Chapter 26 : O104:H4 Pathogenesis: An Enteroaggregative /Shiga Toxin-Producing Explosive Cocktail of High Virulence

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In May 2011, an outbreak caused by of serotype O104:H4 spread throughout Germany ( ). The next month, France also reported a cluster of O104:H4 infections ( ). A total of 46 deaths, 782 cases of hemolytic-uremic syndrome (HUS), and 3,128 cases of acute gastroenteritis were officially attributed to this new clone of enterohemorrhagic (EHEC) (last update from European Centre for Disease Prevention and Control, 27 July 2011). Most or all victims (although diagnosed in different countries in Europe) became infected in Germany or France. The phenotypic and genotypic characterization of the O104:H4 indicated that the isolates from the French and German outbreaks were common to both incidents. Fenugreek seeds imported from Egypt, from which sprouts were grown, were implicated as a common source. However, there is still much uncertainty about whether this is truly the common cause of the infections, as tests on the seeds did not allow the detection of any isolate of serotype O104:H4.

Citation: Navarro-Garcia F. 2015. O104:H4 Pathogenesis: An Enteroaggregative /Shiga Toxin-Producing Explosive Cocktail of High Virulence, p 533-539. In Sperandio V, Hovde C (ed), Enterohemorrhagic and Other Shiga Toxin-Producing . ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EHEC-0008-2013
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Figure 1

Hybrid characteristics of O104:H4 outbreak strain (EAEC/STEC). Schematic representation of the genes harbored by O104:H4; the main genes from EAEC or STEC are highlighted: (coding for Stx 2), , , and (coding for the SPATE proteins); Pic, protein involved in intestinal colonization; SigA, a homolog of Pet, with cytotoxic activity; SepA, a colonization factor of ), (coding for ShET1, a holotoxin AB5), (coding for Iha, a STEC adhesin that is an IrgA homolog), , , , (genes from EAEC plasmids coding for transcription regulator, AAF/I, dispersin, and dispersin transporter, respectively), (coding for Lpf of STEC), (coding for a cluster for Tellurite resistance), CTX-M15 and TEM-1 (antibiotic resistance genes). SigA and SepA are SPATEs detected mainly in sp.

Citation: Navarro-Garcia F. 2015. O104:H4 Pathogenesis: An Enteroaggregative /Shiga Toxin-Producing Explosive Cocktail of High Virulence, p 533-539. In Sperandio V, Hovde C (ed), Enterohemorrhagic and Other Shiga Toxin-Producing . ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EHEC-0008-2013
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Image of Figure 2
Figure 2

Adherence patterns of EAEC, STEC, and O104:H4 outbreak strain to epithelial cells. Subconfluent epithelial cell cultures are infected with the different bacterial strains. Cells are fixed and stained with Giemsa stain. From Scalesky et al. 1999. 3410; Paton et al. 2001. 6999; and Martina Bielaszewska. http://ecdc.europa.eu/en/press/events/Documents/22-231111-Breakthroughs-in-molecular-epidemiology-Bielaszewska.pdf.

Citation: Navarro-Garcia F. 2015. O104:H4 Pathogenesis: An Enteroaggregative /Shiga Toxin-Producing Explosive Cocktail of High Virulence, p 533-539. In Sperandio V, Hovde C (ed), Enterohemorrhagic and Other Shiga Toxin-Producing . ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EHEC-0008-2013
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Figure 3

Transmission electron microscopy (TEM) of Stx2 phage (P13374) induction from lysogenic strain K-12 strain TPE2364 (C600) infected with phage lysates of O104:H4 strain CB13374. (A, B) Ultrathin sections of two bacterial cells (TPE2364) with maturating virion particles within the cytoplasm indicated by arrows (bars, 500 nm). (C) TEM of CsCl-purified, negatively stained phage (P13374) particles released by strain TPE2364 (bar, 100 nm). Short tails (arrows) and a hexagonal head are shown. From Beutin et al. 2012. 10444.

Citation: Navarro-Garcia F. 2015. O104:H4 Pathogenesis: An Enteroaggregative /Shiga Toxin-Producing Explosive Cocktail of High Virulence, p 533-539. In Sperandio V, Hovde C (ed), Enterohemorrhagic and Other Shiga Toxin-Producing . ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EHEC-0008-2013
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Figure 4

Schematic representation of O104:H4 virulence factors and their targets on the mucosal epithelium. The targets and virulence factors are extrapolated from their known function in other pathogens, and the action mechanism for ShET1 is hypothetical.

Citation: Navarro-Garcia F. 2015. O104:H4 Pathogenesis: An Enteroaggregative /Shiga Toxin-Producing Explosive Cocktail of High Virulence, p 533-539. In Sperandio V, Hovde C (ed), Enterohemorrhagic and Other Shiga Toxin-Producing . ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EHEC-0008-2013
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