETEC), enteroaggregative (EAEC), enteroinvasive , and diffusely adherent . The general definition of an pathotype as “a group of strains of a single species that cause a common disease using a common set of virulence factors” ( ) has been further refined for STEC to help assess the clinical and public health risks associated with different STEC strains ( ). An empirical classification scheme was used to classify STEC serotypes into five “seropathotypes” (A through E) according to the reported association of serotypes with human intestinal disease, outbreaks, and hemolytic-uremic syndrome (HUS) ( ). This classification system uses a gradient ranging from seropathotype A (high risk) to seropathotypes D and E (minimal risk). This definition has been of considerable value in cases of human infection but is also problematic because the majority of isolates from STEC infections are not fully characterized and coupled to reliable clinical information. Although the definition of HUS is distinct, the spectrum of diarrheal disease varies considerably and may include a range of symptoms from nonbloody to scanty blood to true hemorrhagic colitis. Additionally, the use of A through E adds confusion because Shiga toxin subtypes are also named alphabetically. Most importantly, the concept of (sero)-pathotypes collides with the requirements of a good taxonomy, which separates elements of each group into subgroups that are mutually exclusive, unambiguous, and, together, include all possibilities. In practice, a good taxonomy should be simple to apply, easy to remember, and easy to use. The need to define human pathogenic STEC and to identify factors of STEC that absolutely predict the potential to cause human disease is obvious in terms of clinical management, supportive or antibiotic treatment, quarantine measurements, risk assessment, surveillance, and outbreak investigations and management. This chapter presents a brief history of the concept of pathotypes and describes the possible alternatives for categorizing STEC based on phenotypic or molecular typing.

Citation: Scheutz F. 2015. Taxonomy Meets Public Health: The Case of Shiga Toxin-Producing , p 17-36. In Sperandio V, Hovde C (ed), Enterohemorrhagic and Other Shiga Toxin-Producing . ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EHEC-0019-2013
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Figure 1

Stx subtypes and variants. Parsimony tree of 107 variants: nine variants of Stx1a (including Shiga toxin from ), four variants of Stx1c, one variant of Stx1d, and subtypes of Stx2, including 21 Stx2a, 16 Stx2b, 18 Stx2c, 18 Stx2d, 14 Stx2e, two Stx2f, and four Stx2g variants. Data from reference and updated by the author.

Citation: Scheutz F. 2015. Taxonomy Meets Public Health: The Case of Shiga Toxin-Producing , p 17-36. In Sperandio V, Hovde C (ed), Enterohemorrhagic and Other Shiga Toxin-Producing . ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EHEC-0019-2013
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Figure 2

Stx bacteriophage insertion sites in LEE-positive STEC include , , , , , , , and . Data from references , and . In LEE-negative STEC genomes additional insertion sites are often different and include , , , , and . Data from references , and . Big circles indicate the preferred bacteriophage integration site.

Citation: Scheutz F. 2015. Taxonomy Meets Public Health: The Case of Shiga Toxin-Producing , p 17-36. In Sperandio V, Hovde C (ed), Enterohemorrhagic and Other Shiga Toxin-Producing . ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EHEC-0019-2013
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