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Public Health Microbiology of Shiga Toxin-Producing

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  • Authors: Alfredo Caprioli1, Gaia Scavia2, Stefano Morabito3
  • Editors: Vanessa Sperandio4, Carolyn J. Hovde5
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    Affiliations: 1: European Union Reference Laboratory for , Dipartimento di Sanità Pubblica Veterinaria e Sicurezza Alimentare, Istituto Superiore di Sanità, Rome, Italy; 2: European Union Reference Laboratory for , Dipartimento di Sanità Pubblica Veterinaria e Sicurezza Alimentare, Istituto Superiore di Sanità, Rome, Italy; 3: European Union Reference Laboratory for , Dipartimento di Sanità Pubblica Veterinaria e Sicurezza Alimentare, Istituto Superiore di Sanità, Rome, Italy; 4: University of Texas Southwestern Medical Center, Dallas, TX; 5: University of Idaho, Moscow, ID
  • Source: microbiolspec November 2014 vol. 2 no. 6 doi:10.1128/microbiolspec.EHEC-0014-2013
  • Received 19 July 2013 Accepted 26 July 2013 Published 07 November 2014
  • Alfredo Caprioli, alfredo.caprioli@iss.it
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  • Abstract:

    Shiga toxin-producing (STEC) strains are the only pathogenic group of that has a definite zoonotic origin, with ruminants and, in particular, cattle being recognized as the major reservoir. Most human STEC infections are food borne, but the routes of transmission include direct contact with animals and a variety of environment-related exposures. Therefore, STEC public health microbiology spans the fields of medical, veterinary, food, water, and environmental microbiology, requiring a “One Health” perspective and laboratory scientists with the ability to work effectively across disciplines. Public health microbiology laboratories play a central role in the surveillance of STEC infections, as well as in the preparedness for responding to outbreaks and in providing scientific evidence for the implementation of prevention and control measures. This article reviews (i) how the integration of surveillance of STEC infections and monitoring of these pathogens in animal reservoirs and potential food vehicles may contribute to their control; (ii) the role of reference laboratories, in both the public health and veterinary and food sectors; and (iii) the public health perspectives, including those related to regulatory issues in both the European Union and the United States.

  • Citation: Caprioli A, Scavia G, Morabito S. 2014. Public Health Microbiology of Shiga Toxin-Producing . Microbiol Spectrum 2(6):EHEC-0014-2013. doi:10.1128/microbiolspec.EHEC-0014-2013.

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References

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24. European Food Safety Authority, Panel on Biological Hazards (BIOHAZ). 2007. Scientific Opinion of the Panel on Biological Hazards on a request from EFSA on monitoring of verotoxigenic Escherichia coli (VTEC) and identification of human pathogenic VTEC types. EFSA Journal 579:1–61.
25. European Food Safety Authority, Panel on Biological Hazards (BIOHAZ). 2009. Technical specifications for the monitoring and reporting of verotoxigenic Escherichia coli (VTEC) on animals and food (VTEC surveys on animals and food) on request of EFSA. EFSA Journal 7:1366.
26. Fisher IS. 1999. The Enter-net international surveillance network—how it works. Euro Surveill 4:52–55. [PubMed]
27. Hoefer D, Hurd S, Medus C, Cronquist A, Hanna S, Hatch J, Hayes T, Larson K, Nicholson C, Wymore K, Tobin-D'Angelo M, Strockbine N, Snippes P, Atkinson R, Griffin PM, Gould LH. 2011. Laboratory practices for the identification of Shiga toxin-producing Escherichia coli in the United States, FoodNet sites, 2007. Foodborne Pathog Dis 8:555–560. [PubMed][CrossRef]
28. Scheutz F, Nielsen EM, Frimodt-Moller J, Boisen N, Morabito S, Tozzoli R, Nataro JP, Caprioli A. 2011. Characteristics of the enteroaggregative Shiga toxin/verotoxin-producing Escherichia coli O104:H4 strain causing the outbreak of haemolytic uraemic syndrome in Germany, May to June 2011. Euro Surveill 16(24). [PubMed]
29. Levine MM. 1987. Escherichia coli that cause diarrhea: enterotoxigenic, enteropathogenic, enteroinvasive, enterohemorrhagic, and enteroadherent. J Infect Dis 155:377–389. [PubMed][CrossRef]
30. Colic E, Dieperink H, Titlestad K, Tepel M. 2011. Management of an acute outbreak of diarrhoea-associated haemolytic uraemic syndrome with early plasma exchange in adults from southern Denmark: an observational study. Lancet 378:1089–1093. [PubMed][CrossRef]
31. Bielaszewska M, Mellmann A, Zhang W, Kock R, Fruth A, Bauwens A, Peters G, Karch H. 2011. Characterisation of the Escherichia coli strain associated with an outbreak of haemolytic uraemic syndrome in Germany, 2011: a microbiological study. Lancet Infect Dis 11:671–676. [PubMed][CrossRef]
32. Scheutz F, Teel LD, Beutin L, Pierard D, Buvens G, Karch H, Mellmann A, Caprioli A, Tozzoli R, Morabito S, Strockbine NA, Melton-Celsa AR, Sanchez M, Persson S, O'Brien AD. 2012. Multicenter evaluation of a sequence-based protocol for subtyping Shiga toxins and standardizing Stx nomenclature. J Clin Microbiol 50:2951–2963. [PubMed][CrossRef]
33. Friedrich AW, Bielaszewska M, Zhang WL, Pulz M, Kuczius T, Ammon A, Karch H. 2002. Escherichia coli harboring Shiga toxin 2 gene variants: frequency and association with clinical symptoms. J Infect Dis 185:74–84. [PubMed][CrossRef]
34. Persson S, Olsen KE, Ethelberg S, Scheutz F. 2007. Subtyping method for Escherichia coli Shiga toxin (verocytotoxin) 2 variants and correlations to clinical manifestations. J Clin Microbiol 45:2020–2024. [PubMed][CrossRef]
35. Barrett TJ, Lior H, Green JH, Khakhria R, Wells JG, Bell BP, Greene KD, Lewis J, Griffin PM. 1994. Laboratory investigation of a multistate food-borne outbreak of Escherichia coli O157:H7 by using pulsed-field gel electrophoresis and phage typing. J Clin Microbiol 32:3013–3017. [PubMed]
36. U.S. Department of Agriculture, Food Safety and Inspection Service. 1999. FSIS Policy on Non-intact Raw Beef Products Contaminated with E. coli O157:H7. Available from http://www.fsis.usda.gov/Oa/background/O157policy.htm.
37. U.S. Department of Agriculture, Food Safety and Inspection Service. 2011. Shiga toxin-producing Escherichia coli in certain raw beef products. Fed Regist 76:58157–58165.
38. European Food Safety Authority, Panel on Biological Hazards (BIOHAZ). 2011. Scientific Opinion on the risk posed by Shiga toxin-producing Escherichia coli (STEC) and other pathogenic bacteria in seeds and sprouted seeds. EFSA Journal 9:2424.
39. European Food Safety Authority. 2011. Tracing seeds, in particular fenugreek (Trigonella foenum-graecum) seeds, in relation to the Shiga toxin-producing E. coli (STEC) O104:H4 2011 outbreaks in Germany and France. Available from http://www.efsa.europa.eu/it/supporting/doc/176e.pdf.
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2014-11-07
2017-09-26

Abstract:

Shiga toxin-producing (STEC) strains are the only pathogenic group of that has a definite zoonotic origin, with ruminants and, in particular, cattle being recognized as the major reservoir. Most human STEC infections are food borne, but the routes of transmission include direct contact with animals and a variety of environment-related exposures. Therefore, STEC public health microbiology spans the fields of medical, veterinary, food, water, and environmental microbiology, requiring a “One Health” perspective and laboratory scientists with the ability to work effectively across disciplines. Public health microbiology laboratories play a central role in the surveillance of STEC infections, as well as in the preparedness for responding to outbreaks and in providing scientific evidence for the implementation of prevention and control measures. This article reviews (i) how the integration of surveillance of STEC infections and monitoring of these pathogens in animal reservoirs and potential food vehicles may contribute to their control; (ii) the role of reference laboratories, in both the public health and veterinary and food sectors; and (iii) the public health perspectives, including those related to regulatory issues in both the European Union and the United States.

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Figures

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FIGURE 1

Number of STEC infections reported in the period 2007–2011 to the FWD surveillance system coordinated by the ECDC. The 2011 data do not include the cases due to STEC O104, which occurred in the framework of the large outbreak that occurred in Germany and other European countries. NT, cases with no information available on the serogroup of the STEC infecting strain. doi:10.1128/microbiolspec.EHEC-0014-2013.f1

Source: microbiolspec November 2014 vol. 2 no. 6 doi:10.1128/microbiolspec.EHEC-0014-2013
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FIGURE 2

Number of STEC infections in the European Union associated with the serogroups other than O157 and O104 most frequently reported in the period 2007–2011 to the FWD surveillance system coordinated by the ECDC. doi:10.1128/microbiolspec.EHEC-0014-2013.f2

Source: microbiolspec November 2014 vol. 2 no. 6 doi:10.1128/microbiolspec.EHEC-0014-2013
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FIGURE 3

STEC serogroups associated with the hemolytic-uremic syndrome in Italy, 1988–2011. Data from the Italian Registry for HUS. doi:10.1128/microbiolspec.EHEC-0014-2013.f3

Source: microbiolspec November 2014 vol. 2 no. 6 doi:10.1128/microbiolspec.EHEC-0014-2013
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FIGURE 4

External quality assessment organized by the EU-RL for on the identification of STEC strains by detection of their main virulence genes by PCR. For each gene, white bars represent the number of laboratories that obtained correct results for all the strains included in the test and black bars the number of laboratories that provided incorrect results or did not perform the assay. doi:10.1128/microbiolspec.EHEC-0014-2013.f4

Source: microbiolspec November 2014 vol. 2 no. 6 doi:10.1128/microbiolspec.EHEC-0014-2013
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FIGURE 5

External quality assessment organized by the EU-RL for on the identification of the STEC serogroups most involved in human disease in Europe. For each serogroup, white bars represent the number of laboratories that obtained correct results for all the strains included in the test and black bars the number of laboratories that provided incorrect results or did not perform the assay. doi:10.1128/microbiolspec.EHEC-0014-2013.f5

Source: microbiolspec November 2014 vol. 2 no. 6 doi:10.1128/microbiolspec.EHEC-0014-2013
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FIGURE 6

External quality assessment organized by the EU-RL for on the detection in food of the STEC serogroups most involved in human disease in Europe, using the real-time PCR-based ISO/TS 13136 method. For each step of the procedure, white bars represent the number of laboratories that obtained correct results for all the samples included in the test and black bars the number of laboratories that provided incorrect results or did not perform the assay. doi:10.1128/microbiolspec.EHEC-0014-2013.f6

Source: microbiolspec November 2014 vol. 2 no. 6 doi:10.1128/microbiolspec.EHEC-0014-2013
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Tables

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TABLE 1

Classification of STEC serotypes into seropathotypes

Source: microbiolspec November 2014 vol. 2 no. 6 doi:10.1128/microbiolspec.EHEC-0014-2013

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